American Sentinel N521 Advanced Pharmacology Assignment 2

American Sentinel N521 Advanced Pharmacology Assignment 2
Assignment 2

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk. He also reports a cough, fatigue, and weight loss. American Sentinel N521 Advanced Pharmacology Assignment 2. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%.

In a paper not to exceed six pages, excluding title and reference pages, please answer the following:

What is R. W.’s likely diagnosis?
What stage of disease does RW have?
List specific pharmacotherapeutic treatment goals for R. W.
What drug therapy would the CNP likely prescribe? Why?
What are the parameters for monitoring the success of the therapy?
Describe specific patient education based on the prescribed therapy.
List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.
What would be the choice for second-line therapy?
What health promotion activities should be recommended for this patient?
If RW was currently taking metoprolol for “headaches” would a change be recommended?

Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.
Rubric American Sentinel N521 Advanced Pharmacology Assignment 2

Competency

40

36

33

0

Points Earned
Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources. Accurate discussion of nine case study questions presented with use of current evidence-based resources.

Accurate discussion of 8 questions using current evidence-based resources

Missing response to questions or inappropriate answers to questions. No use of evidence-based resources.

/40

40

36

33

0

Evidence of

critical thinking
therapeutic decision-making in drug selection and evaluation of patient care
pathophysiology and current pharmacological research
assessment of the effectiveness of drug therapy
formulation of clinical care and teaching plans for persons from diverse populations

Well-defined evidence of

critical thinking
therapeutic decision-making in drug selection and evaluation of patient care
pathophysiology and current pharmacological research
assessment of the effectiveness of drug therapy
formulation of clinical care and teaching plans for persons from diverse populations. American Sentinel N521 Advanced Pharmacology Assignment 2

Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion.

Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology.

Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking.

/40

10

9

8

0

Points Earned
Grammar, spelling, and punctuation There are no errors in grammar, spelling, and punctuation There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors) There are major errors in grammar, spelling, and punctuation .(4-5 errors)

No content or more than 5 errors

/10

10

9

8

0

APA Compliance The paper meets APA formatting guidelines There are a few minor errors (1-3 errors) There are significant errors in the format of the paper (4-5 errors)

No content or more than 5 errors

/10
Total Points

/100

Competency

40

36

33

0

Points Earned

Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales

Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources.

Accurate discussion of nine case study questions presented with use of current evidence-based resources.

Accurate discussion of 8 questions using current evidence-based resources. American Sentinel N521 Advanced Pharmacology Assignment 2

Missing response to questions or inappropriate answers to questions. No use of evidence-based resources.

/40

40

36

33

0

Evidence of

critical thinking
therapeutic decision-making in drug selection and evaluation of patient care
pathophysiology and current pharmacological research
assessment of the effectiveness of drug therapy
formulation of clinical care and teaching plans for persons from diverse populations

Well-defined evidence of

critical thinking
therapeutic decision-making in drug selection and evaluation of patient care
pathophysiology and current pharmacological research
assessment of the effectiveness of drug therapy
formulation of clinical care and teaching plans for persons from diverse populations

Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion.

Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology.

Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking.

/40

10

9

8

0

Points Earned

Grammar, spelling, and punctuation

There are no errors in grammar, spelling, and punctuation

There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors)

There are major errors in grammar, spelling, and punctuation .(4-5 errors) American Sentinel N521 Advanced Pharmacology Assignment 2

No content or more than 5 errors

/10

10

9

8

0

APA Compliance

The paper meets APA formatting guidelines

There are a few minor errors (1-3 errors)

There are significant errors in the format of the paper (4-5 errors)

No content or more than 5 errors

/10

Total Points

/100
Discussion 4

R. S., a 65-year-old African-American man, was referred to the CNP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55, Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages; Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day

Diagnosis: Stage 1 Hypertension

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol
Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.
Discuss the parameters for monitoring the success of the therapy.
Discuss health promotion recommendations you would consider for R. S.
Does the presence of Diabetes Mellitus impact your treatment selection?

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. American Sentinel N521 Advanced Pharmacology Assignment 2
Add a new discussion topic
Discussion 4 Example Approach

Pharmacotherapy for treatment of R.S.’s hypertension and cholesterol would aim toward the goals of managing hypertension, and “reducing cardiovascular disease (including lipid disorders, glucose intolerance or diabetes, obesity, and smoking) and renal disease” (Arcangelo, et al., 2017, p. 259). Arcangelo et al. (2017) state that current guidelines recommend lowering BP to less than 140/90 (p. 270). The American Diabetes Association 2015 guidelines provide a “target BP of less than 140/80” (Arcangelo, et al., 2017, p. 270). To address goals for treating R.S.’s cholesterol, Arcangelo et al. (2017) state that although there are no specific cholesterol level goals, it is recommended that a repeat fasting lipid panel be done between 1 to 3 months after starting medications to assess for adherence to medication regimen (p. 279).

First-line pharmacotherapy to treat R.S.’s hypertension would be one of the following drugs which Solomon and Taler (2018) explain, would help to lessen the likelihood of cardiovascular events: “ACE inhibitors, angiotensin-receptor blockers, calcium-channel blockers, and thiazide-type diuretics” (Solomon and Taler, 2018, p. 637). Benenson (2021) states that “on average, compared with placebo, thiazides reduce systolic BP by 10 to 15 mm Hg and diastolic BP by 5 to 10 mm Hg.” (p. 128). Thiazide diuretics have been shown to produce minimal adverse reactions and help to decrease blood pressure when combined with other antihypertensive medications (Benenson, 2021).

Specific parameters for monitoring the success of therapy for R.S. would include follow up BP monitoring. For all patients with hypertension, a blood pressure target of less than 130/80 mm Hg is advised (Solomon and Taler, 2018, p 639). He would require regular follow-up visits for blood pressure checks as well as checks at every routine visit to monitor the effectiveness of the regimen (Arcangelo, et al., 2017). As stated above, evaluation of cholesterol levels 1 to 3 months after beginning treatment is recommended to assess treatment.

Health promotion strategies for R.S. would include decreasing dietary sodium intake, weight loss, regular aerobic exercise, decreased alcohol intake, and increasing dietary potassium (Solomon and Taylor, 2018). Solomon and Taler (2018) discuss the DASH diet, which focuses on fresh whole foods, low in sodium, as well as encouraging smoking cessation and decreasing caffeine intake.

As R.S. has a 10-year history of DM type II, some treatment considerations as discussed by Mwansa and Mazimba (2018) would include “antihypertensive drug classes, including thiazide diuretics, ACEIs, ARBs, and CCBs” for the treatment of HTN in patients with diabetes (p. 11-12). Arcangelo et al. (2017) state lifestyle changes are encouraged, for example decreasing dietary sodium, weight loss, and regular exercise. American Sentinel N521 Advanced Pharmacology Assignment 2

References

Arcangelo, V.P., Peterson, A.M., Wilbur, V., and Reinhold, J.A. (2017). Pharmacotherapeutics for advanced practice: A practical approach. Fourth edition. Wolters Kluwer.

Benenson, I. (2021). Chlorthalidone or hydrochlorothiazide for treatment of hypertension. The Journal for Nurse Practitioners, 17(1), 128-129. http://dx.doi.org.americansentinel.idm.oclc.org/10.1016/j.nurpra.2020.10.021

Mwansa, H., & Mazimba, S. (2018). Therapeutic strategies for hypertension. Primary Care Reports, 24(9) http://americansentinel.idm.oclc.org/login?url=https://www-proquest-com.americansentinel.idm.oclc.org/trade-journals/therapeutic-strategies-hypertension/docview/2093141126/se-2?accountid=169658

Solomon, C. & Taler, S. J. (2018). Initial treatment of hypertension. The New England Journal of Medicine, 378(7), 636-644. http://dx.doi.org.americansentinel.idm.oclc.org/10.1056/NEJMcp1613481 American Sentinel N521 Advanced Pharmacology Assignment 2
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