DUE AUG 11

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https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_02/index.html

 

 

Write a 1-page narrative in APA format that addresses the following:

  • Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
  • Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

DUE 7/28

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Respond to your peer

 

Community-acquired pneumonia (CAP) is an infectious disease that although common could become deadly when combined with the patients’ comorbidities: COPD, Hypertension and Diabetes. Treatment includes antimicrobial medications and sufficient oxygenation. It can be caused by bacteria, viruses, or fungi and can be prevented through vaccination with pneumococcal, influenza, and COVID-19 vaccines (Rothberg, M.B., 2022). The CAP causing pathogen will be the deciding factor for the pharmacological approach, but allergies to empiric drug therapies such as penicillin further complicate treatment options. Treatment should include: rapid diagnosis, microbiological investigation, prevention and management of complications (eg, respiratory failure, sepsis, and multiorgan failure), empirical antibiotic therapy (Aliberti, S., et al. 2021).

 Commonly used pharmacological treatment of CAP include:

Macrolides: Such as azithromycin, clarithromycin, and erythromycin. These medications are considered first-line therapy for mild to moderate CAP (Metlay, J. P., 2019). Macrolides is a broad-spectrum antibiotic and can treat both Gram-positive and some Gram-negative organisms. The mechanism of action of macrolides is the disruption of the bacterial protein synthesis, specifically targeting the ribosomes.

 Fluoroquinolones: Include levofloxacin and moxifloxacin and are reserved to treat severe cases of CAP or patients with co-morbidities not allowing for the use of Macrolides. The mechanism of action of this class of medication includes targeting the bacteria’s DNA process itself through the interference of DNA gyrase and topoisomerase IV which is responsible for DNA repair and replication.

 Penicillin and their derivatives: Penicillin and their derivatives are prescribed for CAP caused by the Streptococcus pneumoniae.  The mechanism of action of this drug includes inhibiting the bacterial wall synthesis which leads to cell death.

 Third generation cephalosporins like ceftriaxone as well as Doxycycline are antibiotic options for patients who cannot take macrolides or fluoroquinolones. The mechanism of action of this treatment is like Penicillin in which they target the cell wall but also go a step further and cause osmotic lysis.

The patient in this case study was treated with empiric antibiotics which included ceftriaxone and azithromycin due to the causative agent of the community acquired pneumonia currently being unknown. The patient will require blood and sputum cultures to be able to prescribe a more specific pharmacological treatment. The antibiotic regimen will need to continue for 7-10 days taking care not to exceed the recommended time to avoid the development of antibiotic resistance.

Due to the patient’s current issues with diet an infusion of D5 ½ NS would be necessary for the replenishment of electrolytes. Accu-checks would also be required to establish blood sugar levels. The patient’s COPD condition should be managed through the administration of a short acting beta agonist (Albuterol) for exacerbation as well as their long-acting bronchodilators for sustained bronchodilation.

Patient education should include the emphasize of the importance of completing the full course of antibiotics even if symptoms subside. If being discharged the patient’s need for in home oxygen should be assessed and monitoring of oxygen levels should be reiterated. The use of the spirometer should be demonstrated as a tool for lung expansion. 

 

References:

Aliberti, S., Dela Cruz, C. S., Amati, F., Sotgiu, G., & Restrepo, M. I. (2021). Community-acquired pneumonia. Lancet (London, England), 398(10303), 906–919. https://doi.org/10.1016/S0140-6736(21)00630-9

Liapikou, A., Cilloniz, C., Palomeque, A., & Torres, T. (2019). Emerging antibiotics for community-acquired pneumonia. Expert opinion on emerging drugs, 24(4), 221–231. https://doi.org/10.1080/14728214.2019.1685494

Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. American journal of respiratory and critical care medicine, 200(7), e45–e67. https://doi.org/10.1164/rccm.201908-1581ST

Rothberg M. B. (2022). Community-Acquired Pneumonia. Annals of internal medicine, 175(4), ITC49–ITC64. https://doi.org/10.7326/AITC202204190

Williams, D. J., Creech, C. B., Walter, E. B., Martin, J. M., Gerber, J. S., Newland, J. G., Howard, L., Hofto, M. E., Staat, M. A., Oler, R. E., Tuyishimire, B., Conrad, T. M., Lee, M. S., Ghazaryan, V., Pettigrew, M. M., Fowler, V. G., Jr, Chambers, H. F., Zaoutis, T. E., Evans, S., Huskins, W. C., … The DMID 14-0079 Study Team (2022). Short- vs Standard-Course Outpatient Antibiotic Therapy for Community-Acquired Pneumonia in Children: The SCOUT-CAP Randomized Clinical Trial. JAMA pediatrics, 176(3), 253–261. https://doi.org/10.1001/jamapediatrics.2021.5547

Case Study DUE 7/26

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Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

 

Case Study

HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes.

He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (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.

Ht: 5’8”  Wt: 89 kg (196 pounds)

Allergies: Penicillin (delayed, rash)

 

Facilitator/Faculty Tips to do well: 

 

NEED SUBSTANTIVE DISCUSSION.

Discuss very briefly any pharmacological intervention patient is presently on for COPD, HTN, hyperlipidemia & diabetes. Just one or two lines each on what would be drugs used, pharmacological relevance on treating these diseases.

Thoroughly discuss the anti-infective drugs used for treating the infection Community Acquired Pneumonia (pharmacology to include mechanism of action, therapeutic effects, adverse effects, kinetics etc.).

Is the current empiric therapy based on any guidelines?

If allergic to penicillin, why was ceftriaxone given, which is another beta-lactam antibiotic (a cephalosporin which is also a beta lactam antibiotic)?

If penicillin allergy was immediate type, what are the alternate options for treating CAP? (tips: Doxycycline? Levofloxacin?)

 

Need a thorough discussion on a case like this on ADVANCED PHARMACOLOGY, AT CLINICIAN LEVEL.

USE PEER REVIEWED SCHOLARLY, US BASED, CURRENT, PRIMARY SOURCE, CLINICIAN BASED (NOT PATIENT BASED) REFERENCES.

/Alzheimer’s Disease DUE SUNDAY AM 7/23

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http://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html 

 

To Prepare:

  • Review the interactive media piece assigned by your Instructor.
  • Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
  • Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
  • You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

Write a 1- to 2-page summary paper that addresses the following:

  • Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
  • Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
  • What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
  • Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

Pharm due 7/19

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Respond to your peer’s post

 

 

 

Anxiety is an unpleasant feeling that includes both psychological and physical aspects (Rosenthal & Burchum, 2020). This discussion aims to use pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In this discussion, I will highlight, compare, and contrast different treatment options that can be used to treat these patients.

Generalized anxiety disorder (GAD) can be treated with nonpharmacological and pharmacological therapy (Gottschalk & Domschke, 2017). The first-line pharmacotherapies for GAD have often included the medication classes known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Strawn et al., 2018). Four antidepressants are now licensed for GAD: venlafaxine (Effexor XR), duloxetine (Cymbalta), paroxetine (Paxil), and escitalopram (Lexapro, Cipralex) (Rosenthal & Burchum, 2020). Paroxetine and escitalopram are SSRIs, while venlafaxine and duloxetine are SNRIs (Rosenthal & Burchum, 2020). Initial drug reactions can be observed after a week, but optimal responses take several more weeks to develop. This is because anxiolytic effects take time (Rosenthal & Burchum, 2020). Antidepressants are more effective at reducing cognitive and psychic symptoms of anxiety than benzodiazepines are in reducing physical symptoms. Antidepressants also have a lower risk of addiction. However, a sudden stop may result in withdrawal symptoms.

Before SSRIs and SNRIs were developed, benzodiazepines were the primary form of GAD treatment (Strawn et al., 2018). The duration of action, abuse potential, lipophilicity, and metabolism of these drugs differ (Strawn et al., 2018). Although, unlike antidepressant drugs, the therapeutic effects linked to benzodiazepines occur soon after administration. Alprazolam is the only benzodiazepine the FDA has officially approved for treating GAD (Strawn et al., 2018). However, GAD is frequently treated with clonazepam, lorazepam, and diazepam. Although long-acting benzodiazepines like clonazepam and diazepam may be effective in treating GAD, many clinicians restrict their usage out of concern for the potential for abuse and dependence (Strawn et al., 2018). Benzodiazepine therapy for adults is recommended to be short-term (3-6 months), according to current prescribing guidelines (Strawn et al., 2018). It is noteworthy that many medical professionals have expressed the belief that benzodiazepines can be a viable alternative for some patients, such as those with a low risk of substance abuse, when other treatments are contraindicated or are ineffective, provided they are administered with consistent, close monitoring (Strawn et al., 2018). Although SSRIs and SNRIs are the most popular medications for treating GAD, a recent meta-analysis encompassing 12,655 patients found that the Hedges’ g for SSRIs and SNRIs was 0.33 and 0.36, respectively (Strawn et al., 2018). In contrast, the Hedges g for benzodiazepines was 0.5(Strawn et al., 2018). According to these results, benzodiazepines are more successful at treating adults with GAD than SSRIs or SNRIs (Strawn et al., 2018).

While GAD can make patients feel uncomfortable both psychologically and physically, practitioners knowing GAD and the proper medications to treat this disorder is essential. Drugs of SSRIs, SNRIs, and benzodiazepines (or combination), along with therapy, can help these patients overcome this uncomfortable state.

References

Gottschalk, M. B., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in Clinical Neuroscience, 19(2), 159–168. https://doi.org/10.31887/dcns.2017.19.2/kdomschkeLinks to an external site.

Rosenthal, L., & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed). St. Louis, MO: Elsevier.

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070.

 

 

 

adv pharm

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Post a discussion of pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In your discussion, utilizing the discussion highlights, compare and contrast different treatment options that can be used.

Week 6 Due 5/8

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You have an assignment which is to analyze the SOAP note given to you. Submit your assignment in a Word document. This should be written in a narrative format and not a SOAP note. Focus on answering the questions given to you in the assignment instructions area. Review the grading rubric prior to submission.

 

ABDOMINAL ASSESSMENT

Subjective:

CC: “My stomach has been hurting for the past two days.”

HPI: LZ, 65 y/o AA male, presents to the emergency department with a two days history of intermittent epigastric abdominal pain that radiates into his back. He went to the local Urgent Care where was given PPI’s with no relief. At this time, the patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led his to go to the ED at this time. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain. 

PMH: HTN

Medications: Metoprolol 50mg

Allergies: NKDA

FH: HTN, Gerd,  Hyperlipidemia

Social Hx: ETOH, smoking for 20 years but quit both 2 years ago, divorced for 5 years, 3 children, 2 males, 1 female 

Objective:

·        VS: Temp 98.2; BP 91/60; RR 16; P 76; HT 6’10”; WT 262lbs

·        Heart: RRR, no murmurs

·        Lungs: CTA, chest wall symmetrical

·        Skin: Intact without lesions, no urticaria

·        Abd: abdomen is tender in the epigastric area with guarding but without mass or rebound.Diagnostics: US and CTA 

Assessment:

1.     Abdominal Aortic Aneurysm (AAA)

2.     Perforated Ulcer

3.     Pancreatitis

 

 

  1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.
  2. Analyze the objective portion of the note. List additional information that should be included in the documentation.
  3. Is the assessment supported by the subjective and objective information? Why or why not?
  4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
  5. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.