NURS 6521 Advanced Pharmacology
Advanced Pharmacology: Case Studies
Case Study 1
The case study entails Sara, a 45-year-old female, presenting to the clinic for her annual exam. Her BMI is 34.5, and her vitals are BP 160/90, HR 84, and RR 16. During her last visit 3 months ago, her BP was 156/92. She has no known allergies and is currently on ibuprofen 600mg TID for back pain. This discussion presents the patient’s blood pressure goal, the medication prescribed to treat her blood pressure and the education she needs.
The primary problem in this case is elevated blood pressure levels. The American Heart Association (AHA) guidelines state that the target blood pressure for adults without other healthcare conditions is 130/80 and below (Chobufo et al., 2020). The vitals show that the patient’s blood pressure has slightly increased since the last visit, even though it was still high. She has moderate hypertension. The trend indicated that Sara’s blood pressure is poorly controlled, and there is a need to begin a medication intervention to lower it and attain a healthy range. Therefore, the blood pressure goal for this patient is 130/80, considering she does not have an underlying health condition.
The medication I would prescribe to treat her blood pressure is hydrochlorothiazide. According to Herman et al. (2023), hydrochlorothiazide is a diuretic that helps the body eliminate excess water and sodium, reducing blood volume and lowering blood pressure.
Medication Order
Patient Name: Sara
Age: 45 years
Gender: Female
Medication: Hydrochlorothiazide
Dosage: 50mg
Route of administration: oral
Frequency: BID
Patient education is essential for hypertensive patients to adhere to the treatment plan and achieve better outcomes (Abedi et al., 2020). For this patient, the patient education content will include the importance of adhering to the medication, alcohol avoidance to reduce the medication’s side effects, the type and amounts of liquids the patient should take, and the drugs the patient should avoid to prevent drug interactions with the prescribed medication.
Case Study 2
The case study entails Monty, a 52-year-old male, visiting the clinic to follow up on his labs. He is allergic to penicillin, smokes 1 pack/day, and is currently on Lisinopril 20mg POD. His fasting lipid profile is total cholesterol 266, LDL cholesterol 180, HDL cholesterol 40, and Triglycerides 185. This discussion presents the treatment plan I would implement for Monty’s lipid profile, the cholesterol goals, the effectiveness monitoring of the treatment plan, and the patient’s risk factors for coronary artery disease.
According to Lee and Siddiqui (2023), the normal range for fasting triglyceride level is 150mg/dl and below, LDL-C level is 100-129 mg/dl, and HDL level 11-59. Monty’s lipid profile shows elevated total cholesterol, LDL, borderline low FDL cholesterol and slightly elevated triglycerides. These are the cholesterol goals that the patient’s treatment plan will aim to achieve. Iyen et al. (2021) recommend that treatment plans for patients with elevated cholesterol levels incorporate medication interventions and lifestyle modifications. The medication I would prescribe for Monty is Statin, which is recommended for lowering cholesterol levels in individuals with additional risk factors for cardiovascular disease (de Pádua Borges et al., 2021). The lifestyle modifications for this patient include smoking cessation, limiting alcohol consumption, dietary changes, physical activity and weight management.
Furthermore, I would monitor the effectiveness of the treatment plan by scheduling a follow-up appointment whereby I monitor the patient’s lipid profile levels after the treatment plan implementation. If changes toward achieving the lipid profile level goals are noted, the treatment plan will be effective. Monty’s risk factors for coronary artery disease include smoking, elevated cholesterol levels, and being a male with advanced age.
Case Study 3
The case study involves Beatrice, a 17-year-old female. Presenting to the clinic with increased shortness of breath, use of albuterol MDI 3-4 days/week, and being awakened by a cough. She was diagnosed with mild persistent asthma at age 7. She is currently on Flovent HFA 44mcg two puffs BID, Proventil HFA two puffs Q4-6 H PRN in shortness of breath, Yaz one POD, and propranolol 80 mg PO BID. This discussion presents the treatment plan for this patient, the recommended medication changes, and how I will monitor the effectiveness of the treatment plan.
Based on the case study, the patient has been having increased exacerbations and symptoms showing that the asthma is not controlled effectively, including nighttime awakening, increased shortness of breath, and frequent albuterol use. The Global Initiative for Asthma recommends using a Single Maintenance and Reliever Therapy (SMART) plan to manage symptoms and reduce flare-ups (Reddel et al., 2022). Similarly, the treatment plan for this patient will implement the SMART action plan as a step-up therapy on the current treatment regimen to enable the patient to identify and avoid triggers, monitor the condition, and take the medication at the right time.
The medication changes I would make for this patient include increasing the inhaled corticosteroid dose (Flovent to 11o mcg two puffs BID) and addition of Formoterol (Foradil, perforomist) as a separate inhaler to be used concurrently with Flovent (National Heart, Lung, and Blood Institute, n.d.). Lommatzsch et al. (2020) note that in patients with persistent and not well-controlled asthma, the care provider should consider the addition of a Long-Acting beta agonist such as Formoterol to improve asthma control. I would monitor the treatment plan’s effectiveness by scheduling regular follow-up appointments to monitor Beatrice’s asthma control. The treatment plan will be effective if the patient maintains controlled asthma.
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Case Study 4
The case study entails Daute, a 56-year-old male seeking evaluation for increased shortness of breath from about 3 years ago, increasing with physical activity. He was placed on fluticasone inhalation twice daily 2years ago, and he is not sure of the reason for this prescription. He had chronic bronchitis for 8 years, with one exacerbation in the last year of treatment with oral antibiotics. He smokes 40 packs per year. This discussion provides a treatment plan I would implement for this patient, the medications to prescribe and monitoring of the plan’s effectiveness.
Based on Daute’s symptoms, increasing shortness of breath, especially with physical activity, shows moderate to severe Chronic Obstructive Pulmonary Disease (COPD). In addition, his significant smoking and chronic bronchitis history further support the COPD diagnosis. Chuchalin et al. (2022) note that a history of chronic bronchitis and smoking are associated with COPD. The treatment guidelines for COPD recommend integrating medication prescriptions with pulmonary rehabilitation and smoking cessation counseling (Nici et al., 2020).
Furthermore, the patient noted that he is not sure of the diagnosis and stopped using the medications prescribed one year ago, showing that the patient needs education on self-management and the condition. Sandelowsky et al. (2021) note that patient education for COPD patients is associated with better patient outcomes. The medication I would prescribe for this patient is fluticasone. Nici et al. (2020) note that fluticasone is effective for the maintenance treatment of COPD.
Medication Order
Patient Name: Daute
Age: 56 years
Gender: Male
Medication: Fluticasone
Dosage: 88mcg
Route of administration: oral inhalation
Frequency: BID
To monitor the effectiveness of the treatment plan, I would schedule regular follow-up appointments to monitor the patient’s symptoms, lung function, and response to treatment. In addition, response to treatment over time will determine changes in the treatment plan and medications.
References
Abedi, M., Borhani, M., Rahimzadeh, H., Mehri, A., & Hoseini, Z. S. (2020). The role of education in promoting self-care behaviors in patients with hypertension: an application of the PRECEDE model. Journal of Education and Community Health, 7(4), 303-310. https://doi.org/10.29252/jech.7.4.303
Chobufo, M. D., Gayam, V., Soluny, J., Rahman, E. U., Enoru, S., Foryoung, J. B., Agbor, V. N., Dufresne, A., & Nfor, T. (2020). Prevalence and control rates of hypertension in the USA: 2017-2018. International Journal of Cardiology. Hypertension, 6, 100044. https://doi.org/10.1016/j.ijchy.2020.100044
Chuchalin, A. G., Avdeev, S. N., Aisanov, Z. R., Belevskiy, A. S., Leshchenko, I. V., Ovcharenko, S. I., & Shmelev, E. I. (2022). Federal guidelines on diagnosis and treatment of chronic obstructive pulmonary disease. Pulmonology, 32(3), 356-392. https://doi.org/10.18093/0869-0189-2022-32-3-356-392
de Pádua Borges, R., Degobi, N. A. H., & Bertoluci, M. C. (2021). Choosing statins: a review to guide clinical practice. Archives of Endocrinology and Metabolism, 64(6), 639–653. https://doi.org/10.20945/2359-3997000000306
Herman, L.L., Weber, P. & Bashir, K. (2023). Hydrochlorothiazide. In: StatPearls [Internet]. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK430766/
Iyen, B., Akyea, R. K., Weng, S., Kai, J., & Qureshi, N. (2021). Statin treatment and LDL-cholesterol treatment goal attainment among individuals with familial hypercholesterolemia in primary care. Open Heart, 8(2), e001817. https://doi.org/10.1136/openhrt-2021-001817
Lee, Y. & Siddiqui, W.J. (2023). Cholesterol Levels. In: StatPearls [Internet]. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK542294/
Lommatzsch, M., Buhl, R., & Korn, S. (2020). The Treatment of Mild and Moderate Asthma in Adults. German Medical Journal International, 117(25), 434–444. https://doi.org/10.3238/arztebl.2020.0434
Nici, L., Mammen, M. J., Charbek, E., Alexander, P. E., Au, D. H., Boyd, C. M., Criner, G. J., Donaldson, G. C., Dreher, M., Fan, V. S., Gershon, A. S., Han, M. K., Krishnan, J. A., Martinez, F. J., Meek, P. M., Morgan, M., Polkey, M. I., Puhan, M. A., Sadatsafavi, M., Sin, D. D., & Aaron, S. D. (2020). Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine, 201(9), e56–e69. https://doi.org/10.1164/rccm.202003-0625ST
Reddel, H. K., Bateman, E. D., Schatz, M., Krishnan, J. A., & Cloutier, M. M. (2022). A Practical Guide to Implementing SMART in Asthma Management. The Journal of Allergy and Clinical Immunology. In Practice, 10(1S), S31–S38. https://doi.org/10.1016/j.jaip.2021.10.011
Sandelowsky, H., Weinreich, U. M., Aarli, B. B., Sundh, J., Høines, K., Stratelis, G., Løkke, A., Janson, C., Jensen, C., & Larsson, K. (2021). COPD – do the right thing. BMC Family Practice, 22(1), 244. https://doi.org/10.1186/s12875-021-01583-w
The National Heart, Lung, and Blood Institute (NHLBI). (n.d.). Asthma Treatment and Action Plan. Accessed March 21, 2024 https://www.nhlbi.nih.gov/health/asthma/treatment-action-plan
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Directions: For each of the scenarios below, answer the questions below using clinical practice guideline where applicable. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. Use at least 3 sources for each scenario and cite sources using APA format.
- 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?
- 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.
- Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age,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?
- 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?
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. |
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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. |
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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 | ||||
| This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
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 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 | ||||
| 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 | ||||
| This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
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 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 | ||||
| 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 | ||||
| This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
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 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 | ||||
| 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 | ||||
| This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
3 pts | ||||
| Total Points: 100 | ||||||