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NURS 6521 Final Exam Study Guide

Final Review for NURS 6521

For all classes of medications, you will need to understand the mechanism of action,

side effects, appropriate use and contraindications for the classes of drugs and

individual drugs listed below. Also, know the key patient education points including

cautions, expected effects, and appropriate use (with food, empty stomach, etc.).

Week 8: Pharmacology for Psychological Disorders

Review for the different classes: How they will affect the patient, side effects (major

side effects), when to use vs when not to use for the following:

• Antipsychotics

• Bipolar medications

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• Sedatives

• Anxiety Medications

• Stimulants like: methylphenidate, dextroamphetamine, Adderall, etc.

Week 9: Women’s and Men’s Health

Women’s heath:

• Pregnancy: How does it affect pharmacokinetics, what to stay away from, how do

different trimesters affect the medications, medications to get pregnant,

medications to prevent pregnancy, what is the purpose of oxytocin, bethanechol,

magnesium sulfate in pregnancy and how the effects of these medications during

breast feedings? NURS 6521 Final Exam Study Guide

• Oral contraceptives, benefits of using one vs another.

• Estrogen/Progesterone Therapy

• Bisphosphonates, alendronate, tests to diagnosis need for these.

• Review following meds:

o cyclophosphamide

o Meridia

o Terbutaline

o oxybutynin

o tolterodine

o radiotherapy

Men’s Health

• Testosterone therapy, different types, when to use, when not use, when to stop

• erectile dysfunction (ED), different medications, when to use one agent over

another, what not to mix with them.

Week 10: Infections and Hematologic Systems

Lots of information to review, want to focus on side effects, use, when to use, when not

to use, difference in treating ethnicities, allergies with antibiotics, which antibiotics to use

with different infections. Infections and treating a diabetic patient, what to watch for.

• Success or failure of a patient’s chemotherapy / targeted therapies /

thrombophlebitis and thromboembolism

• epoetin alfa

• Casodex

• Dronabinol for cancer side effects

• permethrin

• oprelvekin

• silver sulfadiazine

• Neupogen

• quinine

• Infectious Disease:

• Narrow-spectrum antibiotic vs a broad-spectrum drug, what’s the difference?

• Each class of antibiotics and how they are used.

• Antibiotics vs antivirals

• What characteristic of the drug makes it a conjugated drug?

• Antibiotics and antivirals for STI treatment/prevention

• Resistant strains of microbes

• MTX

• Sulconazole

• MRSA

• Permethrin

Week 11: Pediatrics

• What is the effect on children who are prescribed adult medications

• Teaching medication use to parents, kids, etc.

• Medication administration to an infant, children, and adolescents best practiceswhat not to do

• Best ways to reducing drug errors and how to prevent them

• What is the difference between adult and children dosing? NURS 6521 Final Exam Study Guide

Terminology:

• Efficacy

• Pharmacokinetics

• Pharmacodynamics

• Drug tolerance

• Addiction

• Dependence

• Withdrawal

• First pass effect

• Idiosyncratic response

• Medication Reconciliation

Other Topics:

• Which drug classes produce withdrawal if stopped abruptly? When is withdrawal

life threatening? NURS 6521 Final Exam Study Guide

• How can adverse drug events be minimized?

• Why do drugs require clinical study and FDA approval?

Final Review for NURS 6521

NURS 6521 Final Exam Study Guide

NURS 6521: Advanced Pharmacology Mid-Term Exam Summary & Study Guide

© 2019 Walden University Page 1 of 3

Mid-Term Summary & Study Guide

NURS-6521

o
100-question Exam
which will assess your knowledge on the Learning Resources from Weeks 1-6.

o Time limit of 2 hours.

o Multiple choice or multiple selection.

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Pharmacokinetics:

• Understand the implications of changing renal function on creatinine and drug dosing.

• What is the impact of the following on drug levels and dosing:

o Cirrhosis

o Protein binding

o Drug interactions

o Half-life . NURS 6521: Advanced Pharmacology Mid-Term Exam Summary & Study Guide

Routes of Administration and Dosage Forms:

• Understand the different routes of administration and dosage forms and some of the challenges

and benefits associated with these routes and forms.

• Understand when it is OK to crush (or not crush) certain dosage forms and why.

• Which routes of administration have the fastest and slowest rates of absorption?

• Know the relative onset, monitoring and appropriate use of various dosage forms including:

o Patches (ie; fentanyl, rivastigmine)

o Suppositories (ie; acetaminophen)

o Sublingual tablets

o Tablets

o Liquid (know common measures)

o Injectables

o Sublingual

o Nasogastric

o Elixir (contains alcohol)

© 2019 Walden University Page 2 of 3

Therapeutics: Gastrointestinal, Cardiac, Respiratory, Pscyh, Neurology, Musculoskeletal

Understand the mechanism of action, side effects, appropriate use and contraindications for the classes

of drugs and individual drugs listed below. Also, know the key patient education points including

cautions, expected effects, and appropriate use (with food, empty stomach, etc.).

• Anti-diarrheals (diphenoxylate HCl with atropine sulfate, loperamide, bismuth subsalicylate)

• Laxatives (fiber, osmotics, stimulants, other)
NURS 6521: Advanced Pharmacology
Mid-Term Exam Summary & Study Guide

• Therapy for various gastrointestinal disorders including antiemetics, ulcers, irritable bowel

syndrome, Crohn’s ulcerative colitis (ie; alosetron, PPIs like omeprazole, Mesalamine, ranitidine,

etc.)

• Cough, cold, and sinus therapies including antihistamines and cough suppressants (ie;

dextromethorphan, loratadine, fexofenadine, nasal decongestants)

• Cardiac Medications – Digoxin (understand toxicity, dosing, use), Statins, Colestipol,

Nitroglycerin

• Blood pressure medications (calcium channel blockers, ACE Inhibitors, diuretics, beta-blockers,

nitroprusside, others)

• Diuretics (spironolactone, furosemide, hydrochlorothiazide)

• Benzodiazepines, sedatives, anxiolytics (buspirone) and agents for insomnia (zaleplon, zolpidem)

• Inhalers (albuterol, ICS, LABA, anticholinergics)

• Asthma – Theophylline, zafikurlast, steriods

• Gout and arthritis therapies (allopurinol, etanercept, sulfinpyraxone, methotrexate)

• Antipsychotics (olanzapine, risperidone, haloperidol, others) – What is neuroleptic malignant

syndrome?

• Antineoplastics (etoposide, 5FU, cisplatin, bicalutamide, others)

• Agents for thyroid disease (Levothyroxine, methimazole)

• Antidepressants – SSRIs

• Multiple sclerosis therapies (Dantrium, Glatirimer, Baclofen, Tizanidine, others)

• Substance abuse treatment (disulfuram, buprenorphine, nicotine products, others)

• Antiepileptics (phenytoin, ethosuximide, diazepam, others)

• Osteoporosis (calcitonin, others)

• Hypoglycemics (glyburide, glipizide, metformin, insulin, etc.)

• Pain (opioids, muscle relaxants, NSAIDs, acetaminophen, topical lidocaine, etc.)

• Orlistat

• Adrenergic agonists

• Dextroamphetamines

• Lithium

Terminology:

• Efficacy

• Pharmacokinetics

• Pharmacodynamics

• Drug tolerance

© 2019 Walden University Page 3 of 3

• Addiction

• Dependence

• Withdrawal

• First pass effect

• Idiosyncratic response

• Medication Reconciliation

Other Topics:

o Which drug classes produce withdrawal if stopped abruptly? When is withdrawal life threatening?

o Understand the appropriate use of herbal therapies

o Understand components of cultural competence

o How can adverse drug events be minimized?

o Why do drugs require clinical study and FDA approval?

o Know common teaspoon, tablespoon, and milliliter conversions

o Know DEA schedules and examples of therapies in each scheduled class (1-5). What are the special

prescribing restrictions for these various classes?

o Which medications should be taken with food? Which on an empty stomach?

o What is the purpose of the MedWatch Program? NURS 6521: Advanced Pharmacology Mid-Term Exam Summary & Study Guide

o Symptoms and treatment of drug intoxication from cocaine, opioids, marijuana

o Appropriate use of reversal agents for digoxin, opioids, etc.

NURS 6521 Advanced Pharmacology Mid-Term Exam Summary & Study Guide

NURS 6521: Advanced Pharmacology Mid-Term Exam Summary & Study Guide

Therapy for Pediatric Clients with Mood Disorders – African American Child Suffering From Depression

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

 Client complained of feeling “sad”

 Mother reports that teacher said child is withdrawn from peers in class

 Mother notes decreased appetite and occasional periods of irritation

 Client reached all developmental landmarks at appropriate ages

 Physical exam unremarkable

 Laboratory studies WNL

 Child referred to psychiatry for evaluation

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MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead. Therapy for Pediatric Clients with Mood Disorders – African American Child Suffering From Depression

You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

RESOURCES

§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Decision Point One

Select what you should do:

Begin Zoloft 25 mg orally daily

Begin Paxil 10 mg orally daily

Begin Wellbutrin 75 mg orally BID

http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_02/index.html

Therapy for Pediatric Clients with Mood Disorders – African American Child Suffering From Depression

NURS 6521: Advanced Pharmacology Resource List

Resource List

This page contains all of the resources for this course.

Week 1

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advanced practice providers
. St. Louis, MO: Elsevier.

Chapter 1, “Prescriptive Authority” (pp. 1–3)

Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 5–9)

Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 11–16)

Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 17–40)

Chapter 5, “Adverse Drug Reactions and Medical Errors” (pp. 41–49)

Chapter 6, “Individual Variation in Drug Response” (pp. 51–56)

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American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults.
Journal of the American Geriatrics Society, 67
(4), 674–694. doi:10.1111/jgs.15767
American Geriatrics Society 2019 Updated AGS Beers Criteria

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center. NURS 6521: Advanced Pharmacology Resource List

 

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm NURS 6521: Advanced Pharmacology Resource List

 

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

 

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.deadiversion.usdoj.gov/pubs/manuals/pract/index.html

 

This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

 

This website details key aspects of drug registration. NURS 6521: Advanced Pharmacology Resource List

Fowler, M. D. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application. Retrieved from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/ebookviewer/ebook/bmxlYmtfXzEwMjE3NjNfX0FO0?sid=8cf8b6d3-6338-4e98-8254-2cadb5d74ad5@sessionmgr103&vid=0&format=EB&rid=1

 

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

 

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors. NURS 6521: Advanced Pharmacology Resource List

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing.
The Journal for Nurse Practitioners, 12
(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

Note:
You will access this article from the Walden Library databases.

 

This article provides NPs with information regarding state-based laws for NP prescribing.

 

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students.
Journal of the American Association of Nurse Practitioners, 29(
5), 248–254. doi:10.1002/2327-6924.12446

Note:
You will access this article from the Walden Library databases.

 

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

 

Required Media

Introduction to Advanced Pharmacology

Meet Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences as she discusses the importance of pharmacology for the advanced practice nurse. (8m)

 

Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript
Introduction to Advanced Pharmacology

Week 2

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advanced practice providers
. St. Louis, MO: Elsevier.

Chapter 34, “Review of Hemodynamics” (pp. 335–340)

Chapter 35, “Diuretics” (pp. 341–349)

Chapter 36, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 351–362)

Chapter 37, “Calcium Channel Blockers” (pp. 363–369)

Chapter 38, “Vasodilators” (pp. 371–373)

Chapter 39, “Drugs for Hypertension” (pp. 375–388)

Chapter 40, “Drugs for Heart Failure” (pp. 389–402)

Chapter 41, “Antidysrhythmic Drugs” (pp. 403–418)

Chapter 42, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 419–439)

Chapter 43, “Drugs for Angina Pectoris” (pp. 441–450)

Chapter 44, “Anticoagulant and Antiplatelet Drugs” (pp. 451–472)

 

Required Media

Cardiovascular Disorders

Meet Dr. Norbert Myslinski as he discusses ACE inhibitors, angiotensin inhibitors, beta-blockers, calcium channel blockers, and diuretics as different categories of hypertension drugs. What potential drugs might be best recommended for patients suffering from hypertension? (8m) NURS 6521: Advanced Pharmacology Resource List

 

Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript
Cardiovascular Disorders

Week 3

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advanced practice providers
. St. Louis, MO: Elsevier.

Chapter 60, “Drugs for Asthma and Chronic Obstructive Pulmonary Disease” (pp. 673–693)

Chapter 61, “Drugs for Allergic Rhinitis, Cough, and Colds” (pp. 695–702)

 

Document:

APA Presentation Template

National Heart Lung and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

 

This web resource presents guidelines for diagnosing and managing asthma and outlines treatment recommendations for specific age groups. NURS 6521: Advanced Pharmacology Resource List

 

Week 4

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advanced practice providers
. St. Louis, MO: Elsevier.

Chapter 62, “Drugs for Peptic Ulcer Disease” (pp. 703–714)

Chapter 63, “Laxatives” (pp. 715–722)

Chapter 64, “Other Gastrointestinal Drugs” (pp. 723–735)

Chapter 78, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 867–886)

 

Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., . . . Sanya, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases
. Hepatology, 67(1)
, 328–357. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.29367

 

This article details the diagnosis and management of nonalcoholic fatty liver disease. Review this article to gain an understanding of the underlying pathophysiology as well as the suggested pharmacotherapeutics that might be recommended to treat this disorder.

Week 5

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advanced practice providers
. St. Louis, MO: Elsevier.

Chapter 46, “Drugs for Diabetes Mellitus” (pp. 485–509)

Chapter 47, “Drugs for Thyroid Disorders” (pp. 511–520)

 

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018
. Diabetes Care, 41(Supplement 1)
, S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf  NURS 6521: Advanced Pharmacology Resource List

 

This article provides guidance on pharmacologic approaches to glycemic treatment as it pertains to treating patients with diabetes. Reflect on the content of this article as you continue to examine potential drug treatments for patients with diabetes.

Document:
Mid-Term Summary & Study Guide (PDF)

Week 6

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advanced practice providers
. St. Louis, MO: Elsevier.

Chapter 10, “Basic Principles of Neuropharmacology” (pp. 73–77)

Chapter 11, “Physiology of the Peripheral Nervous System” (pp. 79–90)

Chapter 12, “Muscarinic Agonists and Antagonists” (pp. 91–107)

Chapter 13, “Adrenergic Agonists” (pp. 109–119)

Chapter 14, “Adrenergic Antagonists” (pp. 121–132)

Chapter 15, “Indirect-Acting Antiadrenergic Agents” (pp. 133–137)

Chapter 16, “Introduction to Nervous System Pharmacology” (pp. 139–141)

Chapter 17, “Drugs for Parkinson Disease” (pp. 143–158)

Chapter 18, “Drugs for Alzheimer Disease” (pp. 159–166)

Chapter 19, “Drugs for Epilepsy” (pp. 167–189)

Chapter 20, “Drugs for Muscle Spasm and Spasticity” (pp. 191–201)

Chapter 57, “Drug Therapy of Rheumatoid Arthritis” (pp. 629–641)

Chapter 58, “Drug Therapy of Gout” (pp. 643–651)

Chapter 59, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 653–672)

 

American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

 

This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia.

Document:
Mid-Term Summary & Study Guide (PDF)

Required Media

Laureate Education (Producer). (2019b).
Alzheimer’s disease
[Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease. NURS 6521: Advanced Pharmacology Resource List

Laureate Education (Producer). (2019e).
Complex regional pain disorder
[Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders.

Disorders of The Nervous System

Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)

 

Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript 
Disorders of the Nervous System

Week 8

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advanced practice providers
. St. Louis, MO: Elsevier.

Chapter 24, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 231–246)

Chapter 25, “Antidepressants” (pp. 247–265)

Chapter 26, “Drugs for Bipolar Disorder” (pp. 267–274)

Chapter 27, “Sedative-Hypnotic Drugs” (pp. 275–285)

Chapter 28, “Management of Anxiety Disorders” (pp. 287–292)

Chapter 29, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 293–299)

 

Required Media

Laureate Education (Producer). (2019a).
Adult geriatric depression
[Interactive media file]. Baltimore, MD: Author. NURS 6521: Advanced Pharmacology Resource List

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.

Laureate Education (Producer). (2019c).
Attention deficit hyperactivity disorder
[Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.

Laureate Education (Producer). (2019d).
Bipolar therapy
[Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.

Laureate Education (Producer). (2019g).
Generalized anxiety disorder
[Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder.

Week 9

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advacned practice providers
. St. Louis, MO: Elsevier.

Chapter 48, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 521–533) NURS 6521: Advanced Pharmacology Resource List

Chapter 49, “Birth Control” (pp. 535–547)

Chapter 50, “Androgens” (pp. 549–556)

Chapter 51, “Drugs for Erectile Dysfunction and Benign Prostatic Hyperplasia” (pp. 557–569)

 

Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men.
Aging Male
,
18
(1), 5–15. doi:10.3109/13685538.2015.1004049

Note:
Retrieved from the Walden Library databases.

 

This article presents recommendations on the diagnosis, treatment, and monitoring of hypogonadism in men. Reflect on the concepts presented and consider how this might impact your role as an advanced practice nurse in treating men’s health disorders.

 

Roberts, H., & Hickey, M. (2016). Managing the menopause: An update
. Maturitas, 86
(2016), 53–58. https://doi.org/10.1016/j.maturitas.2016.01.007

Note:
Retrieved from the Walden Library databases.

 

This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition.

 

Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html

 

This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling. NURS 6521: Advanced Pharmacology Resource List

Week 10

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advanced practice providers
. St. Louis, MO: Elsevier.

Chapter 68, “Basic Principles of Antimicrobial Therapy” (pp. 769–781)

Chapter 69, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 783–790)

Chapter 73, “Sulfonamides and Trimethoprim” (pp. 619–826)

Chapter 74, “Drug Therapy of Urinary Tract Infections” (pp. 827–831)

Chapter 75, “Antimycobacterial Agents” (pp. 833–847)

Chapter 76, “Miscellaneous Antibacterial Drugs” (pp. 849–853)

Chapter 77, “Antifungal Agents” (pp. 855–866)

Chapter 78, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 867–886)

Chapter 80, “Drug Therapy of Sexually Transmitted Diseases” (pp. 905–911)

 

Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting
. PLoS ONE, 9
(2)
,
e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872 NURS 6521: Advanced Pharmacology Resource List

 

This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.

Document:
Final Exam Study Guide (PDF)

Required Media

Pathopharmacology: Pharmacology and Immunological Disorders: Improvements in Medications and Drug Administration

Nurse Manager, Bette Nunn discusses how technology has improved the practice of administering drugs and created new and improved drug therapies. Why is technology as well as a patient’s knowledge of their own drug history important for nursing practice?
(
8m)

 

Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript 
Pharmacology and the Immunological Disorders

Week 11

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2018).
Lehne’s pharmacotherapeutics for advanced practice providers
. St. Louis, MO: Elsevier.

Chapter 8, “Drug Therapy in Pediatric Patients” (pp. 65—67)

 

Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives.
The Journal of Pediatric Pharmacology and Therapeutics
,
20
(4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/

 

This article highlights pediatric governmental initiatives to prevent unlicensed and off-label drug use in children. Review these initiatives and guidelines and how they might impact your practice as an advanced practice nurse.

Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children.
The Journal of Pediatric Pharmacology and Therapeutics
,
22
(6), 423–429. doi:10.5863/1551-6776-22.6.423 NURS 6521: Advanced Pharmacology Resource List

Note:
You will access this article from the Walden Library databases.

 

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing. This study also examines off-label prescribing to children with ADHD.

 

Document:
Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2019i).
Therapy for pediatric clients with mood disorders
[Interactive media file]. Baltimore, MD: Author. NURS 6521: Advanced Pharmacology Resource List

76-year-old Iranian Male Decision Tree case study – lzheimer’s Disease

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.” 76-year-old Iranian Male Decision Tree case study – lzheimer’s Disease

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

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During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia. 76-year-old Iranian Male Decision Tree case study – lzheimer’s Disease

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

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RESOURCES

§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources. 76-year-old Iranian Male Decision Tree case study – lzheimer’s Disease

Decision Point One

Select what you should do:

Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

: Begin Aricept (donepezil) 5 mg orally at BEDTIME

Begin Razadyne (galantamine) 4 mg orally BID

76-year-old Iranian Male Decision Tree case study – lzheimer’s Disease

A Young Girl With ADHD Decision Tree case study – Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder

A Young Girl With ADHD

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give you a copy of a form titled 
“Conner’s Teacher Rating Scale-Revised”.
This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work. A Young Girl With ADHD Decision Tree case study – Attention Deficit Hyperactivity Disorder.

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Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time. A Young Girl With ADHD Decision Tree case study – Attention Deficit Hyperactivity Disorder

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

RESOURCES

§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291. A Young Girl With ADHD Decision Tree case study – Attention Deficit Hyperactivity Disorder

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Decision Point One

Select what you should do:

Begin Wellbutrin (bupropion) XL 150 mg orally daily

Begin Intuniv extended release 1 mg orally at BEDTIME

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING A Young Girl With ADHD Decision Tree case study – Attention Deficit Hyperactivity Disorder

Complex Regional Pain Disorder – White Male With Hip Pain

BACKGROUND

This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical interview, the client reports that his family doctor sent him for psychiatric assessment because the doctor felt that the pain was “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.”

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SUBJECTIVE

The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 o’clock to 12 o’clock position). He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said “there is no such thing as RSD, it comes from depression” and this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states “I said ‘no,’ there is no need for a wheelchair, I can beat this!” Complex Regional Pain Disorder – White Male With Hip Pain

The client reports that he used to be a machinist where he made “pretty good money.” He was engaged to be married, but his fiancé got “sick and tired of putting up with me and my pain, she thought I was just turning into a junkie.”

He reports that he does get “down in the dumps” from time to time when he sees how his life has turned out, but emphatically denies depression. He states “you can’t let yourself get depressed… you can drive yourself crazy if you do. I’m not really sure what’s wrong with me, but I know I can beat it.” Complex Regional Pain Disorder – White Male With Hip Pain

During the client interview, the client states “oh! It’s happening, let me show you!” this prompts him to stand with the assistance of the corner of your desk, he pulls off his shoe and shows you his right leg. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward and his foot looks like it is folding in on itself. “It will last about a minute or two, then it will let up” he reports. Sure enough, after about two minutes, the color begins to return and the cramping in the foot/toes appears to be releasing. The client states “if there is anything you can do to help me with this pain, I would really appreciate it.” He does report that his family doctor has been giving him hydrocodone, but he states that he uses is “sparingly” because he does not like the side effects of feeling “sleepy” and constipation. He also reports that the medication makes him “loopy” and doesn’t really do anything for the pain. Complex Regional Pain Disorder – White Male With Hip Pain

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is dressed appropriately for the weather and time of year. He makes good eye contact. Speech is clear, coherent, goal directed, and spontaneous. His self-reported mood is euthymic. Affect consistent to self-reported mood and content of conversation. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes appreciated. Judgment, insight, and reality contact are all intact. He denies suicidal/homicidal ideation, and is future oriented. Complex Regional Pain Disorder – White Male With Hip Pain

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Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)

Decision Point One

Select what you should do:

Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter

Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day

Neurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed

Complex Regional Pain Disorder – White Male With Hip Pain

Client of Korean Descent/Ancestry Bipolar Therapy Decision tree case study

Bipolar Therapy

Client of Korean Descent/Ancestry

BACKGROUND INFORMATION

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.

Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?” Client of Korean Descent/Ancestry Bipolar Therapy Decision tree case study

She weights 110 lbs. and is 5’ 5”

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SUBJECTIVE

Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago. Client of Korean Descent/Ancestry Bipolar Therapy Decision tree case study

MENTAL STATUS EXAM

The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.

The Young Mania Rating Scale (YMRS) score is 22

RESOURCES

§ Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

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Decision Point One 

Select what you should do:

Begin Lithium 300 mg orally BID

Begin Risperdal 1 mg orally BID

Begin Seroquel XR 100 mg orally at HS

Client of Korean Descent/Ancestry Bipolar Therapy Decision tree case study

Middle-Aged White Male With Anxiety Decision Tree case study Generalized Anxiety Disorder

Generalized Anxiety Disorder

Middle-Aged White Male With Anxiety

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL. Middle-Aged White Male With Anxiety Decision Tree case study Generalized Anxiety Disorder

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He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.

In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.

Client has never been on any type of psychotropic medication.

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MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation. Middle-Aged White Male With Anxiety Decision Tree case study Generalized Anxiety Disorder

You administers the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorder

RESOURCES

§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Decision Point One

Select what you should do:

Begin Zoloft 50 mg po daily

Begin Imipramine 25 mg po BID

Begin Buspirone 10 mg po BID

Middle-Aged White Male With Anxiety Decision Tree case study Generalized Anxiety Disorder

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

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Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

 

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease. Discussion: Pharmacokinetics and Pharmacodynamics/

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.

Think about a personalized plan of care based on these influencing factors and patient history in your case study. Discussion: Pharmacokinetics and Pharmacodynamics

By Day 3 of Week 1

Post
 a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

By Day 6 of Week 1

Read
 a selection of your colleagues’ responses and 
respond
 to 
at least two
 of your colleagues on 
two different days
by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure. Discussion: Pharmacokinetics and Pharmacodynamics

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion Discussion: Pharmacokinetics and Pharmacodynamics