NURS-6521 Advanced Pharmacology W4: Gastrointestinal and Hepatobiliary Systems

Introduction to NURS-6521 week 4 scenarios

Welcome to NURS-6521 Advanced Pharmacology W4: Gastrointestinal and Hepatobiliary Systems. The W4 Scenarios assignment  focuses on applying your knowledge of pharmacokinetics and pharmacodynamics to specific patient cases related to gastrointestinal and hepatobiliary systems. Through case studies, you will evaluate and justify drug treatment plans based on patient history and diagnosis. This NURS-6521 guide provides step-by-step instructions to help you successfully complete each scenario.

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?

 Sara’s Blood Pressure Management

• The goal for Sara’s blood pressure is to lower it to less than 140/90 mmHg.
• Use clinical practice guidelines to determine the target blood pressure.
• Choose an antihypertensive medication, such as an ACE inhibitor or a calcium channel blocker.
• Consider Sara’s other medications and potential interactions.
• Patient Education: Educate Sara on lifestyle changes, including diet, exercise, and reducing sodium intake.
• Discuss the importance of medication adherence and monitoring blood pressure regularly.

Example

Sara, a 45-year-old female, presents with a blood pressure (BP) of 160/90 mmHg, an increase from 156/92 mmHg recorded three months ago. Her current medications include ibuprofen 600 mg tid for back pain. The goal for Sara’s blood pressure is to reduce it to below 140/90 mmHg, as per clinical guidelines. Given her current readings and history, initiating an antihypertensive medication is warranted (Mahmood et al., 2021).

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.

Monty’s Lipid Profile Management 

• Initiate statin therapy to lower LDL cholesterol.
• Consider prescribing atorvastatin or simvastatin.
• Set Cholesterol Goals: Aim for TC < 200 mg/dL, LDL-C < 100 mg/dL, and HDL-C > 60 mg/dL.
• Use guidelines to set realistic and achievable targets.
• Monitor Effectiveness: Schedule follow-up lipid panels every 3 months.
• Adjust medication dosage based on lipid panel results.
• Identify Risk Factors: Monty has four risk factors: smoking, hypertension, elevated LDL, and low HDL.
• Educate Monty on smoking cessation and lifestyle modifications.

Example

Monty, a 52-year-old male, presents with a fasting lipid profile indicating hyperlipidemia: total cholesterol (TC) of 266 mg/dL, LDL cholesterol of 180 mg/dL, HDL cholesterol of 40 mg/dL, and triglycerides of 185 mg/dL. He has a history of smoking (1 pack per day) and is currently on Lisinopril 20 mg daily for hypertension. Given his elevated lipid levels, the treatment plan should include initiating statin therapy, such as atorvastatin 20 mg once daily, to lower LDL cholesterol and reduce overall cardiovascular risk (Tong et al., 2021). 

Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7. 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?

 Beatrice’s Asthma Management  

• Step up therapy by increasing the dosage of inhaled corticosteroids and adding a long-acting beta-agonist (LABA) if needed.
• Consider combination therapy with fluticasone/salmeterol.
• Adjust Medications: Discontinue propranolol as it may exacerbate asthma symptoms.
• Replace with a beta-1 selective blocker if necessary.
• Monitor Effectiveness: Schedule follow-up visits every 4-6 weeks to assess symptom control and medication adherence.
• Use spirometry to measure lung function.

Exam

Beatrice, a 17-year-old female with mild persistent asthma, reports increased use of her albuterol metered-dose inhaler (MDI) and frequent nighttime awakenings due to coughing. Her current medications include Flovent HFA 44 mcg two puffs BID, Proventil HFA two puffs Q 4-6 H PRN, Yaz one PO daily, and Propranolol 80 mg PO BID. Given her increased asthma symptoms, the treatment plan should be stepped up (Cazzola et al., 2021). 

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?

  Daute’s Shortness of Breath Management  

• Restart Advair Diskus and consider adding a long-acting muscarinic antagonist (LAMA) such as tiotropium.
• Emphasize the importance of medication adherence.
• Advair Diskus one inhalation BID, Tiotropium one inhalation daily.
• Ensure the patient understands how to use inhalers properly.
• Schedule regular follow-up appointments to assess symptom control and adjust treatment as necessary.
• Use COPD assessment tools and spirometry for monitoring.

Example

Daute, a 56-year-old man with a history of chronic bronchitis and a significant smoking history, presents with increasing shortness of breath (SOB) over the past three years. He has been non-compliant with his previously prescribed salmeterol/fluticasone (Advair Diskus). To manage his symptoms effectively, the treatment plan should include restarting Advair Diskus, one inhalation twice daily, to provide both long-acting beta-agonist and corticosteroid benefits(Singh et al., 2020).

 Closing 

In the W4 assignment for NURS-6521 Advanced Pharmacology W4: Gastrointestinal and Hepatobiliary Systems, you will enhance your understanding of pharmacokinetics and pharmacodynamics by evaluating drug treatment plans for various patient scenarios. By following these Owlisdom guidelines, you can effectively address each patient’s needs, prescribe appropriate medications, and ensure thorough monitoring of treatment plans. This practice will help solidify your clinical decision-making skills and improve patient outcomes in gastrointestinal and hepatobiliary disorders. In the next module of NURS-6521, we will discuss Advanced Pharmacology Week 5: Endocrine System Disorders.

References

Cazzola, M., Matera, M. G., Rogliani, P., Calzetta, L., & Ora, J. (2021). Step-up and step-down approaches in the treatment of asthma. Expert Review of Respiratory Medicine, 15(9), 1159–1168. https://doi.org/10.1080/17476348.2021.1935245 

Mahmood, S., Jalal, Z., Hadi, M. A., Khan, T. M., Haque, M. S., & Shah, K. U. (2021). Prevalence of non-adherence to antihypertensive medication in Asia: A systematic review and meta-analysis. International Journal of Clinical Pharmacy, 43(3), 486–501. https://doi.org/10.1007/s11096-021-01236-z