Categories
Pharmacology

Provide your responses and rationales.

Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)
A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking diazepam (valium). She occasionally takes diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking diazepam.
Q1. Explain the cause of this patient’s difficulty in maintaining her balance?
Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?
A 75-year-old woman develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The medication contains diphenhydramine, acetaminophen, and phenylephrine. She takes the recommended adult dose but soon after taking the medication she becomes very confused and disoriented.
Q3. What is likely causing the signs of confusion?
A 26-year-old woman who has never been pregnant is seeking preconception care as she is planning to pursue pregnancy in a couple of months. Currently, she has no symptoms to report and on review of body systems, there were no concerns. Her past medical history is significant for a history of rheumatic fever as a child. She subsequently underwent valve replacement with a mechanical heart valve. She is followed by a cardiologist who has already evaluated her cardiac function and she has received clearance from her cardiologist to pursue pregnancy. Records from her cardiologist include a recent cardiac echocardiography report that reveals a normal ejection fraction indicating normal cardiac function.
She has no alterations in her daily activities related to her heart. She has no other signi?cant medical or surgical history. She is a non-smoker, drinks occasionally but has stopped as she is attempting to conceive, and does not use any non-prescription drugs.
Current Medications: Her current medications include only prenatal vitamins, which she has begun in anticipation of pregnancy, and warfarin. She has no known drug allergies.
Vital Signs: On examination, her pulse is 80 beats per minute, blood pressure is 115/70 mm Hg, respiratory rate is 18 breaths per minute, and she is afebrile.
Measurements: Weight = 152 pounds, Height = 5’5 ?, BMI= 25.29
Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?
Q5. Explain the hepatic drug metabolism of children 1 year and older. How do they compare with the hepatic drug metabolism of infants and adults?
Q6. Explain protein binding in the neonate.

Categories
Pharmacology

Explain protein binding in the neonate.

Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)
A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking diazepam (valium). She occasionally takes diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking diazepam.
Q1. Explain the cause of this patient’s difficulty in maintaining her balance?
Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?
A 75-year-old woman develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The medication contains diphenhydramine, acetaminophen, and phenylephrine. She takes the recommended adult dose but soon after taking the medication she becomes very confused and disoriented.
Q3. What is likely causing the signs of confusion?
A 26-year-old woman who has never been pregnant is seeking preconception care as she is planning to pursue pregnancy in a couple of months. Currently, she has no symptoms to report and on review of body systems, there were no concerns. Her past medical history is significant for a history of rheumatic fever as a child. She subsequently underwent valve replacement with a mechanical heart valve. She is followed by a cardiologist who has already evaluated her cardiac function and she has received clearance from her cardiologist to pursue pregnancy. Records from her cardiologist include a recent cardiac echocardiography report that reveals a normal ejection fraction indicating normal cardiac function.
She has no alterations in her daily activities related to her heart. She has no other signi?cant medical or surgical history. She is a non-smoker, drinks occasionally but has stopped as she is attempting to conceive, and does not use any non-prescription drugs.

Current Medications: Her current medications include only prenatal vitamins, which she has begun in anticipation of pregnancy, and warfarin. She has no known drug allergies.
Vital Signs: On examination, her pulse is 80 beats per minute, blood pressure is 115/70 mm Hg, respiratory rate is 18 breaths per minute, and she is afebrile.
Measurements: Weight = 152 pounds, Height = 5’5 ?, BMI= 25.29
Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?
Q5. Explain the hepatic drug metabolism of children 1 year and older. How do they compare with the hepatic drug metabolism of infants and adults?
Q6. Explain protein binding in the neonate.

Categories
Pharmacology

Which of the following is a likely cause?

In your initial post, please answer all the questions and provide your rationales with supportive evidence in well-developed paragraphs using APA formatting, integrating two evidence-based resources.
Accompanied by her boyfriend, Shaynah Anderson, age 23, visits your office. Her boyfriend states, “She hasn’t been herself the last month. She has headaches and is completely confused and tired for no reason.” Shaynah denies using illicit drugs and any recent traumatic injuries. She thinks her problem started approximately a month ago when she was at a club dancing. Her friends told her that she became confused and began tugging at her clothes. Then she fell down and was unconscious for a few minutes. When she awoke, she felt extremely tired and did not know what was going on. Her boyfriend recalls that she had been hit in the head with a softball during a game the day before they went dancing. Past medical history discloses insulin use since early childhood (currently 10 units NPH in the morning and 10 units regular insulin before meals), Prilosec at bedtime, and Ibuprofen (1 or 2 tablets twice a day) for headaches. She is interested in becoming pregnant in the next 12 to 24 months. The patient says she has no allergies and does not drink or use recreational drugs or tobacco.
On physical examination, Shaynah is 5 foot 4 inches and 130 lb. Her temperature is 37°C, pulse rate 78, blood pressure 118/76, and glucose level 90. Skin appears normal. Head and neck are normal, chest is clear for anterior and posterior sounds, cardiovascular RRR and (2) r/m/g, and laboratory values are within normal limits. EEG findings include sharp-wave discharges. At a follow-up visit 2 months later, patient and her boyfriend report that things have gotten worse. The boyfriend states that as the patient was eating dinner one night she had a seizure. She was completely stiff for a short time, and then her arms and legs began moving. He believes that she was unconscious for a few minutes.Patient says she could not remember what had happened when she woke up.
1)Diagnosis: Generalized Tonic-Clonic Seizure
Which of the following should be true regarding your initial Adverse Effect Drugs (AED) regimen?
A) Initial combination therapy is warranted due to increased success rates.
B) Drugs that are taken two to three times daily are preferred due to a lower risk of seizure
if a dose is missed.
C) Levetiracetam is the preferred agent for all seizure types and patients.
D) The risks of pregnancy must be discussed prior to starting any AED.
2)Which of the following is the most appropriate initial antiepileptic regimen for this patient?
A) Levetiracetam 500 mg PO daily
B) Phenytoin 100 mg PO three times daily
C) Pregabalin 50 mg PO three times daily
D) Clobazam 5 mg PO twice daily
3) The patient fails to respond and has significant side effects to her initial therapy. Her initial therapy is to be discontinued. Which of the following would be the most appropriate replacement?
A) Valproic acid 500 mg twice daily
B) Lamotrigine 100 mg twice daily
C) Lacosamide 100 mg twice daily
D) Rufinamide 200 mg twice daily
4.) After several different AEDs, the patient ends up on carbamazepine and phenytoin. The carbamazepine serum concentration on week 2 of therapy was 6 mcg/mL. The patient presents after 8 weeks of therapy with increased seizures and she is found to have a serum concentration of 2 mcg/mL. Which of the following is a likely cause?
A) Autoinduction of CYP3A4.
B) Patient has the HLA-B*1502 subtype.
C) The oral contraceptive that she recently started.
D) Co-administration with alcohol.
5.) Despite the use of oral contraception, the patient becomes pregnant. Her AED regimen consists of valproic acid and lacosamide. What is the most appropriate treatment intervention?
A) Discontinue valproic acid and continue lacosamide monotherapy.
B) Discontinue lacosamide and continue valproic acid monotherapy.
C) Continue combination therapy.
D) Discontinue valproic acid and add phenytoin.

Categories
Pharmacology

Which of the following would be the most appropriate replacement?

In your initial post, please answer all the questions and provide your rationales with supportive evidence in well-developed paragraphs using APA formatting, integrating two evidence-based resources.
Accompanied by her boyfriend, Shaynah Anderson, age 23, visits your office. Her boyfriend states, “She hasn’t been herself the last month. She has headaches and is completely confused and tired for no reason.” Shaynah denies using illicit drugs and any recent traumatic injuries. She thinks her problem started approximately a month ago when she was at a club dancing. Her friends told her that she became confused and began tugging at her clothes. Then she fell down and was unconscious for a few minutes. When she awoke, she felt extremely tired and did not know what was going on. Her boyfriend recalls that she had been hit in the head with a softball during a game the day before they went dancing. Past medical history discloses insulin use since early childhood (currently 10 units NPH in the morning and 10 units regular insulin before meals), Prilosec at bedtime, and Ibuprofen (1 or 2 tablets twice a day) for headaches. She is interested in becoming pregnant in the next 12 to 24 months. The patient says she has no allergies and does not drink or use recreational drugs or tobacco.
On physical examination, Shaynah is 5 foot 4 inches and 130 lb. Her temperature is 37°C, pulse rate 78, blood pressure 118/76, and glucose level 90. Skin appears normal. Head and neck are normal, chest is clear for anterior and posterior sounds, cardiovascular RRR and (2) r/m/g, and laboratory values are within normal limits. EEG findings include sharp-wave discharges. At a follow-up visit 2 months later, patient and her boyfriend report that things have gotten worse. The boyfriend states that as the patient was eating dinner one night she had a seizure. She was completely stiff for a short time, and then her arms and legs began moving. He believes that she was unconscious for a few minutes.Patient says she could not remember what had happened when she woke up.
1)Diagnosis: Generalized Tonic-Clonic Seizure
Which of the following should be true regarding your initial Adverse Effect Drugs (AED) regimen?
A) Initial combination therapy is warranted due to increased success rates.
B) Drugs that are taken two to three times daily are preferred due to a lower risk of seizure
if a dose is missed.
C) Levetiracetam is the preferred agent for all seizure types and patients.
D) The risks of pregnancy must be discussed prior to starting any AED.
2)Which of the following is the most appropriate initial antiepileptic regimen for this patient?
A) Levetiracetam 500 mg PO daily
B) Phenytoin 100 mg PO three times daily
C) Pregabalin 50 mg PO three times daily
D) Clobazam 5 mg PO twice daily
3) The patient fails to respond and has significant side effects to her initial therapy. Her initial therapy is to be discontinued. Which of the following would be the most appropriate replacement?
A) Valproic acid 500 mg twice daily
B) Lamotrigine 100 mg twice daily
C) Lacosamide 100 mg twice daily
D) Rufinamide 200 mg twice daily
4.) After several different AEDs, the patient ends up on carbamazepine and phenytoin. The carbamazepine serum concentration on week 2 of therapy was 6 mcg/mL. The patient presents after 8 weeks of therapy with increased seizures and she is found to have a serum concentration of 2 mcg/mL. Which of the following is a likely cause?
A) Autoinduction of CYP3A4.
B) Patient has the HLA-B*1502 subtype.
C) The oral contraceptive that she recently started.
D) Co-administration with alcohol.
5.) Despite the use of oral contraception, the patient becomes pregnant. Her AED regimen consists of valproic acid and lacosamide. What is the most appropriate treatment intervention?
A) Discontinue valproic acid and continue lacosamide monotherapy.
B) Discontinue lacosamide and continue valproic acid monotherapy.
C) Continue combination therapy.
D) Discontinue valproic acid and add phenytoin.

Categories
Pharmacology

Fresh garlic—3 cloves c.

NU641 Case Study Week 7 – Upper Respiratory Infections Jackie is a 45-year-old white female with a past medical history of controlled hypertension, controlled asthma, and eczema. She has a four-day history of nasal congestion, headache, sore throat, sneezing, and productive cough. She denies fever, nausea, vomiting, and myalgias. She has three children who recently went back to school following summer vacation. No one else in her household is currently presenting with similar symptoms. She has no known drug allergies but is allergic to mums and ragweed. She calls her primary care provider’s office requesting medication to treat her illness. She takes several medications, including the following: • Mometasone 220 mcg—1 puff daily for asthma. • Albuterol 90 mcg—1 to 2 puffs q4–6 hours as needed for shortness of breath. • Lisinopril 10 mg—one tablet by mouth daily for hypertension. • Oxymetazoline hydrochloride 0.05% nasal spray—2 sprays per nostril bid × 3 days. Provide rationales for your answers: 1. Which of the following is the MOST appropriate drug to recommend? a. Oxymetazoline hydrochloride 0.05% nasal spray— 2 sprays per nostril bid until symptoms resolve. b. Naproxen 220 mg—one tablet by mouth every 12 hours as needed until symptoms resolve. c. Dextromethorphan ER oral liquid—60 mg every 12 hours until symptoms resolve. d. Amoxicillin–clavulanic acid 500 mg every 8 hours for seven days. 2. Which of the following nonpharmacological therapies is NOT recommended? a. Steam inhalation b. Increased water intake c. Menthol lozenges d. Saline gargle 3. Jackie is insistent on taking complementary therapy to help treat her symptoms. What is the MOST appropriate recommendation? a. Echinacea purpurea tincture—0.75 mL b. Fresh garlic—3 cloves c. Acidophilus probiotic—1 tablet daily d. Vitamin C—1 g

Categories
Pharmacology

He reports that his sputum has increased in consistency and amount over the past few days.

Answer the following questions in three well-developed paragraphs (450–500 words) using APA formatting, integrating at least three evidence-based resources Anthony Miller, a 59-year-old male, presents to the clinic with complaints of cough, shortness of breath, and increased sputum production. His past medical history is significant for COPD with chronic bronchitis, hypertension, diabetes, and hyperlipidemia. He reports that his sputum has increased in consistency and amount over the past few days. His last exacerbation was about 6 months ago, for which he received amoxicillin. This is his third exacerbation in the past year. He has a 40-pack year history of cigarette smoking and quit smoking 3 years ago. He does not take chronic steroids. Physical exam reveals rhonchi and expiratory wheezes. His vital signs are blood pressure 140/83 mm Hg, pulse rate 80 beats/min, respiration rate 20 breaths/min, and temperature 98.8°F. He has no known drug allergies. A sputum Gram stain in the office reveals purulent sputum (presence of WBCs). Chest x-ray findings are negative for pneumonia. Diagnosis: Acute Exacerbation of Chronic Bronchitis—Please provide your rationales for each answer with supporting data 1) Which of the following would suggest the need for antibiotic therapy in A.M.? -Cough, history of smoking, and expiratory wheezes on physical examination -Elevated respiratory rate and shortness of breath -Increased dyspnea, increased sputum production, and increased sputum purulence -History of previous COPD exacerbations, cough, and fever 2.) What is a likely pathogen associated with an acute exacerbation of chronic bronchitis in A.M.? -Mycobacterium tuberculosis -Pseudomonas aeruginosa -Staphylococcus aureus -Streptococcus pneumonia 3)What antibiotic would be most appropriate to treat an acute exacerbation of chronic bronchitis in A.M.? -Amoxicillin–clavulanate -Azithromycin -Linezolid -Sulfamethoxazole/trimethoprim 4)What is the mechanism of action of the medication of choice in question #3? Provide rationale. 5)What kind of counseling points would you provide for A.M.?

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Pharmacology

Topic;setting up pharmacy services for a new 20 bed icu unit to handle additional critically ill patients, the type of critically ill patients will be primarily patients with cardiac issues

We are creating a business plan using THE TOPIC BELOW. There should be a word document attached of all the bullet points that should be addressed. TOPIC;Setting up pharmacy services for a new 20 bed ICU unit to handle additional critically ill patients, the type of critically ill patients will be primarily patients with cardiac issues

Categories
Pharmacology

Jason tyler is a 65-year-old male admitted to the hospital with a history of chronic cancer pain using morphine sr 60 mg po q8h.

Answer the following questions for A and B in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources to include clinical practice guidelines. As an Advanced Nurse Practitioner (ANP), you are working in an acute care setting. Jason Tyler is a 65-year-old male admitted to the hospital with a history of chronic cancer pain using Morphine SR 60 mg PO q8h. On admission, morphine 2 mg IV q4h was ordered. The patient reports his pain only went from a 9 to an 8 after the morphine dose and is asking for more pain medication. The staff begins to question the motivation of the patient and if addiction is present. The resident decides to start a PCA for his pain. In a few hours, the patient is comfortable, resting in bed. A: Answer the following questions and provide your rationales for your choices. J.T.’s behavior is best described as: (Please provide the definition for your choice and your rationales) Tolerance Addiction Pseudo addiction Dependence During his hospital stay, J.T. went into acute renal failure. He is increasingly lethargic and is experiencing confusion and some hallucinations. The physician believes the morphine metabolites may be responsible and would like to convert to an alternative regimen. What would be your recommendation? Change opioid to fentanyl patch 50 mcg q72h. Decrease morphine SR dose to 60 mg PO q8h. Switch to hydromorphone 8 mg orally q4h as needed. Add haloperidol 1 mg PO q6h. Tolerance will not develop to which adverse opioid effect? Respiratory depression Sedation Constipation Nausea B: What pieces of the holistic assessment are missing from this scenario: (Answer the following questions and provide your rationales) As a healthcare provider, what else do you need to understand about this patient related to pain management? In your response please provide the teaching you would provide to JT. What is meant by the DEA Drug Classification Schedule? Explain each category/classification.

Categories
Pharmacology

He never followed up and has been taking over-the-counter antacids and histamine receptor antagonists (h2ras) for 2 weeks without relief.

Joshua George is a 42-year-old white man presenting with a 2-month history of intermittent mid-epigastric pain. The pain sometimes wakes him up at night and seems to get better after he eats a meal. J.G. informs you that his doctor told him that he had an infection in his stomach 6 months ago. He never followed up and has been taking over-the-counter antacids and histamine receptor antagonists (H2Ras) for 2 weeks without relief. He takes no other medications. He is concerned because the pain is continuing. He has no other significant history except he is a 20-pack-year smoker and he drinks 5 cups of coffee a day. He eats late at night and goes to bed about 30 minutes after dinner. He is allergic to penicillin. Diagnosis: Peptic Ulcer Disease List specific goals for treatment for J.G. What drug therapy would you prescribe for J.G.? Please provide your rationale. What are the parameters for monitoring the success of the therapy? Discuss specific patient education based on the prescribed therapy. List one or two adverse reactions for the selected agent that would cause you to change therapy. What would be the choice for second-line therapy? What over-the-counter and/or alternative medications would be appropriate for J.G.? What lifestyle changes would you recommend to J.G.? Describe one or two drug-drug or drug-food interactions for the selected agent.

Categories
Pharmacology

Answer the following questions in three well-developed paragraphs (450–500 words

Answer the following questions in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources. Topic: Heart Failure Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d. Medical History: His medical history includes moderate prostatic hypertrophy for 5 years, adult-onset diabetes mellitus for 10 years, hypertension for 10 years, and degenerative joint disease for 5 years. Medications: His medication history includes hydrochlorothiazide (HydroDIURIL) 50 mg/d, atenolol (Tenormin) 100 mg/d, controlled-delivery diltiazem 180 mg/d, glyburide (DiaBeta) 5 mg/d, and indomethacin (Indocin) 25 to 50 mg three times a day as needed for pain. While reviewing his medical records, you see that his last physical examination revealed a blood pressure of 160/95 mm Hg, a pulse of 95 bpm, a respiratory rate of 18, normal peripheral pulses, mild edema bilaterally in his feet, a prominent S3 and S4, neck vein distention, and an enlarged liver. Diagnosis: Heart Failure Class II 1 List specific goals of treatment for Michael. 2 What drug(s) would you prescribe? Please provide rationales. 3 What are the parameters for monitoring the success of your selected therapy? 4 Discuss specific patient education based on the prescribed therapy. 5 Describe one or two drug–drug or drug–food interactions for the selected agent(s). 6 List one or two adverse reactions for the selected agent(s) that would cause you to change therapy. 7 What would be the choice for the second-line therapy? 8 What over-the-counter or alternative medications would be appropriate for Michael? 9 What dietary and lifestyle changes should be recommended for Michael