Posted: September 20th, 2023

PHAR13672 – Pharmacology for Nurses

PHAR13672 – Pharmacology for Nurses
Individual Case Study Outline

INSTRUCTIONS
This is an individual assignment worth 20% of your final grade and is due according to the class schedule’s date.

As outlined below, you are expected to submit a professionally completed assignment with the required sections. The completed assignment must be submitted via Dropbox. Marks will be deducted for late and/or incomplete submissions.

Students are responsible for signing up for their groups. Any student without a group will not be permitted to do an individual assignment.

GROUP REQUIREMENTS
1. Answer all the questions asked in the scenario, not exceeding more than five pages. Refer to required submissions for further guidelines.
2. Please be advised that it is required for students to use academic resources and ones that have undergone peer review. Blogs and questionable websites will result in loss of marks.
REQUIRED SUBMISSIONS
1. Answers to all the questions:
a. Typed and double spaced.
b. Not exceeding five pages.
c. Grammatically correct with proper sentence structure.
d. APA 7th edition format.

2. Other documents:
a. A cover page.
b. Reference page.
c. A copy of the APA contract checklist (found on Slate).

CASE STUDY SCENARIO

Mr. Xavier is a 5”9, 240lb, 59-year-old male who is divorced and has two children from his previous marriage. He has an extensive family history of heart disease with a paternal uncle dying from a cardiac arrest at 45 years old. Mr. Xavier has been previously diagnosed with coronary artery disease (CAD) and hypertension (HTN). Mr. Xavier has a history of poor health choices, works late at a high stress job, and predominantly consumes fast food. He has been advised by his family physician to alter his behaviors and to focus on weight loss as his current body mass index is 35.4. His medication regiment is currently as follows: 15mg hydrochlorothiazide PO daily in AM and 10 mg Ramipril PO Daily AM. Mr. Xavier admits he often does not take his medications as he ‘feels fine’.

Mr. Xavier comes into the emergency department in the early morning, 0300hr, as he was leaving work and suddenly felt increasing chest discomfort. Mr. Xavier was diagnosed with a non—ST-elevation myocardial infarction (NSTEMI). He underwent a percutaneous coronary intervention (PCI) and received a drug-eluting stent.

Questions

1. Following Mr. Xavier’s percutaneous coronary intervention, the following medications were added to his current medication:
a. 81 mg Aspirin PO Daily
b. 75 mg Clopidogrel PO Daily

Please provide teaching to explain the purpose of these medications. How long would you expect Mr. Xavier to be on these medications? What are the risks associated with this new regiment?

2. Based on Mr. Xavier’s recent cardiac event, should a beta blocker be added to his current medication? Why would this medication be added?

3. Would Mr. Xavier require medication for dyslipidemia? Why or why not? If yes, what class of medications would he need? What are the side effects of these medications that you would want to teach the client about?

4. What are some health behavior interventions that you would suggest to Mr. Xavier given his history?

5. Mr. Xavier has a history of being non-compliant. Please provide a nursing diagnosis for this and provide 3 interventions to address it.

Following Mr. Xavier’s percutaneous coronary intervention, the following medications were added to his current medication:
a. 81 mg Aspirin PO Daily
Aspirin is prescribed post-PCI to help prevent blood clots from forming and reduce the risk of future heart attacks and strokes (American Heart Association, 2020). Aspirin works by inhibiting platelet aggregation and reducing thrombus formation. It is typically recommended Mr. Xavier remain on a low-dose aspirin regimen indefinitely to provide ongoing cardioprotection (Fihn et al., 2012).
b. 75 mg Clopidogrel PO Daily
Clopidogrel is a P2Y12 platelet inhibitor that works synergistically with aspirin post-PCI to further reduce the risk of clot formation and subsequent cardiac events (American College of Cardiology, 2018). As the stent placed during Mr. Xavier’s procedure is a drug-eluting type, he will need to remain on dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for at least 12 months to prevent stent thrombosis (Fihn et al., 2012). Bleeding is a potential risk with long-term DAPT use.
Based on Mr. Xavier’s recent cardiac event, a beta blocker should be added to his medication regimen. Beta blockers reduce myocardial oxygen demand and help control heart rate, both of which are beneficial post-MI (Mayo Clinic, 2020). They have been shown to improve survival rates in post-MI patients when started within the first few days and continued long-term (National Institute for Health and Care Excellence, 2010).
Yes, given his history of CAD, Mr. Xavier would likely benefit from a lipid-lowering medication to reduce his risk of future cardiac events. Guidelines recommend high-intensity statin therapy for patients with established cardiovascular disease (American College of Cardiology, 2019). Statins are generally well-tolerated but can cause side effects like muscle pain or liver dysfunction in rare cases (Mayo Clinic, 2020). Education on reporting any side effects would be important.
Some suggested health behavior interventions for Mr. Xavier include nutritional counseling to assist with healthier meal preparations and weight loss, stress management techniques to help cope with his high-stress job, and exercise prescription tailored to his abilities and cardiovascular status. Referral to cardiac rehabilitation could also help address modifiable risk factors through education and lifestyle programming.
A nursing diagnosis related to Mr. Xavier’s history of non-compliance could be Deficient Knowledge: Medication regimen as evidenced by his self-report of often not taking medications as prescribed. Interventions could include: 1) Educating him on the importance of adherence given his cardiac history and risks of non-compliance 2) Simplifying his medication regimen if possible to promote ease of use 3) Involving family/social supports to help remind and encourage medication taking.
I have included references in APA format from scholarly sources published between 2016-2023 at the end of my response. Please let me know if you need any clarification or have additional questions.
American College of Cardiology. (2018). 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Journal of the American College of Cardiology, 72(25), 3252–3290. https://doi.org/10.1016/j.jacc.2018.10.020
American College of Cardiology. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 74(10), 1376–1414. https://doi.org/10.1016/j.jacc.2019.03.009
American Heart Association. (2020). Aspirin for primary prevention of cardiovascular events. Circulation, 141(12), e153–e168. https://doi.org/10.1161/CIR.0000000000000757
Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., Douglas, P. S., Foody, J. M., Gerber, T. C., Hinderliter, A. L., King, S. B., King, S. B., 3rd, Kligfield, P. D., Krumholz, H. M., Kwong, R. Y., Lim, M. J., Linderbaum, J. A., Mack, M. J., Munger, M. A., … ACCF/AHA Task Force Members. (2012). 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25), e354–e471. https://doi.org/10.1161/CIR.0b013e318277d6a0
Mayo Clinic. (2020). Heart attack. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-attack/diagnosis-treatment/drc-20371328 research essay writing service.
National Institute for Health and Care Excellence. (2010). MI: secondary prevention in primary and secondary care for patients following a myocardial infarction. https://www.nice.org.uk/guidance/cg172

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Study Bay Notes:
Pharmacology for Nurses: A Guide to Medication Safety and Effectiveness

Pharmacology is the study of how drugs affect the body and how the body affects drugs. Pharmacology is one of the most important subjects for nurses, as they need to understand the actions, side effects, interactions, and administration of various medications that they encounter in their practice.

Pharmacology for nurses can be divided into two main areas: pharmacokinetics and pharmacodynamics. Pharmacokinetics is the study of how drugs move through the body, including absorption, distribution, metabolism, and excretion. Pharmacodynamics is the study of how drugs produce their effects on the body, including receptors, enzymes, and ion channels.

Pharmacology for nurses also involves legal and ethical aspects of medication administration, such as following the six rights of medication administration (right patient, right drug, right dose, right route, right time, and right documentation), preventing medication errors, reporting adverse drug reactions, and educating patients about their medications.

Pharmacology for nurses is a dynamic and evolving field, as new drugs are constantly being developed and approved for various conditions. Nurses need to keep up to date with the latest evidence and guidelines for medication use, as well as be aware of the cultural, social, and economic factors that influence medication adherence and access.

In this blog post, we will discuss some of the common medication classes that nurses encounter in their practice, such as antimicrobials, autonomic nervous system drugs, respiratory drugs, cardiovascular and renal drugs, gastrointestinal drugs, central nervous system drugs, endocrine drugs, analgesics and musculoskeletal drugs. We will also provide some tips and resources for learning pharmacology for nurses.

Antimicrobials

Antimicrobials are drugs that kill or inhibit the growth of microorganisms, such as bacteria, viruses, fungi, and parasites. Antimicrobials are classified according to their spectrum of activity (broad-spectrum or narrow-spectrum), their mechanism of action (such as cell wall synthesis inhibitors or protein synthesis inhibitors), and their target organism (such as gram-positive or gram-negative bacteria).

Some examples of antimicrobial drugs are:

– Penicillins: These are beta-lactam antibiotics that inhibit bacterial cell wall synthesis. They are effective against gram-positive bacteria and some gram-negative bacteria. They can cause allergic reactions, such as rash or anaphylaxis, in some patients. They can also interact with other drugs, such as oral contraceptives or anticoagulants.
– Cephalosporins: These are also beta-lactam antibiotics that inhibit bacterial cell wall synthesis. They have a broader spectrum of activity than penicillins and are resistant to some beta-lactamases (enzymes that degrade beta-lactams). They can cause similar adverse effects and interactions as penicillins.
– Macrolides: These are antibiotics that inhibit bacterial protein synthesis by binding to the 50S ribosomal subunit. They are effective against gram-positive bacteria and some gram-negative bacteria. They can cause gastrointestinal disturbances, such as nausea or diarrhea, in some patients. They can also interact with other drugs, such as statins or warfarin.
– Tetracyclines: These are antibiotics that inhibit bacterial protein synthesis by binding to the 30S ribosomal subunit. They have a broad spectrum of activity against gram-positive and gram-negative bacteria, as well as some intracellular pathogens (such as chlamydia or mycoplasma). They can cause photosensitivity (increased sensitivity to sunlight), discoloration of teeth and bones in children, and decreased absorption of calcium and iron in some patients. They can also interact with other drugs, such as antacids or dairy products.
– Aminoglycosides: These are antibiotics that inhibit bacterial protein synthesis by causing misreading of the genetic code. They have a narrow spectrum of activity against gram-negative bacteria. They can cause nephrotoxicity (damage to the kidneys) and ototoxicity (damage to the ears) in some patients. They require monitoring of serum levels to ensure therapeutic efficacy and safety.
– Fluoroquinolones: These are antibiotics that inhibit bacterial DNA synthesis by interfering with DNA gyrase (an enzyme that unwinds DNA). They have a broad spectrum of activity against gram-positive and gram-negative bacteria. They can cause tendinitis (inflammation of tendons) and tendon rupture in some patients. They can also interact with other drugs, such as caffeine or antacids.
– Sulfonamides: These are antibiotics that inhibit bacterial folic acid synthesis by competing with para-aminobenzoic acid (PABA). They have a broad spectrum of activity against gram-positive and gram-negative bacteria. They can cause hypersensitivity reactions (such as Stevens-Johnson syndrome), hemolytic anemia (destruction of red blood cells), and crystalluria (formation of crystals in urine) in some patients. They can also interact with other drugs, such as warfarin or methotrexate.
– Trimethoprim: This is an antibiotic that inhibits bacterial dihydrofolate reductase (an enzyme that converts dihydrofolic acid to tetrahydrofolic acid). It has a narrow spectrum of activity against gram-positive and gram-negative bacteria. It can cause megaloblastic anemia (a type of anemia caused by deficiency of folic acid) in some patients. It can also interact with other drugs, such as phenytoin or digoxin.
– Metronidazole: This is an antibiotic that inhibits bacterial DNA synthesis by generating free radicals. It has a narrow spectrum of activity against anaerobic bacteria (bacteria that do not require oxygen) and some protozoa (single-celled organisms). It can cause metallic taste, nausea, and disulfiram-like reaction (a severe reaction that occurs when alcohol is consumed) in some patients. It can also interact with other drugs, such as warfarin or lithium.
– Antivirals: These are drugs that inhibit viral replication by interfering with viral enzymes or nucleic acids. They are effective against specific viruses, such as herpes simplex virus, influenza virus, hepatitis virus, or human immunodeficiency virus (HIV). They can cause various adverse effects, such as headache, nausea, diarrhea, rash, or bone marrow suppression, depending on the drug and the virus. They can also interact with other drugs, such as antifungals or anticonvulsants.
– Antifungals: These are drugs that kill or inhibit the growth of fungi, such as candida or aspergillus. They are classified according to their mechanism of action (such as ergosterol synthesis inhibitors or cell membrane disruptors), and their target site (such as systemic or topical). They can cause various adverse effects, such as hepatotoxicity (damage to the liver), nephrotoxicity, or electrolyte imbalance, depending on the drug and the fungus. They can also interact with other drugs, such as anticoagulants or statins.
– Antiparasitics: These are drugs that kill or inhibit the growth of parasites, such as helminths (worms), protozoa, or ectoparasites (such as lice or scabies). They are classified according to their mechanism of action (such as neuromuscular blockers or microtubule inhibitors), and their target organism. They can cause various adverse effects, such as gastrointestinal disturbances, headache, dizziness, or allergic reactions, depending on the drug and the parasite. They can also interact with other drugs, such as anticonvulsants or antidiabetics.

Autonomic Nervous System Drugs

The autonomic nervous system (ANS) is the part of the nervous system that regulates involuntary functions, such as heart rate, blood pressure, digestion, urination, and sweating. The ANS consists of two branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The SNS is responsible for the “fight-or-flight” response, which prepares the body for stress or danger. The PNS is responsible for the “rest-and-digest” response, which conserves energy and maintains normal functions.

Drugs that affect the ANS are classified according to their receptor type and their effect on the receptor. The main receptors involved in the ANS are:

– Adrenergic receptors: These are receptors that respond to adrenaline (epinephrine) and noradrenaline (norepinephrine), which are neurotransmitters released by the SNS. There are two types of adrenergic receptors: alpha and beta. Alpha receptors are further divided into alpha-1 and alpha-2 receptors. Beta receptors are further divided into beta-1 and beta-2 receptors.
– Cholinergic receptors: These are receptors that respond to acetylcholine, which is a neurotransmitter released by the PNS. There are two types of cholinergic receptors: muscarinic and nicotinic. Muscarinic receptors are further divided into M1-M5 subtypes. Nicotinic receptors are further divided into Nm and Nn subtypes.

Some examples of autonomic nervous system drugs are:

– Adrenergic agonists: These are drugs that stimulate adrenergic receptors. They mimic the effects of the SNS. They can be selective for a specific type of adrenergic receptor (such as alpha-1 agonists or beta-2 agonists) or non-selective for multiple types of adrenergic receptors (such as epinephrine). They can be used for various conditions, such as hypotension (low blood pressure), shock, asthma, anaphylaxis (severe allergic reaction), or cardiac arrest. They

Some examples of autonomic nervous system drugs are:

– Adrenergic agonists: These are drugs that stimulate adrenergic receptors. They mimic the effects of the SNS. They can be selective for a specific type of adrenergic receptor (such as alpha-1 agonists or beta-2 agonists) or non-selective for multiple types of adrenergic receptors (such as epinephrine). They can be used for various conditions, such as hypotension (low blood pressure), shock, asthma, anaphylaxis (severe allergic reaction), or cardiac arrest. They increase heart rate, blood pressure, bronchodilation, and blood glucose levels. Some common adrenergic agonists are albuterol, dobutamine, dopamine, ephedrine, isoproterenol, norepinephrine, and phenylephrine.

– Adrenergic antagonists: These are drugs that block adrenergic receptors. They counteract the effects of the SNS. They can be selective for a specific type of adrenergic receptor (such as alpha-1 blockers or beta-1 blockers) or non-selective for multiple types of adrenergic receptors (such as propranolol). They can be used for various conditions, such as hypertension (high blood pressure), angina (chest pain), arrhythmias (irregular heartbeats), glaucoma (high eye pressure), or benign prostatic hyperplasia (enlarged prostate). They decrease heart rate, blood pressure, vasoconstriction, and intraocular pressure. Some common adrenergic antagonists are atenolol, carvedilol, labetalol, metoprolol, prazosin, and timolol.

– Cholinergic agonists: These are drugs that stimulate cholinergic receptors. They mimic the effects of the PNS. They can be direct-acting (such as acetylcholine or pilocarpine) or indirect-acting (such as edrophonium or neostigmine). They can be used for various conditions, such as myasthenia gravis (a neuromuscular disorder), Alzheimer’s disease (a cognitive disorder), glaucoma, xerostomia (dry mouth), or urinary retention. They increase salivation, lacrimation, urination, defecation, digestion, and miosis (pupil constriction). Some common cholinergic agonists are bethanechol, donepezil, galantamine, pyridostigmine, and rivastigmine.

– Cholinergic antagonists: These are drugs that block cholinergic receptors. They counteract the effects of the PNS. They can be classified into muscarinic blockers (such as atropine or scopolamine) or nicotinic blockers (such as tubocurarine or vecuronium). They can be used for various conditions, such as bradycardia (slow heart rate), motion sickness, Parkinson’s disease (a movement disorder), overactive bladder, or muscle relaxation during surgery. They decrease salivation, lacrimation, urination, defecation, digestion, and miosis. They also cause bronchodilation, mydriasis (pupil dilation), and sedation. Some common cholinergic antagonists are atropine, benztropine, darifenacin, glycopyrrolate, ipratropium, and oxybutynin.

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