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Module 6: Psychological Disorders

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act…mental health is important at every stage of life, from childhood and adolescence through adulthood.

—Centers for Disease Control and Prevention, 2018

As an advanced practice nurse, treating patients who may present with psychological disorders requires critical clinical decision making. It is your expertise in clinical decision making that will ensure that the pharmacotherapeutics and other suggested treatments prescribed to your patients will not only promote positive patient health outcomes but will lead to sustained health and well-being.

Reference: Centers for Disease Control and Prevention. (2018). Mental health. Retrieved from https://www.cdc.gov/mentalhealth/index.htm

What’s Happening In This Module?

Module 6: Psychological Disorders is a 1-week module, Week 8 of the course. In this module, you will examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

Go to the Week’s Content

Week 8: Pharmacology for Psychological Disorders

How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?

Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care.

This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

Learning Objectives

Students will:

• Evaluate patients for treatment of psychological disorders
• Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders
• Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology
• Evaluate patients for treatment of neurological and musculoskeletal disorders
• Analyze decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders
• Justify decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders

Learning Resources

Required Readings

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2^nd) St. Louis, MO: Elsevier.
• Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
• Chapter 27, “Antidepressants” (pp. 214–226)
• Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
• Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
• Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
• Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)

Required Media

Laureate Education (Producer). (2019a). Adult geriatric depression [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 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.

Discussion: Decision Making When Treating Psychological Disorders

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

• Review this week’s interactive media pieces and select one to focus on for this Discussion.
• Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

By Day 3 of Week 8

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

By Day 6 of Week 8

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

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!

Assignment: Decision Tree for Neurological and Musculoskeletal

By Day 7 of Week 8

Submit your Assignment, started in Week 6.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
• Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 8 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

            Sample Paper Week 8

Walden NURS 6521 – Decision Making When Treating Psychological Disorders

Treating Psychological Disorders

Student’s Name:

Institutional Affiliation:

Mental health issues are serious and do have debilitating outcomes, affecting normal functioning, increasing dependency levels, and not only affects the diagnosed person but also their loved ones. Mental health illness symptoms may occur temporarily or chronic and can range from mild, moderate, and severe. The mild symptoms of mental illness can be managed through life adjustment and psychotherapy, but when they are severe, a combination with medication/ pharmacotherapy is recommended. The majority of mental health experts do agree that a combination of pharmacotherapy and psychotherapy is more effective compared to implementing the individual approaches in the treatment of severe mental health issues (Pedrelli et al., 2015). This paper aims to review a case study of a Hispanic male with a major depressive disorder to assess some of the three medications proposed: Zoloft 25 mg orally daily, Effexor XR 37.5 MG orally daily, and Phenelzine 15 mg orally TID to recommend the most appropriate.

Before recommending any medications to a patient, it is best to collect sufficient information such as the patient characteristics such as age and health condition, current medication, past medical history, psychiatric history of the family, and generally the patient’s functional status. The caregiver also has to collect the patient’s objective data. After assessing the patient’s cognitive and emotional state, as in the case study, the caregiver can plan for the prescription such as patient and support education, dosage, frequency, route, and the span based on information collected (Mayo-Wilson et al., 2014). It is also best to review the medications for effectiveness, interactions, and side effects based on the patient’s condition.

Zoloft 25 Mg Orally Daily

Zoloft is a selective serotonin reuptake inhibitor (SSRI) and works by restoring serotonin in the brain. The medication is used in treating depression, post-traumatic stress disorder, panic attacks, obsessive-compulsive disorder, and social phobia. Zoloft may mend sleep disorders, appetite, mood, energy levels, and increase interest in activities which one loves (Milgrom et al., 2015). The medication may also interfere with the urge to partake in repetitive tasks that one faces in daily living, such as counting. The appropriate dosage for persons with MDD is 50mg, with a maximum upper range of 200mg for unresponsive patients.

Effexor XR 37.5 Mg Oral Daily

Also known as Venlafaxine, Effexor XR is used as a mood and energy enhancer to rejuvenate interest (Dahale e al., 2014). The antidepressant is used to treat social anxiety disorder, depression panic attacks, and anxiety. Effexor XR is a serotonin-norepinephrine reuptake inhibitor and works by restoring and balancing norepinephrine and serotonin in the brain. The oral medication is taken once daily, either in the morning or evening, and is not to be chewed as it may increase the chances of side effects. The medication is not stopped unless the caregiver orders so, and the benefits are gradual to note and may take several weeks for positive results. The 37.5 mg dosage is best at the beginning for the patient to adjust; then, it can be raised to 75mg, which is the recommended dose.

Phenelzine 15 Mg Oral TID

Phenelzine is a usual dose for depression and mostly administered to adults. The initial dose for depression is 15mg tid but can be increased to 90 mg for patients who require high monoamine oxidase inhibition. The results of Phenelzine may be noted after at least a month at 60mg daily dosing. The 15 mg dose can only be used for maintenance purposes after benefits are attained. Phenelzine is not recommended as the initial depressant to use in patient treatment, but as the last option after other medications are unresponsive on the patient (Willaert et al., 2014).

Appropriate Choice

The three medications are antidepressants and seem to have almost similar side effects such as suicidal thoughts and behavior; hence caregivers need to balance between the clinical benefits to the patient and the risks involved (Mayo-Wilson et al., 2014). From assessing the above medication in treating MDD, the first to exclude is the Phenelzine 15 mg oral TID dosage as it should be used as an alternative treatment after all other options have failed. Zoloft 25 mg orally daily is also a better prescription, but the problem is that that dosage is way below for the 50mg appropriate for treatment of MDD; hence, it may take time to restore the patient’s wellbeing. Zoloft does also have the risk of interfering with repeated tasks; thus, the patient’s job may be at stake, which may affect the patient’s wellbeing further and worsen the situation.

The recommendable medication, in this case, is Effexor XR 37.5 mg oral daily as it begins with the lowest dosage, which can be controlled based on the patient’s response. Since the medication is taken once a day, it can be prescribed in a period where the patient is off work hence cannot interfere with their daily activities. The caregivers need to monitor the patient carefully as they use antidepressants, and so should the family of the patient keeping close contact with the prescriber in case of any negative observations.

References

Dahale, A. B., Narayanaswamy, J. C., Venkatasubramanian, G., & Bagewadi, V. I. (2014). Successful use of agomelatine and venlafaxine combination in major depression. General hospital psychiatry, 36(1), e3.

Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376.

Milgrom, J., Gemmill, A. W., Ericksen, J., Burrows, G., Buist, A., & Reece, J. (2015). Treatment of postnatal depression with cognitive behavioural therapy, sertraline and combination therapy: a randomised controlled trial. Australian & New Zealand Journal of Psychiatry, 49(3), 236-245.

Pedrelli, P., Nyer, M., Yeung, A., Zulauf, C., & Wilens, T. (2015). College students: mental health problems and treatment considerations. Academic Psychiatry, 39(5), 503-511.

Willaert, L., Verbeke, P., Sienaert, P., & De, J. F. (2014). Irreversible monoamine oxidase inhibitors (IMAOI) to treat depressive disorders-limited use at present in Flanders. Tijdschrift voor psychiatrie, 56(10), 651-659.

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What’s Coming Up in Week 7?

Next week, you will continue working on your Assignment started in Week 6, and you will complete your Midterm Exam.

Next Week

To go to the next week:

Week 7

Week 7: Midterm Exam

This week, you will continue working on your Assignment started in Week 6, and you will complete your Midterm Exam.

Learning Objectives

Students will:

Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders

Midterm Exam

The Exam covers the content you have explored throughout the first 6 weeks of this course.

This exam is a test of your knowledge in preparation for your certification exam. No outside resources—including books, notes, websites, or any other type of resource—are to be used to complete this quiz. You are not allowed to take screenshots or record the exam questions in any other format while taking the exam. You are expected to comply with Walden University’s Code of Conduct.

By Day 7 of Week 7

Complete the Midterm Exam. You have 120 minutes to complete the exam. You may only attempt this exam once.

Submission and Grading Information

Complete the Exam by Day 7 of Week 7

To Complete this Exam:

Week 7 Exam

What’s Coming Up in Module 6?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In the next module, you will examine types of drugs prescribed to patients who present with psychological disorders.

In the next module, you will examine types of drugs prescribed to patients who present with psychological disorders.

Next Week

To go to the next week:

PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING PAPERS MARKET TODAY AND GET AN AMAZING DISCOUNT

What’s Coming Up in Module 5?

In the next module, you will examine diagnoses for patients with neurologic and musculoskeletal disorders, and you will complete your Midterm Exam.

Looking Ahead: Midterm Exam

Please review the Resources and content in the previous modules in preparation for your Midterm Exam in Module 5.

Next Week

To go to the next week:

Module 5

Module 5: Neurologic and Musculoskeletal Systems

What’s Happening In This Module?

Module 5: Neurologic and Musculoskeletal Systems is a 2-week module, Weeks 6 and 7 of the course. In this module, you will analyze drugs prescribed to treat neurological and musculoskeletal disorders and explore patient education strategies for treatment and management of these disorders. You will also evaluate the impact of patient factors on the effects of prescribed drugs and drug therapy plans for neurologic and musculoskeletal disorders. You will also complete your Midterm Exam.

Go to the Week’s Content

Week 6

Week 7

Week 6: Neurologic and Musculoskeletal Disorders

Sabrina is a 26-year-old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

Learning Objectives

Students will:

Evaluate patients for treatment of neurologic and musculoskeletal disorders

Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Learning Resources

Required Readings

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2^nd) St. Louis, MO: Elsevier.
• Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)
• Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)
• Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)
• Chapter 14, “Muscarinic Antagonists” (pp. 90-98)
• Chapter 15, “Adrenergic Agonists” (pp. 99–107)
• Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
• Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
• Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
• Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
• Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
• Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
• Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
• Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)
• Chapter 60, “Drug Therapy of Gout” (pp. 528–536)
• Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)

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.

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.

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)

Sample Paper Week 6

Walden NURS 6521 – Neurologic and Musculoskeletal Disorders

Multiple Sclerosis

Student’s Name:

Institutional Affiliation

Multiple Sclerosis

From the case study, Sabrina is a 26-year-old female patient who was diagnosed with multiple sclerosis. The patient booked an appointment with her physician for the management and treatment of the condition. Sabrina presents several questions concerning her diagnosis. As such, she calls the nurse helpline for her hospital network. She notes that multiple sclerosis affects her musculoskeletal and neurologic systems upon talking to the physicians. She learns that although the condition is an autoimmune disease, its symptoms and signs can affect other functions. Therefore, Sabrina should be aware of the specific drug therapy and other options of treatment that her physicians could decide to administer.

Symptoms of the Disorder

Signs of multiple sclerosis may vary from person to person. Typically, the symptoms affect movement functions. They include weakness or numbness in the limbs, which mostly touch one side of the patient’s body at a time. The numbness may affect the trunk and the legs of the patient (Claes et al., 2014). Another symptom of the disorder in the electric shock sensation which occurs when the neck makes specific movements. It happens especially when the neck bends forward. Also, patients of multiple sclerosis experience unsteady gait, lack of coordination, and tremors.

Decision Tree

Multiple sclerosis has no actual cure. As such, treatment aims at speeding up the recovery process from the attacks, management of the MS signs and symptoms, and slowing the progression of the disease (Claes et al., 2014). Some patients have very mild signs, so that no treatment is necessary.

Treatment Decision for MS Attacks

Medications knowns as corticosteroids, which include oral prednisone and IV methylprednisolone, are administered to minimize the effects of nerve inflammation. However, these drugs have side effects such as mood swings, fluid retention, and insomnia. Plasmapheresis (plasma exchange) is another option for the treatment of MS attacks (Spencer et al., 2015). The liquid part of the blood is removed and isolated from the blood cells. The blood cells should then be mixed with albumin and put back into the body. This decision is made when the symptoms are severe, and they have failed to respond to the corticosteroids.

Treatment Decision to Reduce Progression

The physician may also decide to give a prescription to modify MS progression. Disease-modifying therapy (DMT) is given the MS patients to slow down the rate of progress. Treatment choices for relapsing-remitting MS are composed of different intravenous medications (Spencer et al., 2015). Glatiramer acetate medication helps to block the patient’s immune system from attacking myelin. The drug is usually injected below the skin. Beta interferons are also commonly administered to reduce the severity and frequency of relapses.

Treatment Decision for Signs and Symptoms

Another treatment decision for the MS should aim at relieving the symptoms. Physical therapy can help the patients to relax the muscles through stretching and strengthening exercises (Stangel et al., 2015). Muscle relaxants such as tizanidine (Zanaflex) are useful in alleviating the uncontrollable muscle pain, spasms, and stiffness.

Sabrina’s Treatment Decision

For Sabrina’s case study, the treatment decision was aimed at the reduction of progression. Sabrina is a young patient who was diagnosed with early symptoms of MS. The DMT therapy would ensure that the disease progression would be slightly lower than the untreated cases. Also, the treatment option given to Sabrina ensures that the relapse rate and the formation of lesions are reduced.

Differences between Actual and Expected Results

The decision to treat MS attacks is expected to reduce the effects of nerve inflammation. However, the actual outcome may differ from the anticipated results due to the side effects of the drugs, which include flu-like symptoms. Also, the treatment option to reduce progression is expected to reduce the rates of relapse (Stangel et al., 2015). However, the actual results may vary due to side effects such as blurred vision and nausea.

References

Claes, N., Dhaeze, T., Fraussen, J., Broux, B., Van Wijmeersch, B., Stinissen, P., … & Somers, V. (2014). Compositional changes of B and T cell subtypes during fingolimod treatment in multiple sclerosis patients: a 12-month follow-up study. PLoS One, 9(10), e111115.

Spencer, C. M., Crabtree-Hartman, E. C., Lehmann-Horn, K., Cree, B. A., & Zamvil, S. S. (2015). Reduction of CD8+ T lymphocytes in multiple sclerosis patients treated with dimethyl fumarate. Neurology-Neuroimmunology Neuroinflammation, 2(3), e76.

Stangel, M., Penner, I. K., Kallmann, B. A., Lukas, C., & Kieseier, B. C. (2015). Towards the implementation of ‘no evidence of disease activity’ in multiple sclerosis treatment: the multiple sclerosis decision models. Therapeutic advances in neurological disorders, 8(1), 3-13.

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What’s Coming Up in Module 4?

In the next module, you will examine types of drugs prescribed to patients with endocrine disorders, such as diabetes, and you will consider the impact of patient factors on the effects of these drugs.

Next Week

To go to the next week:

Module 4: Endocrine System

The endocrine system plays an important role in the regulation and coordination of activities throughout the body. When alterations of these systems occur, many patients require long-term drug therapies. In addition to drugs prescribed by their health care providers, patients with these disorders also often take herbal and dietary supplements. This may impact the effects of prescribed drugs, as well as pose a concern of adverse drug reactions in patients. When treating patients with endocrine disorders, it is important to educate them on associated risks. As an advanced practice nurse prescribing drugs, you must carefully consider all drug, herbal, and dietary therapies prior to finalizing treatment plans.

What’s Happening In This Module?

Module 4: Endocrine System is a 1-week module, Week 5 of the course. In this module, you examine types of drugs prescribed to patients with endocrine disorders, as well as consider the impact of patient factors on the effects of drugs. You also examine types of diabetes and the impact of diabetes drugs on patients.

Go to the Week’s Content

Week 5: Endocrine System Disorders and the Treatment of Diabetes

The endocrine system includes eight major glands throughout the body which affect such things as growth and development, metabolism, sexual function, and mood (National Institutes of Health). Some of the most commonly diagnosed endocrine disorders include hypothyroidism, diabetes, and Hashimoto’s disease. Not surprisingly, treating any one endocrine disorder may have effects on other body systems or their functions. As an advanced practice nurse, treating patients who may suffer from endocrine disorders requires an acute understanding of the structure and function of the endocrine system. Additionally, a solid understanding of patient factors and behaviors will assist in developing the best drug therapy plans possible to treat your patients. Some of most commonly diagnosed endocrine disorders include

This week, you differentiate the types of diabetes and examine the impact of diabetes drugs on patients. You also evaluate alternative drug treatments and patient education strategies for diabetes management.

Reference: National Institutes of Health. (n. d.). National Institute of Diabetes and Digestive and Kidney Disorders. Endocrine diseases. Retrieved July 3, 2019 from https://www.niddk.nih.gov/health-information/endocrine-diseases

Learning Objectives

Students will:

• Differentiate types of diabetes
• Evaluate the impact of diabetes drugs on patients
• Evaluate alternative drug treatments and patient education strategies for diabetes management

Learning Resources

Required Readings

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

• Chapter 48, “Drugs for Diabetes Mellitus” (pp. 397–415)
• Chapter 49, “Drugs for Thyroid Disorders” (pp. 416–424)

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

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.

Discussion: Diabetes and Drug Treatments

Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations.

For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/

To Prepare

• Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
• Select one type of diabetes to focus on for this Discussion.
• Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
• Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.

By Day 3 of Week 5

Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

By Day 6 of Week 5

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

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!

Post by Day 3 of Week 5 and Respond by Day 6 of Week 5

Sample Paper Week 5 Discussion

Walden NURS 6521 Diabetes and Drug Treatments

Diabetes

Student’s Name:

Institutional Affiliation:

Diabetes

Diabetes is a chronic condition that is usually associated with blood sugar levels that are abnormally high. There are different types of diabetes. Type 1 diabetes is caused by the inability of the pancreas to produce enough insulin or failure to produce the insulin.  In most cases, it develops during adolescence or childhood, but it can also develop in adults. Type 2 diabetes is a condition that affects how glucose in the body is metabolized. For this type of diabetes, the body tends to resist the insulin effects or fail to produce enough insulin to maintain normal glucose levels. Type 2 diabetes has no cure but various diabetes medications or insulin therapy, as well as the change of lifestyle, can help manage the symptoms of the condition (Chatterjee, Khunti, & Davies, 2017).  Gestational diabetes develops when blood sugar levels become high during pregnancy. It happens in the second half of pregnancy.  This type of diabetes usually goes away after a person gives birth. Gestational diabetes increases the risk of a person getting type 2 diabetes later in life and can also affect the baby’s health (McIntyre et al., 2019). Juvenile diabetes affects mostly young people. This type of diabetes is considered the same as type 1 diabetes, mainly because approximately 90% of people below 25 years are affected by type 1 diabetes (Bimstein, Zangen, Abedrahim, & Katz, 2019).

Treatment for Type 2 Diabetes

The condition can be managed through medication, and lifestyle change, such as healthy eating and physical activity. One type of drug that is used to treat type 2 diabetes is metformin. This drug works by lowering the production of glucose in the liver and improving the body’s sensitivity to insulin. This helps the body to be in a better position of using insulin more effectively. FDA approved this medication in 1994 as an antidiabetic medication that should be used in the treatment of type 2 diabetes mellitus (American Diabetes Association. 2018). The medication comes as an extended-release as well as an immediate release. The medication should be administered orally from 500 to 2550 mg per day. Patients are usually advised to take the medication with a meal to help reduce GI upset. Some of the gastrointestinal effects include nausea and vomiting as well as diarrhea. In addition to that, the medication should be taken at the same time daily (Rena, Hardie, & Pearson, 2017). Some of the dietary considerations for patients who have been diagnosed with type 2 diabetes include complex carbohydrates such as whole wheat, brown rice, oatmeal, quinoa, vegetables, lentils, and beans. Examples of the foods that should be avoided include pasta, sugar, flour, white bread, and pastries (Sami, Ansari, Butt, & Ab Hamid, 2017).

Impact of Type 2 Diabetes

The short-term impact of type 2 diabetes includes hyperosmolar hyperglycemic nonketotic syndrome and hypoglycemia. The long-term impact includes diabetic neuropathy, diabetic retinopathy, kidney disease, and microvascular problems. Drugs used in treating Type 2 diabetes-like Thiazolidinedione increase an individuals’ risk of heart problems; DPP-4 inhibitors result in joint pain and ay cause pancreatic inflammation (Afanasiev et al., 2018).

In Conclusion, diabetes has several types, such as Type 1 Diabetes, juvenile diabetes, which is insulin-dependent. Gestational diabetes is usually temporary and occurs during pregnancy. All kinds of diabetes can be managed through medication, a healthy diet, and physical exercise.

References

Afanasiev, S. A., Garganeeva, A. A., Kuzheleva, E. A., Andriyanova, A. V., Kondratieva, D. S., & Popov, S. V. (2018). The impact of type 2 diabetes mellitus on long-term prognosis in patients of different ages with myocardial infarction. Journal of diabetes research, 2018.

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

Bimstein, E., Zangen, D., Abedrahim, W., & Katz, J. (2019). Type 1 Diabetes Mellitus (Juvenile Diabetes)–A review for the pediatric oral health provider. Journal of Clinical Pediatric Dentistry, 43(6), 417-423.

Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239-2251.

McIntyre, H. D., Catalano, P., Zhang, C., Desoye, G., Mathiesen, E. R., & Damm, P. (2019). Gestational diabetes mellitus. Nature Reviews Disease Primers, 5(1), 1-19.

Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of metformin. Diabetologia, 60(9), 1577-1585.

Sami, W., Ansari, T., Butt, N. S., & Ab Hamid, M. R. (2017). Effect of diet on type 2 diabetes mellitus: A review. International journal of health sciences, 11(2), 65.

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Module 2: Cardiovascular and Respiratory Systems

What’s Happening In This Module?

Module 2: Cardiovascular and Respiratory Systems is a 2-week module, Weeks 2 and 3 of the course. In this module, you will examine how patient factors may influence pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics used in the treatment of cardiovascular and respiratory disorders. You will also explore and suggest drug therapy plans for asthma and analyze the stepwise approach for asthma treatment and management.

Go to the Week’s Content

Week 2: Cardiovascular System

Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. In clinical settings, patients often present with symptoms of several cardiovascular disorders, making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options.

This week, you examine the impact of patient factors that may lead to changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.

Learning Objectives

Students will:

Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes

Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies

Evaluate drug therapy plans for cardiovascular disorders

Learning Resources

Required Readings

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2^nd) St. Louis, MO: Elsevier.
• Chapter 33, “Review of Hemodynamics” (pp. 285–289)
• Chapter 37, “Diuretics” (pp. 290–296)
• Chapter 38, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 297–307)
• Chapter 39, “Calcium Channel Blockers” (pp. 308–312)
• Chapter 40, “Vasodilators” (pp. 313–317)
• Chapter 41, “Drugs for Hypertension” (pp. 316–324)
• Chapter 42, “Drugs for Heart Failure” (pp. 325–336)
• Chapter 43, “Antidysrhythmic Drugs” (pp. 337–348)
• Chapter 44, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 349–363)
• Chapter 45, “Drugs for Angina Pectoris” (pp. 364–371)
• Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)

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)

Assignment: Pharmacotherapy for Cardiovascular Disorders

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

• Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
• Review the case study assigned by your Instructor for this Assignment.
• Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
• Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
• Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
• Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

By Day 7 of Week 2

Write a 2- to 3-page paper that addresses the following:

• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
• Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 2 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submitbutton to complete your submission.

 Submit Your Assignment by Day 7 of Week 2

Sample Paper Week 2 Assignment

Walden NURS 6521 Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders

Student’s Name:

Institutional Affiliation:

Explain How the Factor You Selected Might Influence the Pharmacokinetic and Pharmacodynamic Processes

The patient factor I selected is age. It is assumed that the patient is aged because he presents with old age-associated comorbidities like obesity, overweight, hypertension, and hyperlipidemia. The patient is also on five prescription drugs. Research shows that most Americans aged individuals take at least three prescription drugs daily due to multiple age-related comorbidities .the state has significant implications in patient’s pharmacokinetic and pharmacodynamic processes in regards to drug interaction and adverse drug reactions (Van den Anker, Reed, Allegaert & Kearns, 2018).

Aging is accompanied by progressive random changes in the body that influence the pharmacokinetics and pharmacodynamics process. Cardiovascular conditions in elderly individuals cause decreased renal functioning, reduced hepatic blood flow, increased body fat, and reduced muscle mass and total body water, thus affecting distribution, metabolism, and elimination of cardiovascular drugs (Cossart, Cottrell, Campbell, Isbel & Staatz, 2019).

These changes in the elderly include reduced elasticity and a reduction in the intrinsic heart rate, and renal impairment that impairs effective blood flow, thus hindering drug distribution in the body to the target tissues. The gastrointestinal system also changes with age.  Absorption of several substances decreases with age. Decreased organ functionality impairs the secretion of digestive enzymes that facilitate the absorption of drugs in the small intestine. Impaired muscle movement and renal impairment also cause uncontrolled fast movement of food along the duodenum, thus impairing maximum drug absorption.

Advancing age is associated with a progressive reduction in liver volume and liver blood flow. It is also associated with decreased organ functioning like liver and kidney functioning thus impairing drug clearance and facilitating high drug concentration and toxicity.

Describe How Changes in the Processes Might Impact the Patient’s Recommended Drug Therapy

The patient’s current prescription drugs are daily doses of Atenolol, Doxazosin, Hydralazine, Sertraline, and Simvastatin. The patient’s age is a factor in the absorption, distribution, metabolism, and excretion of these drugs.  The patient is on atenolol, a beta-blocker prescribed for r hypertension. The sensitivity to beta-blockers is higher increases with age, leading to increased risk of drug side effects. Therefore, a much lower dose should be used for older adults. The increased sensitivity results in increased absorption, thus increased plasma concentration and leading to increased risk of stroke and heart failure, the significant side effects. The high concentration results in increased kidney functioning to excrete the drug through urine, thus resulting in frequent urination and thirst. The drug, therefore, covers up diabetic symptoms in elderly individuals, which may lead to a late diabetes diagnosis. For this reason, the drug is discouraged in older adults (Wang, Xiang, Chen & Ji, 2019).

The second drug is doxazosin, an alpha-blocker prescribed for hypertension. Older adults are more sensitive to alpha-blockers, leading to increased absorption and high plasma concentration, therefore consequent severe side effects. The concentration is increased by impaired kidney functioning due to old age, which results in decreased drug excretion. The side effects include fainting, dizziness, and kidney failure (Abdi & Campbell, 2018). Co-administration of beta-blockers and alpha-blockers leads to extremely low blood pressure, which caused malfunctioning of blood vessels, due to muscle weakness associated with old age. It consequently impairs drug distribution via blood circulation. This is because they both act as muscle relaxers.

The third prescription is sertraline, prescribed for hyperlipidemia.it side effects include gastrointestinal complications like diarrhea, stomach upset, and intestinal bleeding. Due to the decrease in mucous lining along the digestive system associated with old age, these symptoms are severe in older adults. This consequently results in fast movement of food and impaired absorption of drugs, thus decreasing plasma concentration and drug effectiveness. Co-administration with beta and alpha-blockers increases the bleeding due to consequent muscle relaxation. This hinders transportation of drug to target tissues for metabolism (Chen et al., 2016).

The other prescription is simvastatin, a statin prescribed for high cholesterol levels. It impairs the processing of cholesterol by the liver, thus reducing general liver functioning. Old age is associated with muscle wear out hence consequent organ failure. Therefore, the drug causes faster liver failure in older individuals, leading to the permanent synthesis of body cholesterol. One of its side effects among the elderly is muscle problems. Therefore, if administered with beta and alpha-blockers, it alters the action of muscle relaxation, thus hindering drug distribution through blood circulation (Rosenthal & Burchum, 2018).

Explain How You Might Improve the Patient’s Drug Therapy Plan

First, since co-administration of beta-blockers and alpha-blockers causes’ excessive low blood pressure, and the two types of drugs lead to risk of cardiovascular complications like stroke, the AHA, only recommends prescription of Thiazide Diuretics as a first-line therapy in the treatment of hypertension in the elderly population. This is   because they have been established prevent other cardiovascular conditions like stroke, coronary artery disease and chronic heart failure. I would, therefore, discontinue Atenolol and Doxazosin, and prescribe Thiazide Diuretics; a dose of 12.5 mg of hydrochlorothiazide instead. The low dose helps prevent toxicity caused by high plasma concentration due to old age associated renal function impairment. It is supplemented by non-pharmacological approaches. Hydralazine should also be terminated as well since it should ideally be given with a beta-blocker. Simvastatin dose should be continued as it is the AHA prescribed the first-line drug for hyperlipidemia. However, the dose should be lowered to 40 g to decrease the risk of diabetes, which is one of the side effects of the drug. The reason is that although the patient does not have diabetes, his age puts him at risk of diabetes. Bariatric surgery such as gastric bypass and laparoscopic adjustable gastric banding will be prescribed for treatment, rather than obesity drugs, to prevent drug interaction.

I will also recommend Non- pharmacologic Treatment. AHA recommends that hypertension treatment in the elderly should entail both pharmacological and non-pharmacological approaches to avoid drug interaction, associated with the use of multiple drugs. It involves Lifestyle modification like exercise, Weight control, and Dietary Approaches like consumption of low sodium, sugar, and fat diet.

References

Abdi, E., & Campbell, A. (2018). Urological symptoms and side effects of treatment. In The MASCC Textbook of Cancer Supportive Care and Survivorship (pp. 469-503). Springer, Cham.

Chen, S. T., Narvaez, T. A., Harwood, D. G., Leskin, L. P., Brommelhoff, J. A., Bussel, N., & Sultzer, D. L. (2016). Sertraline for the treatment of depression in vascular cognitive impairment. The American Journal of Geriatric Psychiatry, 24(3), S171-S172.

Cossart, A. R., Cottrell, W. N., Campbell, S. B., Isbel, N. M., & Staatz, C. E. (2019). Characterizing the pharmacokinetics and pharmacodynamics of immunosuppressant medicines and patient outcomes in elderly renal transplant patients. Translational andrology and urology, 8(Suppl 2), S198.

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

Van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58, S10-S25.

Wang, Q., Xiang, B., Chen, S., &Ji, Y. (2019). Efficacy and safety of oral atenolol for the treatment of infantile haemangioma: A systematic review. Australasian Journal of Dermatology, 60(3), 181-185.

What’s Coming Up in Week 3?

Next week, you will examine strategies for the treatment and management of respiratory disorders, including asthma. You will analyze asthma and stepwise management and consider the impact of this approach for patient health.

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Assignment: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

• Review the scenario assigned by your Instructor for this Assignment.
• Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
• Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

By Day 7 of Week 1

Write a 2- to 3-page paper that addresses the following:

• Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
• Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
• Explain the process of writing prescriptions, including strategies to minimize medication errors.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK1Assgn+last name+first initial.(extension)” as the name.
• Click the Week 1 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 1 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK1Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Submit Your Assignment by Day 7 of Week 1

Sample Paper Week 1 Assignment

Walden NURS 6521 Ethical and Legal Implications of Prescribing Drugs

Advanced Pharmacology

Student’s Name:

Institutional Affiliation:

Advanced Pharmacology

Ethical Considerations

Several Ethical issues may arise from medicine prescription error. The nursing ethical principle of autonomy and right to self-determination accords the patients a right to make their own treatment choices according to their views, beliefs and perceived benefits (Niemann et al. 2015). Therefore, the nurse is obligated to keep patients updated on the medical progress of the treatment process which includes involves errors. They also have to help patients, make informed decisions in deciding on mitigation measures.

Additionally, the principle of beneficence and no maleficence imposes to the nurses the duty to do what is best for patients and avoid causing harm to the patient respectively. Although prescription error can be harmful to the patient in terms of loss of life and quality of life primarily due to associated long-term disabilities, the prescribing nurses should minimize damage by informing patients and management of the error so that they can decide on the most appropriate remedy earliest possible.

Prescription errors are a reflection of problematic and unethical organizational culture as well as negligent nursing which violates the QSEN ethical nursing competences of such as safety driven culture. Consequently, Nurses and organizations can be sued for medical negligence which often leads to cancelation of practice license. The lawsuits have negative impacts on organizations as well in terms of heavy financial fines, lousy reputation, and revocation of practice license. Moreover, Nurses and healthcare organizations have an ethical obligation to admit mistakes. They are required to maintain honesty and truth-telling in communication with patients and their families to establish trust. The negative impacts of non-disclosure to patients can negatively impact on the family in terms of financial burden and emotional as well as erosion of trust. Patients family entrust nurses with the health; thus when an error occurs, they expect a disclosure and a promise of measures to prevent future recurrence of the failure.

Strategies to Guide Decision Making

When a medication error occurs, the nurses reporting approach should be based on the depth of information provided by the approach about the mistake, and the ability of the method to providing information that informs a sophisticated investigation of the specific errors to understand the nature and magnitude of the problem.  As an advanced practice nurse, I would verbally report to the collaborating physician as it saves time thus enabling the application of countermeasures as early as possible. It also portrays my willingness as a nurse to communicate and recognize errors, which is a crucial aspect of nursing. Secondly, I would also consider a written report and attaching it to the patient’s story as it provides detailed information to facilitate an investigation that would help prevent future recurrence. It also enables other subsequent shift nurses to know about the medical history of the specific patient.

References

Niemann, D., Bertsche, A., Meyrath, D., Koepf, E. D., Traiser, C., Seebald, K., … & Bertsche, T.

(2015). A prospective three‐step intervention study to prevent medication errors in drug handling in paediatric care. Journal of clinical nursing, 24(1-2), 101-114.

What’s Coming Up in Module 2?

In the next module, you will examine the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders and the types of drugs prescribed to patients with respiratory disorders.

Looking Ahead: Week 2 Assignment

In Week 2, your Instructor will assign you a case study related to Assignment 1 by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and Learning Resources in order to complete your Assignment on time.

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Week 1: Basic Pharmacotherapeutic Concepts/Ethical and Legal Aspects of Prescribing

How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.

This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.

Learning Objectives

Students will:

• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients
• Assess patient factors and history to develop personalized plans of care
• Evaluate ethical and legal implications related to prescribing drugs
• Analyze ethical and legal practices of prescribing drugs
• Analyze strategies to address disclosure and nondisclosure
• Justify advanced practice nurse strategies to guide prescription drug decision-making
• Analyze the process of writing prescriptions to avoid medication errors

Learning Resources

Required Readings

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

• Chapter 1, “Prescriptive Authority” (pp. 1–3)
• Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
• Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
• Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
• Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
• Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

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 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.

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

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.legalsideofpain.com/uploads/pract_manual090506.pdf
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.

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, Maryland: American Nurses Association.

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.

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

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 ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

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 (click to expand/reduce)

Introduction to Advanced Pharmacology

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

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.

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.

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.

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.

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!

Sample Paper Week 1 Discussion

Walden NURS 6521 Pharmacokinetics and Pharmacodynamics

Advanced Pharmacology

Student’s Name:

Institutional Affiliation:

Case

Recently, there has been a growing interest in personalized medicine due to the genetic, age and other factors differences among patients. There is a need to consider some risk factors that can worsen the condition of a patient especially during the intervention phase (Weerink et al. 2017). Mr. L, a 75-year-old African American man was admitted to the hospital after he complained of numbness in the limbs and face especially one side, problems in vision, severe headaches, lack of coordination, and difficulty in communication. Additionally, the patient expressed some behaviors such as being startled easily and avoiding eye contact. Besides, he had increased heart rate, shaking and sweating, numbness and cold flushes. He was diagnosed with stroke and depression

Pharmacokinetics

The patient was subjected to selective serotonin reuptake inhibitors (SSRIs) which seemed to be weakening the bones of the patient.  After some time he was subjected to ensam antidepressant drugs that were administered through transdermal routes. The absorption of these drugs was affected because of the reduced tissue blood perfusion. This is common among the elderly (Shimizu et al. 2016). Drug distribution was not profoundly affected since the drugs administered were not hydrophilic. The liver is responsible for drug metabolism, and since aging is related to low liver mass, the response to the medicine was not highly positive as compared to when younger people are administered the drug. Elimination and drug interaction was not affected by age.

Pharmacodynamics

Pharmacodynamics depends on the drug concentration at the receptor, the receptor response, post-receptor events within the cells as well as the homeostatic mechanisms (Hochhaus et al. 2016). Aging affected all these pharmacodynamics. Plasma concentration in the body of this man led to a high risk of adverse effects such as headaches, insomnia, and rash.

A Personalized Plan of Care

In treating depression and anxiety, I would use selective serotonin reuptake inhibitors (SSRIs). These drugs work by escalating brain chemicals that fight depression. To avoid thinning of bones which might cause fractures among the elderly, I would start the medication at low doses and increase them slowly for the elderly. I would also consider injection rather than transdermal routes.

References

Hochhaus, G., Khan, P., Mobley, C., & Issar, M. (2016). Pharmacokinetics and pharmacodynamics of drugs delivered to the lungs. In Pharmaceutical Inhalation Aerosol Technology, Second Edition (pp. 222-257). CRC Press.

Shimizu, R., Hotta, K., Yamamoto, S., Matsumoto, T., Kamiya, K., Kato, M., … & Tanaka, S. (2016). Low-intensity resistance training with blood flow restriction improves vascular endothelial function and peripheral blood circulation in healthy older adults. European journal of applied physiology, 116(4), 749-757.

Weerink, M. A., Struys, M. M., Hannivoort, L. N., Barends, C. R., Absalom, A. R., & Colin, P. (2017). Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clinical pharmacokinetics, 56(8), 893-913.

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