Advanced Pharmacology

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 of medication/treatment?

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Discussion Question 1

For these questions, please read the following case study and then respond to the questions noted below.

Ms. BD is a 33-year-old G2P1 African-American female who presents to your clinic today complaining of unusual fatigue, nausea, and vomiting for the last five days. She has a medical history of chronic hypertension (HTN) that was diagnosed shortly after her first pregnancy two years ago and GERD. MS. BD’s blood pressure is controlled on Lisinopril-Hydrochlorothiazide 20/12.5mg by mouth twice a day, and GERD controlled on Bismuth Subsalicylate 262mg by mouth every 6 hours as needed. During the interview, you learn that she is single, sexually active, has one partner and that her menses is ten days late. She performed a home pregnancy the three days after missing her menstrual cycle, and the results were inconclusive. She states she feels terrible and needs relief. She has no other medical problems, symptoms, or concerns.

Assessment: Physical examination is unremarkable. BP128/68, HR is 74, Urine human chorionic gonadotropin (HCG) positive, beta HCG sent, potassium 4.2, blood
urea nitrogen (BUN) 14, creatinine is 0.6, Alanine aminotransferase (ALT) 29, White blood cells (WBCs) 6.5, hemoglobin (Hgb) 12.8, hematocrit (Hct) 39, and platelets 330,000.

List the additional questions you would need to ask this patient. Explain.
What is the safety profile of Lisinopril-hydrochlorothiazide and bismuth subsalicylate in pregnant women? What are the possible complications to the pregnant woman and her fetus?
What is the importance of assessing laboratory values when prescribing medications? How might the laboratory values, in this case, impact your treatment plan?
Would you make any changes to Ms. BD’s blood pressure and GERD medications? Explain. If yes, what would you prescribe? Discuss the medications safety in pregnancy, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.
How does ethnopharmacology apply to this patient if she were NOT pregnant? Explain.
What health maintenance or preventive education do you provide in this client case based on your choice of medications/treatment?
Would you treat this patient or refer her? Explain. If you refer, where would you refer this patient?

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Explore weight loss management and treatments that are used today
Discuss the prevalence of obesity in US among children
Describe medications/foods that contribute to weight gain
Explain indications for pharmacologic therapy
Create an educational handout that can be used for improving patient’s knowledge of alternative medication and treatments

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The Central Nervous System (CNS) is a complicated network that controls behaviors and is adaptive to environment.

Select a medication class that is used to treat seizure disorder
Choose three medications within the class
Provide each drugs’ mechanism of action, indication, absorption, distribution, and metabolism in a separate section for each drug selected

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Explain the mechanism of action of a “biologic drug”
Identify two advantages and two disadvantages of using this medication for chronic disease states
Provide a patient case and drug treatment plan to support it

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1. Provide patient educational material to assist with adherence to treatment and/or non-pharmacologic management of Benign Prostatic Hyperplasia and provide 1 reference article less than 5 years old.

2. Respond to this classmate’s post and provide 1 reference article

(Post from classmate) Benign prostatic hyperplasia (BPH) is a disease that is manifested by symptoms such as poor urinary flow, urgency, nocturia, incomplete voiding and dribbling (Ababneh et al., 2019). Typically, the treatment goal of BPH is to reduce the severity of the patient’s symptoms and prevent long-term complications. Adherence to patient medications has a significant role in reducing the severity of symptoms and improving one’s clinical outcomes. The clinician’s role in this instance is to provide adequate and thorough education to the patient regarding treatment options, their risks and benefits, and duration of treatment. It has been shown that, with verbal communication only, patients only retain about 20% of the information taught (Sare et al., 2020). Improvement of treatment adherence and clinical outcomes can occur when using both verbal and written material to ensure higher education retention rates. This written material would be better accessed through the Internet, such as a website or application, rather than brochures and pamphlets can be easily lost during traveling or in the home. One factor to be cognoscente of when creating educational material is to ensure it has high readability. On average, an American is able to read at a level of a seventh to eight grade student (Sare et al., 2020). The clinician needs to be mindful of the educational status and cognitive status of their client when providing material for treatment adherence.

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1. Provide patient educational material to assist with adherence to treatment and/or non-pharmacologic management of Benign Prostatic Hyperplasia and provide 1 reference article less than 5 years old.

2. Respond to this classmate’s post and provide 1 reference article

(Post from classmate) Benign prostatic hyperplasia (BPH) is a disease that is manifested by symptoms such as poor urinary flow, urgency, nocturia, incomplete voiding and dribbling (Ababneh et al., 2019). Typically, the treatment goal of BPH is to reduce the severity of the patient’s symptoms and prevent long-term complications. Adherence to patient medications has a significant role in reducing the severity of symptoms and improving one’s clinical outcomes. The clinician’s role in this instance is to provide adequate and thorough education to the patient regarding treatment options, their risks and benefits, and duration of treatment. It has been shown that, with verbal communication only, patients only retain about 20% of the information taught (Sare et al., 2020). Improvement of treatment adherence and clinical outcomes can occur when using both verbal and written material to ensure higher education retention rates. This written material would be better accessed through the Internet, such as a website or application, rather than brochures and pamphlets can be easily lost during traveling or in the home. One factor to be cognoscente of when creating educational material is to ensure it has high readability. On average, an American is able to read at a level of a seventh to eight grade student (Sare et al., 2020). The clinician needs to be mindful of the educational status and cognitive status of their client when providing material for treatment adherence.

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Download the LDL-C Manager app by the American College of Cardiology – the URL is: https://www.acc.org/LDLCmanager

For the initial post provide data that correlates with the following case:

52 y/o African American male with ST-elevation myocardial infarction (STEMI) 6 months ago

Strong fam hx of heart disease

Patient went to cardiac rehab for the first 3 months after his MI but has just been going to the gym to ride the bike two to three times a week now. He denies unilateral weakness, numbness/tingling, or changes in vision. He denies CP and only has SOB if he really pedals hard on the bike for longer than 15 minutes. He denies changes in bowel or urinary habits. He denies any lower extremity edema.

MEDICATION LIST:

Carvedilol 25mg po bid

Atorvastatin 80mg po qd

aspirin 81mg po qd

Plogridolel 75 mg PO once daily

Lisinopril 40 mg po qd

Clothalidone 25mg po qd

BP 136/85, P 64, RR 18, T 38.2°C; Wt 102.3 kg, Ht 6′0″

Total Cholesterol 190; HDL 40; LDL 121; triglycerides 145

PE: normal heart, lung and abdomen. Liver enzymes WNL

Calculated patient risk of a cardiovascular event
What are the patients CV risk factors (consider med list)
Change at least one data parameter (LDL, HDL, smoking cessation, et. al) and provide the new CV risk calculation
Discuss what resources were most helpful in this tool – Lowering LDL-C booklet – and how it can be used in the clinic setting

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Your responses should be a minimum of 250 words, scholarly written, APA formatted, and referenced. A minimum of 4 references are required (other than your text).

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