1- pathophysiology of Essential Hypertension . 2 – definition of calcium channel blockers 3. Definition of diuretics 4. What is the mechanism of action of hydrochlorothiazide and spironolactone, and lisinopril and their pharmacokinetics


 

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Heading – Title Page
Heading – Pathophysiology of Assigned Disease
Heading – Definitions of the Two Assigned Drug Classes
Heading – Discussion of 4 Medications (2 drugs from each assigned drug class)
Heading – Pharmacokinetics, Pharmacodynamics, Safety/Monitoring, & Pregnancy/Lactation of the 4 Medications Discussed Earlier
Heading – Contraindications of the 4 Medications Discussed Earlier
Heading – Conclusions
Heading – References


 

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Howard is a 24 year-old male who presents to the clinic with his wife for what he states is severe lower back pain. He states the pain is so bad that he rates it as a “50 out of 10.” He also tells you that due to a past medical history of an ulcer, he cannot take any medications “like Motrin.” He states that the pain is from a car accident in 2012, and that it flairs up and he needs pain medications. He also tells you that he has a high pain tolerance, and that when he gets pain meds he requires the higher doses. After some investigating, you find that Howard actually is seeing a pain specialist who has given him epidural injections, and prescribes medication for him.

How does that impact any intervention that you may consider?
What other pharmacological options could you offer him?
What nonpharmacological options could you suggest?


 

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At her annual medical checkup appointment, she told her primary care provider that she seemed
to be tired all the time, and she was gaining weight because she had no interest in her usual
exercise activities and had been overeating, not from appetite but out of boredom. She denied
that she and her husband have had marital difficulties beyond the ordinary and she was pleased
with the achievements of her children. She noticed that she has difficulty falling asleep at night
and awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep even
though she still feels tired. She finds little joy in her life but cannot pinpoint any particular
concern. Although she denies suicidal feelings, she does not feel that there is meaning to her life:
“My husband and kids would go on fine if I died and probably wouldn’t miss me that much.”
The primary care provider asks Angela to fill out a Beck’s Depression Scale, which
indicated she has moderate depression.

1. What medication would you first prescribe to this patient?
2. She comes back in 2 weeks and states she has not noticed and change in her mood since starting on the medication. What would be your response?
3. What are the possible problems with the medication you prescribed?
4. How long should you continue the treatment regimen?


 

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Mr. JD is a 24-year-old who presents to Urgent Care with a 2-week history of cough and congestion. He says it started out as a “normal cold” and it will not go away. He has a productive cough for green mucous and has green nasal discharge. He says he has had a low-grade temperature for the past 2 days. John reports an intermittent frontal headache with this cold. He is otherwise healthy, with no known allergies.
In his assessment it is found that his vital signs are stable, temperature is 99.9 degrees F, tympanic membranes (TMs) are clear bilaterally, pharynx is erythematous with no exudate; there is greenish postnasal drainage; turbinates are swollen and red; frontal sinus tenderness; no cervical adenopathy, and lungs are clear bilaterally.

Is there any additional subjective or objective information you need for this client? Explain.
Would you treat Mr. JDs cold? Why or why not?
What would you prescribe and for how many days? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.
Would this treatment vary if Mr. JD was a 10 year-old 78 lb child? Include the class of the medication, mechanism of action, dosing, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings
What health maintenance or preventive education is important for this client based on your choice medication/treatment?


 

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Johnathan, age 7, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours. He is accompanied by his mother, who is a good historian. She reports that her son started having symptoms of a viral upper respiratory infection 2 to 3 days ago, beginning with a runny nose, low-grade fever of 101.0 degrees F orally, and loose cough. Wheezing started on the day before the visit, so Johnathan ‘s mother started administering albuterol metered-dose inhaler (MDI) two puffs before bed and then two puffs at around 2 AM. The cough and wheezing appear worse today, according to the mother. He had difficulty taking deep-enough breaths to inhale this morning’s dose of albuterol, even using the spacer.

Johnathan has been a patient at the clinic since birth and is up to date on his immunizations. His growth and development have been normal, and he is generally healthy except for mild intermittent asthma. This is his first asthma exacerbation of the school year, and his mother expresses a concern about sending him to school with an inhaler.

Johnathan is afebrile with a respiratory rate of 36 and a tight cough every 1 or 2 minutes. He weighs 45 pounds (20.5 kgs.). The examination is all within normal limits except for his breath sounds. He has diffused expiratory wheezes and mild retractions. Pulse oximetry readings have been 93% of oxygen saturation.

What are the appropriate pharmacological therapies to be prescribed for Johnathan?
What information is necessary to provide to Johnathan and his mother regarding asthma exacerbation?
What is an appropriate clinical assessment tool to be use with Johnathan?
What are the classification of asthma?
How would you as the NP address his mother’s concern regarding providing an inhaler at school?
What is an appropriate plan of care for Johnathan?


 

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Your presentation must include the following headings.

Heading – Title Page
Heading – Pathophysiology of Assigned Disease
Heading – Definitions of the Two Assigned Drug Classes
Heading – Discussion of 4 Medications (2 drugs from each assigned drug class)
Heading – Pharmacokinetics, Pharmacodynamics, Safety/Monitoring, & Pregnancy/Lactation of the 4 Medications Discussed Earlier
Heading – Contraindications of the 4 Medications Discussed Earlier
Heading – Conclusions
Heading – References


 

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Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs. It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well.

The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations. He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done after his MI demonstrated a preserved left ventricular ejection fraction (LVEF). Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy. He no longer smokes and does not use alcohol or recreational drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid.

Mr. EBR’s physical examination includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally. He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits. Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND). Extremities are without clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally

What would you add to the current treatment plan? Why?
Would you discontinue any of the currently prescribed medication? Why or why not?
How does the diagnosis stage 3 chronic kidney disease affect your choices?
Why is the patient prescribed more than one antihypertensive?
What is the benefit of the aspirin therapy in this patient?


 

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Gami is a 48-year-old who you discover when completing a health history is taking cinnamon to treat Type II Diabetes. She is specifically using cassia Cinnamon. You also discover that she is taking Ginseng to assist with memory. Her prescribed medications are Aricept and Coumadin.

Ms. GM is a 48-year-old who presents to your clinic to establish care. During the health history, you learn that she has a history of Type II Diabetes. When asked about prescription and non-traditional medications, she reports being prescribed Aricept, Coumadin, Cassia cinnamon for Type II Diabetes and Ginseng for memory.

Is there any additional subjective or objective information you need for this client? Explain.
What would be your position on the Ms. GMs use of alternative supplements for her diabetes and memory? Explain and include contraindications, if any.
Are there any additional test/assessments you would complete for this patient given this list of medications? Explain.
How might your treatment plan, in terms of medications, differ for this patient? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; contraindications and black box warnings.
What health maintenance or preventive education is important for this client based on your choice medication/treatment?


 

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What is Jardiance medication. Does this medication have any adverse drug-drug interactions?


 

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