Overview
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.
Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
For your week 9 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
To Prepare:
- Review assignment rubric and case studies. Be sure to thoroughly answer ALL
- Explain the problem and discuss how you would address the problem.
- When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.
- Answer questions using your required learning resources, clinical practice guidelines, Medscape and JNC 8.
- Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.
WEEK 9 ASSIGNMENT (covers weeks 9-11)
SCENARIO 1
What are the errors in the following prescriptions (5 total)? Rewrite each prescription correctly. What is each medication classification? What is the mechanism of action (MOA)?
tamsulosin 4 mg po daily, 30 minutes after the same meal each day #30 2 RF
levofloxcin 750 mg po daily for 5 days #5 0 RF
ciprofloxacin 0.3% otic solution for bacterial conjunctivitis; instill 1-2 drops into eye every 2 hours while awake for 2 days then 1-2 drops every 4 hours while awake for the next 5 days #1 bottle 0 RF
Paxlovid 300 mg ritonavir plus 100 mg nirmatrelvir po BID x 5 days #1 dose pack 0 RF
Depo-Provera 150 mg IM inject once monthly #1 3 RF
SCENARIO 2
FS is a 26-year-old sexually active female who presents with a 5-day history of yellow vaginal discharge, pelvic discomfort, and burning with urination. She reports unprotected intercourse with a new male partner over the past month. A gonorrhea culture returns positive. FS has documented allergies to latex and penicillin. What is the recommended first-line treatment for gonorrhea in this patient? What additional sexually transmitted infection should be empirically treated, and with which medication? Provide complete medication orders. How long should she abstain from sex to avoid reinfection, and what patient education should be provided?
SCENARIO 3
JH is a 68-year-old male recently discharged from the hospital following a diagnosis of deep vein thrombosis (DVT). He was started on warfarin 5 mg PO daily with INR monitoring. At his follow-up clinic visit 6 days post-discharge, he reports that his primary care provider prescribed Bactrim DS (sulfamethoxazole/trimethoprim 800/160 mg) twice daily for 7 days to treat a urinary tract infection. Today, his INR is 6.9. He has minor bruising on his arms but no active bleeding. Additional medications include sertraline 100 mg po daily for depression and lisinopril 10 mg po daily for hypertension. What is the mechanism behind this interaction? How should JH’s medication therapy be adjusted?
SCENARIO 4
A patient is prescribed vancomycin 15 mg/kg IV every 12 hours for a 70 kg patient. The pharmacy stocks vancomycin 1 g per 20 mL vials.
1. How much vancomycin (mg) should be administered per dose?
2. How many milliliters of vancomycin solution should be drawn up for each dose?
3. If the infusion rate is 10 mg/min, how long will it take to administer one dose?
4. A trough level is drawn 30 minutes before the 4th dose, and the result is 9 mcg/mL. Is the current dosing regimen appropriate based on the trough level? Would you increase, decrease, or leave the dose the same?
5. Why is vancomycin usually given IV and not PO?
Note: If you do not purchase Lecturio, please consult these resources for this week.
- Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
- Chapters 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425a–436)
- Chapter 51, “Birth Control” (pp. 437–446)
- Chapter 52, “Androgens” (pp. 447a–453)
- Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)
- Chapter 82, “Drug Therapy for Sexually Transmitted Diseases” (pp. 763–770)
- Chapter 87, “Drugs for the Eye” (pp. 823a–833)
- Chapter 88, “Drugs for the Skin” (pp. 834–848)
- Chapter 89, “Drugs for the Ear” (pp. 849–856)