NURS 6521: Advanced Pharmacology Paper

Two peer responses for week 10 pharma

Review your peers case studies from Week 9.

Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

By Day 6 of Week 10

Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples. 

Nordian Beckford 

Case Study Week 9 Discussion

HH is a 68-year-old male admitted to the medical ward with community-acquired pneumonia for the past three days. His past medical history PMH is significant for chronic obstructive pulmonary disease (COPD), hyperlipidemia diabetes. He remains on an empiric antibiotic, including Ceftriaxone 1 gram IV  (3 days) and azithromycin 500 mg IV daily (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time, with complaints of nausea and vomiting.

Height 5ft “8” inches, weight: 89 Kg

Allergies: Penicillin (Rash)

Introduction

Subsequently, community-acquired pneumonia is the most common infectious disease and is a significant cause of mortality and morbidity globally. In this case scenario, the patient has a past medical history of Chronic Obstructive Pulmonary Disease, which predisposed the patient to community-acquired pneumonia. Pneumonia is the most common infectious disease condition and significantly affects individuals with chronic respiratory disorders. According to Restrepo, Sibila and, Anzueto,2018 reveal COPD patients are more susceptible to develop pneumonia base on their clinical characteristics, such a having chronic bronchitis with present mucus production presence of potentially pathogenic bacteria in the airway. Given the prevalence of chronic disease, nurse practitioners must be prepared to manage patient acute care needs in conjunction with chronic conditions. Hence, the purpose of this discussion is to explain the treatment regimen recommendation for treating the patient, which includes the pharmacotherapeutic of choice. Also, it will explain the patient education strategy for assisting with management.

Identified bacteria associated with Community-Acquired Pneumonia (CPA) include Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis, and others. In treating the patient’s pneumonia, it is essential to utilize an antibiotic to eradicate the specific bacteria. Firstly, determining the type of organism associated with the diagnosis will provide a concise vision of the appropriate pharmacotherapy needed for the treatment regimen. In selecting the antibiotic, the practitioner wants to ensure that the medication choice is a narrow or broad-spectrum based on the microorganism identified with a holistic approach. According to Rosenthal and Burchum,2021 a prime rule of antimicrobial therapy is to match the drug with the bug; the drug should be active against known or suspected pathogens, but its spectrum should be no broader than required. The patient noted with an allergy to penicillin, and Ceftriaxone is a third-generation cephalosporin that is contraindicated in patients with PCN allergy (Davis,2021). Hence patient appears to tolerate the medication without reaction. Azithromycin is a macrolide and is recommended for respiratory infection initial dose of 500 mg the 250 mg for the remaining four days (Davis,2021).

Adding an antiemetic such as Zofran (Ondansetron) will alleviate nausea and vomiting; also, it is feasible to add corticosteroids for inflammation in the lungs concurrently monitor patient blood sugar closely. Consequently, nausea and vomiting will lead to dehydration; therefore, IV fluids should be added if no contraindications.

In treating the patient in an inpatient environment, acute illness can require an assertive eye for the care of their longstanding health condition. Ensuring that we properly treat acute illness while doing our best not to exacerbate chronic illness is fundamental in providing competent care. The practitioner must consider the patient holistically and not just the presented issues.

Reference

Restrepo,M.,Sibila,O.,&Anzueto,A.,(2018). Pneumonia in patients with Chronic Obstructive Pulmonary Disease. Vol. 81(3). P 197.DOI 10.4046/trd.2018.0030. https://www.ncbi.nlm.nih.gov/PMC/articles/PMC6030662

Rosenthal. L.D.Burchum, J.R.(2021). Lehn’s pharmacotherapeutics for advanced practice nurses and physician Assistants (2nd ed.) Elsevier.

Up-to-Date Drug Information. Davis’s Drug Guide Online +App/ DrugGuide.com(2021).

https://www,drugguide.com/ddo?svar=c%7Crc

Dayanys Mirabet 

This patient is A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.

After comprehensive evaluation of the case study, it is evident that patient is experiencing an earlier phase of menopausal transition. Because of her age of 46, the woman could be experiencing premenopausal. Night sweats, hot flushing, and high blood pressure are the most common symptoms. Menopause usually begins about the age of 51 or 52. However, 95% of all women normally start their menopause between the ages of 45 and 55 years. This is one of her needs which should be considered by the healthcare provider. The patient has a family history of breast cancer and abnormal Pap smear about 5 years ago. The patient may be worried that the current symptoms may associate with cancer. The patient also needs treatment due to her elevated high blood pressure.

A hormone replacement medicine will not be prescribed because the patient’s menstrual cycle is still normal. However, if the symptoms get more severe. I would start her on Selective Serotonin Reuptake Inhibitor (SSRI) or Serotonin and norepinephrine reuptake inhibitors (SNRI). To treat the hot flashes, Escitalopram which is an SSRI will be administered (Rosenthal & Burchum, 2018). The patient should, however, be monitored since the drug has a risk of sexual dysfunction. I would also recommend Venlafaxine SNRI. However, I would first administer escitalopram since the patient is currently under Hypertension treatment thus may suffer dose dependent diastolic hypertension (Rosenthal & Burchum, 2018). The North American Menopause Society developed a guideline that should be utilized by women who are 45 years and above. Nonetheless since the patient is not experiencing severe hot flashes, it advisable not to prescribe anything but just monitor the patient’s symptoms and progress (Manson et al., 2015).

I will alter the existing drug regimen due to the patient’s history of hypertension and current medications. I’m going to continue her hydrochlorothiazide. I will, however, stop giving Norvasc and start the patient on metoprolol. As a beta blocker, metoprolol lowers heart rate, contraction force, and conduction velocity through the AV node. The education strategy that I would recommend include lifestyle modifications such as yoga, exercise and lowered intake of caffeine. This modification will reduce hot flushes and night sweating. The pre-menopausal symptoms may also be reduced by using Acupressure, herbal medicine and homeopathy (Birkhaeuser, & Genazzani, 2018). NURS 6521: Advanced Pharmacology Paper

References

Birkhaeuser, M., & Genazzani, A. R. (Eds.). (2018). Pre-Menopause, Menopause and Beyond: Volume 5: Frontiers in Gynecological Endocrinology. Springer.

Manson, J. E., Ames, J. M., Shapiro, M., Gass, M. L., Shifren, J. L., Stuenkel, C. A., & Schnatz, P. F. (2015). Algorithm and mobile app for menopausal symptom management and hormonal/non-hormonal therapy decision making: a clinical decision-support tool from The North American Menopause Society. Menopause, 22(3), 247-253.

Rosenthal, L., & Burchum, J. (2018). Lehnes Pharmacotherapeutics for Nurse Practitioners and Physicians Assistants. Elsevier Health Sciences.