Posted: June 11th, 2023

Nursing assignment 4 pharmacology ASSIGNMENT: CASE STUDIES

Research Paper on Pharmacology Case Studies

Abstract
This paper examines four pharmacology case studies involving patients with hypertension, dyslipidemia, asthma, and chronic obstructive pulmonary disease (COPD). Evidence-based treatment plans are developed for each patient, taking into account their individual characteristics, medical history, and current medications. Monitoring plans and patient education are also discussed.

Introduction
Pharmacological interventions play a crucial role in managing chronic conditions such as hypertension, dyslipidemia, asthma, and COPD. However, treatment must be tailored to each patient’s unique circumstances. This paper analyzes four case studies to demonstrate the application of evidence-based pharmacotherapy in real-world clinical scenarios.

Case 1: Hypertension
Sara, a 45-year-old female, presents with a blood pressure of 160/90 mmHg and a history of elevated readings. The goal for her blood pressure should be <130/80 mmHg, as per the 2017 ACC/AHA guidelines (Whelton et al., 2018). Given her current use of ibuprofen, which can increase blood pressure, an angiotensin-converting enzyme inhibitor (ACEI) such as lisinopril would be an appropriate first-line treatment (Unger et al., 2020). Sara should be educated on lifestyle modifications, including weight loss, dietary sodium reduction, and regular exercise. Case 2: Dyslipidemia Monty, a 52-year-old male smoker, has a fasting lipid profile showing elevated total cholesterol (266 mg/dL), LDL-C (180 mg/dL), and triglycerides (185 mg/dL), with low HDL-C (40 mg/dL). Based on the 2018 AHA/ACC guidelines, the goal LDL-C for Monty should be <70 mg/dL, given his multiple risk factors (Grundy et al., 2019). Treatment should include a high-intensity statin such as atorvastatin 40-80 mg daily, in addition to lifestyle modifications (Mach et al., 2020). Monty has several coronary artery disease risk factors, including age >45, male sex, smoking, and dyslipidemia. Effectiveness can be monitored with repeat lipid testing in 4-12 weeks.

Case 3: Asthma
Beatrice, a 17-year-old female with mild persistent asthma, reports increasing symptoms despite using a short-acting beta-2 agonist (SABA) and an inhaled corticosteroid (ICS). Per the 2020 GINA guidelines, her treatment should be stepped up to a low-dose ICS-long-acting beta-2 agonist (LABA) combination, such as fluticasone-salmeterol 100/50 mcg one puff twice daily (Reddel et al., 2020). Her SABA (albuterol) should be continued as needed for symptom relief. Monitoring should include assessment of symptom control, lung function, and medication adherence at each visit.

Case 4: COPD
Daute, a 56-year-old man with a history of chronic bronchitis and smoking, presents with increasing dyspnea. Based on his symptoms and exacerbation history, he likely has moderate COPD. Per the 2021 GOLD guidelines, treatment should include a LAMA (long-acting muscarinic antagonist) such as tiotropium, and a LABA such as salmeterol (Halpin et al., 2021). Smoking cessation counseling and support are crucial. Effectiveness can be monitored using symptom scales (e.g., CAT), lung function (spirometry), and exacerbation frequency.

Conclusion
These case studies illustrate the importance of individualized, evidence-based pharmacotherapy for managing chronic conditions. Treatment plans must consider patient characteristics, comorbidities, and current medications. Monitoring and patient education are essential for ensuring optimal outcomes.

References:
Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., … & Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 73(24), e285-e350.

Halpin, D. M., Criner, G. J., Papi, A., Singh, D., Anzueto, A., Martinez, F. J., … & Vogelmeier, C. F. (2021). Global Initiative for the diagnosis, management, and prevention of chronic obstructive lung disease: the 2020 GOLD science committee report on COVID‐19 & COPD. American Journal of Respiratory and Critical Care Medicine, 203(1), 24-36.

Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., … & Patel, R. S. (2020). 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal, 41(1), 111-188.

Reddel, H. K., FitzGerald, J. M., Bateman, E. D., Bacharier, L. B., Becker, A., Brusselle, G., … & Wechsler, M. E. (2020). GINA 2020: a fundamental change in asthma management: treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents. The European respiratory journal, 55(6).

Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., … & Wainford, R. D. (2020). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension, 75(6), 1334-1357.

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey Jr, D. E., Collins, K. J., Himmelfarb, C. D., … & Wright Jr, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.
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Nursing assignment 4 pharmacology
ASSIGNMENT: CASE STUDIES

Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
RESOURCES
Review the following Video Resources and Content Pages in the Lecturio Platform by clicking button below labeled Load Week 4: Learning Resources in a new window.
• Motility Disorder medication
• Stomach Ulcer (Peptic Acid Disease) Medication
• Nausea Medication: Antiemetics – Gastrointestinal Drugs
• Pancreatic Enzyme Replacement Therapy (PERT) and Gallstone Prevention – Gastrointestinal Drugs
• Irritable Bowel Syndrome (IBS) Medication
• Questions and Case Studies: GERD Medications
• Inflammatory Bowel Disease Medication
• Questions and Case Studies: Steroids, Cyclosporine and Crohn’s Disease
• Hepatitis Treatment – Antiviral Drugs
• Overview – Antiviral Agents and Treatment of CMV Retinitis – Antiviral Drugs
If you have any technical issues, please contact the Customer Care Team at 1-800-925-3368.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
• Chapter 68, “Drugs for Weight Loss” (pp. 627–637)

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
• Review the case study posted in “Announcements” by your Instructor for this Assignment
• Review the information provided and answer questions posed in the case study
• When recommending a medication, write out a complete prescription for the medication
• Whenever possible, use clinical practice guidelines in developing your answers when possible
• Include at least three references to support your answer and cite them in APA format.
BY DAY 7 OF WEEK 4
Submit the Assignment.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
1. To submit your completed assignment, save your Assignment as WK4Assgn_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review.

Rubric
NURS_6521_Week4_Assignment_Rubric
NURS_6521_Week4_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeScenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. 15 to >11.0 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate. 11 to >7.0 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues. 7 to >3.0 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient. 3 to >0 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts
This criterion is linked to a Learning OutcomeScenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 3 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 0 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts
This criterion is linked to a Learning OutcomeScenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. 4 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used. 3 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors. 2 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors. 0 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts
This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 3 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 2 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 1 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts
This criterion is linked to a Learning OutcomeScenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. 15 to >11.0 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate. 11 to >7.0 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues. 7 to >3.0 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient. 3 to >0 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts
This criterion is linked to a Learning OutcomeScenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 3 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 0 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts
This criterion is linked to a Learning OutcomeScenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. 4 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used. 3 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors. 2 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors. 0 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts
This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 3 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 2 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 1 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts
This criterion is linked to a Learning OutcomeScenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. 15 to >11.0 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate. 11 to >7.0 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues. 7 to >3.0 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient. 3 to >0 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts
This criterion is linked to a Learning OutcomeScenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 3 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 0 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts
This criterion is linked to a Learning OutcomeScenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. 4 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used. 3 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors. 2 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors. 0 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts
This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 3 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 2 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 1 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts
This criterion is linked to a Learning OutcomeScenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. 15 to >11.0 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate. 11 to >7.0 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues. 7 to >3.0 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient. 3 to >0 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts
This criterion is linked to a Learning OutcomeScenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 3 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 0 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts
This criterion is linked to a Learning OutcomeScenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. 4 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used. 3 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors. 2 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors. 0 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts
This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 3 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 2 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 1 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts
Total Points: 100
Week 4: Gastrointestinal and Hepatobiliary Disorders
Class, this week we delve into the topics of gastrointestinal and hepatobiliary disorders. At first thought, nausea, diarrhea, or perhaps GERD may come to mind when thinking of disorders in this group, however, there are many more. This week we will be covering these and many other important topics. For example, there are several new treatments being introduced for IBS and Hepatitis C, bringing these disorders into the public eye. As a practitioner, you may begin to encounter more patients with these disorders as public awareness about them increases. Also, nausea, vomiting, and diarrhea are some of the most common side effects that accompany many drug treatments, so awareness of how to mitigate this is crucial in learning about pharmacology.
This week you will be completing another assignment on case studies. Be sure to review the rubric for what is being graded. Write out prescription orders for each case being sure to include the “5 rights” of prescribing. Note that the case studies are not solely on GI and hepatobiliary disorders. The case studies are below:
Week 4 Cases
1. Sara is a 45-year-old female presenting for her annual exam. Her blood pressure today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal for her blood pressure? What medication would you prescribe to treat her blood pressure? What education would you prescribe?
2. Monty is a 52-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan would you implement for Monty’s lipid profile? What is the goal Total Cholesterol (TC), HDL-C, and LDL-C level for Monty? How would you monitor the effectiveness of your treatment plan? How many risk factors for coronary artery disease does this patient have? Identify them specifically.
3. Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days per week over the past 2 months. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough three nights during the last month. She is becoming more short of breath with exercise. She also has a fluticasone MDI, which she uses “most days of the week.” Her current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80 mg PO BID. What treatment plan would you implement for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan?
4. Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?

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