Amercian Sentinel N521 2021 May Discussions Latest (Full)

N521 Advanced Pharmacology

Module 1 Discussion

Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:

Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a collaborative agreement, and explain why/why not.

Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.

Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.

Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 2 Discussion

A.C. is a 60-year-old Caucasian woman with newly diagnosed peptic ulcer disease, generalized anxiety disorder, and iron deficiency anemia. She also has a long history of asthma and depression. She is a strong believer of herbal medicine. She takes St. John’s wort for her depression, iron pills for her anemia, and alprazolam (Xanax) as needed for her anxiety. During her asthma exacerbation, she is instructed to take prednisone for at least 5 days. She also takes esomeprazole (Nexium) for her peptic ulcer disease. Three months later, she experienced severe fatigue, shortness of breath, dizziness, and swelling/soreness in the tongue. Her asthma is well controlled with the occasional use of albuterol (Proventil) inhaler. During her physical exam, her physician suspected that she had bacterial vaginosis and gave her a prescription for a 1-week course of metronidazole (Flagyl). She drinks at least two to three cans of beer per day.

Review the above case and post a discussion that evaluates the potential for interactions that may increase drug availability.  What is the cause of increased drug availability?  Evaluate for interactions that will decrease drug availability.  What is the cause of decreased drug availability?  What recommendations may be made concerning the co-administration of these medications?

Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 3 Discussion

M. L. is a 15-year-old Hispanic female who plays soccer for her school team. She has noticed that when running, she sometimes has trouble catching her breath. She also reports an increased runny nose and itchy eyes. She has a frequent dry cough and is awakened with coughing spells at least four times a week. Her mother and father have seasonal allergies and her mother has asthma. This morning she woke up and heard “funny sounds” when she took a breath. Her coughing increased when she took a deep breath. In her nose, the mucosa is pale and swollen bilaterally. Her lungs have bilateral expiratory wheezing; respirations are 22 and PEF is 400. Her heart shows a normal sinus rhythm, with no murmurs or gallops; pulse is 72; and there is no cyanosis.        

Diagnosis: Mild Persistent Asthma

In this discussion forum: 

Discuss specific goals of pharmacotherapy for treating M. L.’s mild persistent asthma.

Discuss the drug therapy a CNP would likely prescribe and why.

Discuss the parameters for monitoring the success of the therapy.

Discuss age appropriate health promotion recommendations you would consider for M. L.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 4 Discussion

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.

 

 

N521 Advanced Pharmacology

Module 5 Discussion

This week if your last name begins with A-L complete case 1 and reply to two peers in case 2.  If your last name begins with M-Z complete case 2 and reply to two peers in case 1.

Case 1:

C. J. is a 55-year-old Hmong postmenopausal woman presenting with Type II diabetes mellitus, hypertension and urinary incontinence. She reports that she often cannot get to the bathroom in time when she feels the urge to urinate. She also wets herself when she laughs or sneezes. She is very embarrassed about this problem and has decreased her excursions from the house because of it. She drinks six cups of coffee a day. She does not follow a special diet, She takes hydrochlorothiazide for hypertension, and metformin for DM. Today her HgbA1C is 12.  She wants treatment for her urinary complaints.

Diagnosis: Uncontrolled Type II DM, HTN, and urinary incontinence

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating C. J..

Discuss the drug therapy a CNP would likely prescribe and why.    

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for C. J.

Case 2:

Mr. Z is a 36-year-old construction worker who presents to the nurse with fatigue and a foot ulcer. He is a smoker with type 1 diabetes for 25 years, and he take 20 units of

70/30 insulin twice a day. He lost his meter a year ago. He is very thin, although he eats constantly on the job because he is worried about hypoglycemia; he cannot remember the last time he had hypoglycemia, but it was years ago.  He recently received a call from the office because his TSH level was greater than 10 and he was told he has “thyroid” problems.  He thinks this may be the cause of his fatigue.

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating Mr Z

Discuss the drug therapy a CNP would likely prescribe and why.    

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for Mr Z.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

 

 

N521 Advanced Pharmacology

Module 6 Discussion

J. P. is a 36-year-old Caucasian gay male who was diagnosed with HIV infection 2 years ago. He and his male partner, T. R., were married shortly after his diagnosis. T. R. is not HIV positive. He has been feeling well for the past 2 years, and he maintains a healthy, active lifestyle by exercising three to four times a week and eating a balanced diet. His medications include a multiple vitamin and occasional omeprazole for heartburn. He has never received antiretroviral therapy. He comes to your office for a routine physical exam and blood work. The physical examination is unremarkable, and the laboratory results are as follows: Electrolytes, serum creatinine, liver function tests: within normal limits; Complete blood count with differential: within normal limits, CD4+ T-cell count: 210 cells/mm3; Viral load: 10,000 copies/mL, Genotype: No resistance mutations detected                            

Diagnosis: Asymptomatic HIV Infection

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. P.’s asymptomatic HIV infection.

Discuss when prophylaxis for infection is indicated ie daily bactrim

Discuss the drug therapy a CNP would likely prescribe and why.

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for J. P.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 7 Discussion

J. T., who is a Native American male, age 8, is always interrupting his teacher, jumping out of his seat in class, fidgeting relentlessly, and butting into other children’s games. At home, he runs around recklessly and is uncontrollable. His mother comes to the CNP in the Pediatric Clinic and wonders why he will not listen. She is concerned because his grades at school are dropping. After medical evaluation, you find nothing wrong with J. T. physically, and he is taking no other medications. Through questioning, you determine that he has trouble concentrating on his homework, often forgets he has homework, loses pieces of games frequently, and hates to sit and read. His mother is unsure of the time frame over which these behaviors developed, but she thinks it has been since her second child was born 5 years ago. While in your office, J. T. did not seem to be hyperactive or inattentive, but you notice he is easily distracted by people passing in the hallway because the door is slightly ajar.  

Diagnosis: Attention-Deficit Hyperactive Disorder (ADHD)

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. T.’s ADHD.

Discuss the first-line drug therapy for J. T., and why.

Discuss monitoring parameters you would institute for J. T.’s parents and his teachers.

Discuss specific patient education you would provide to J. T.’s parents based on the prescribed therapy.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 8 Discussion

J. L., a 27-year-old African-American female account executive, presents to the Family Medicine office for her annual checkup with her CNP. She has no significant past medical history. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. She is interested in a reliable form of contraception. After discussing the various contraceptive options, she decides that an oral contraceptive (OC) would best fit her needs.

In this discussion forum:                                

Discuss what tests or examinations the CNP would likely perform before prescribing an OC regimen, and why.

Discuss two different OC regimens that could be chosen for J. L. Discuss their differences and why you chose them.

Discuss the potential side effects of each OC regimen that need to be relayed to J. L. Discuss especially those effects for which she should seek immediate medical care.

Discuss health promotion recommendations you would consider for J. L.

What ethical issues should be considered?

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.