SCENARIO 3
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AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease. What would you prescribe? Consider her labs and provide an updated drug therapy plan. Include complete medication orders. How would you monitor drug therapy? Labs: TSH 3.9 mU/L, vitamin D 24 ng/mL, B12 450 pg/mL, Hb 12.5 g/dL, blood glucose = 100 mg/dL, HgA1C = 5.4% Medications include: insulin glargine 20 units once daily qhs, insulin lispro 6 units before each meal (adjusting based on carbohydrate intake)
NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems
SCENARIO 3
AT is a patient who presents with features of early-onset Alzheimer’s disease (AD). The first therapy plan is the use of cholinesterase inhibitors that include donepezil and other treatments for deficiencies, including low vitamins, which have been proven to affect cognitive functioning. Donepezil 5 mg is taken orally at night to treat Alzheimer’s symptoms; there is a desire to halt this progression. In addition, Vitamin D3 supplement administration at 2000 IU has started to address deficiency and fulfill health needs (Blackman et al., 2021). Both medications are prescribed in quantity of thirty days and three refluxes.
The patient gets to be educated on the kind of treatment they are bound to receive next. The patient is read the purpose of donepezil in the management, and they are told that it slows the worsening of AD; the patient is prescribed to take donepezil at night to help minimize gastrointestinal side effects. Significance is also therefore laid on the compliance to the vitamin D program (Blackman et al., 2021). The cognitive function and the laboratory results are checked six weeks later with a clinic appointment.
It includes neuropsychological tests which are administered semestrial, one of which is called the Mini-Mental State Examination. Serum Vitamin D will be assessed frequently to ascertain that the patient serum Vitamin D will be more than 30ng/ML (Wang et al., 2020). This would also include symptoms of nausea and bradycardia which could be precipitated by donepezil.
Similar to most of the drugs used in the treatment of Alzheimer’s disease, donepezil is an antagonist of acetylcholinesterase that increases the concentration of acetylcholine in cerebral cortex. Again, intervention or prevention of Vitamin D deficiency is relevant because it arguably defines the overall health experience for patients diagnosed with Alzheimer’s disease (Kumar et al., 2022).
References
Blackman, J., Swirski, M., Clynes, J., Harding, S., Leng, Y., & Coulthard, E. (2021). Pharmacological and non‐pharmacological interventions to enhance sleep in mild cognitive impairment and mild Alzheimer’s disease: A systematic review. Journal of sleep research , 30 (4), e13229.
Kumar, V., Kim, S. H., & Bishayee, K. (2022). Dysfunctional glucose metabolism in Alzheimer’s disease onset and potential pharmacological interventions. International Journal of Molecular Sciences , 23 (17), 9540.
Wang, L. Y., Pei, J., Zhan, Y. J., & Cai, Y. W. (2020). Overview of meta-analyses of five non-pharmacological interventions for Alzheimer’s disease. Frontiers in aging neuroscience , 12 , 594432.
ASSIGNMENT
Submit your Assignment by Day 7 of Week 4 (Sunday night, 11:59 pm ET)
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 your week 4 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
To Prepare:
Review NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease assignment rubric and case studies. Be sure to thoroughly answer ALL questions.
Explain the problem and discuss how you would address the problem.
When recommending medications, write out a complete prescription for each medication. A complete prescription includes the following information: drug, dose, route, frequency, duration (if applicable), quantity, # of refills and indication for use. An example of a complete prescription is as follows: lisinopril 10mg #30 tabs, take 1 tab PO once daily for high blood pressure, refills: 2.
Answer questions using your required learning resources, clinical practice guidelines, Medscape, etc.
Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.
SCENARIO 1
JG is a 37-year-old male presenting with wheezing and shortness of breath. During his visit today, he reports having to use his albuterol 3 days per week over the past month. He reports being awakened by a cough six nights during the last month. His current medications include: salmeterol 50 mcg inhaler BID, albuterol MDI two puffs q4-6 hr PRN shortness of breath, prednisone 20mg qam, loratadine 10 mg daily, diphenhydramine 50 mg qhs prn. How would you step up asthma therapy for this patient (include complete medication order)? What medication changes would you make? What drug classification is salmeterol? Can it be used as monotherapy? What patient teaching and monitoring would you provide regarding the updated drug therapy plan ?
SCENARIO 2
KH is a 48-year-old male diagnosed with type II diabetes 1 year ago. He has controlled his blood glucose through dietary changes. He has hypertension and is currently on lisinopril 10 mg po daily. He has no known allergies. His lab work today includes: fasting BG is 175 mg/dL; HgA1C = 7.5%. Basic Metabolic Profile (BMP) is normal except for Cr 1.8 and eGRF 28. What treatment plan would you implement for KH (include complete medication order)? What education would you provide regarding his treatment plan? How would you monitor the effectiveness of this plan ? What is the goal A1C?
SCENARIO 3
AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease. What would you prescribe? Consider her labs and provide an updated drug therapy plan. Include complete medication orders. How would you monitor drug therapy? Labs: TSH 3.9 mU/L, vitamin D 24 ng/mL, B12 450 pg/mL, Hb 12.5 g/dL, blood glucose = 100 mg/dL, HgA1C = 5.4% Medications include: insulin glargine 20 units once daily qhs, insulin lispro 6 units before each meal (adjusting based on carbohydrate intake)
SCENARIO 4
HM is a 42 year-year-old female seeking evaluation for feelings of fullness, bloating and acid reflux with symptoms worse at night. HM eats fast food once a day and consumes 2 cups of coffee a day. She drinks alcohol socially on weekends. PMH includes asthma, diabetes and hypertension. Her blood pressure today is 142/85. Current medications include prn famotidine, prn albuterol, Pulmicort Flexhaler 90 mcg 2 inhalations twice daily, cetirizine 10 mg daily, bisoprolol 5 mg po daily and metformin 1000 mg po daily with food. How would you improve her drug therapy plan? What changes would you make (include complete medication orders)? What information would you provide to the patient at her visit? Can a patient take a H2 blocker and PPI at the same time ? NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease.
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 NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease.
