Unit 8 Pharmacology Self-Reflection Assignment

Hall

Alexandria Hall

Professor Garrison

Biology 393- Pharmacology

7 August 2020

I really enjoyed taking this class. I was super skeptical and scared about taking a fast- paced pharmacology class, knowing that I was going to be bombarded with hundreds of drugs and their properties. I would have to say that pharmacology has been the toughest class so far in my academic endeavors. I had to keep a positive mindset, and remember to take it one day at a time. I thought you did a great job in helping us have a better understanding of this subject and mastering the content. I believe the aspect of this course that was most beneficial to me would have to be the various assignments we did throughout the 8 weeks. This class was not solely based on quizzes and tests like a lot of my other prerequisite courses, which allowed me to step out of my comfort zone. I feel confident in the knowledge I have gained in this course, and I now have a better understanding of pharmacology..

To begin, I would like to mention the few things I learned in this pharmacology course that I was clueless about before jumping right into the course. The lessons I learned are: how to solve dosage calculation problems, the side effects and adverse reactions that prescription and OTC cholinergic and adrenergic drugs cause that people may or may not know about, how to treat a patient that is pregnant with epilepsy given her history and present symptoms, studying about COVID and how the antiviral Remdesvir can treat it ( discussing social implications and adverse reactions), and being able to matching the classification of the drug to the prototype. Not only this, but I learned a lot of drugs and their various properties.

One very important topic that I learned during this 8 week pharmacology course that I had little knowledge of prior to taking this course is dosage calculations. The simple way you taught us how to do dosage calculation problems was so easy to grasp. Before taking pharmacology, I knew that calculating dosages was important, but I did not know how important it was. Let’s just think about it. If I miss calculated a dose of a certain drug, I could end up killing a patient. I see why you made it a goal to get a 95% or better on the quizzes.

The dosage calculations that are in the same units are my favorite. All you have to do is divide what you give by what is available. For example, if you have to give 50 mcg, and you have 100 mcg in one mL, you would divide 50 mcg by 100 mcg and administer 0.5 mL. The next type of questions were a little bit harder because you had to convert between units, but it was the same concept: divide what you give by what is available. The trickiest type of problems were the word dosage calculation problems. I learned to ignore the excess information and only focus on the important things. I multiplied the weight in kilograms by what I had to give. If the units were not the same, I would convert them. Then, I would do give divided by what I have.

The next thing I want to talk about is the discussion board on cholinergic and adrenergic drugs and their unwanted side effects and adverse reactions. Prior to taking this pharmacology course, I did not know much about cholinergic and adrenergic drugs. This was definitely in my list of the top 5 things I learned. I discovered that cholinergic and adrenergic drugs have an effect on certain receptors. These drugs either imitate or halt the action of the neurotransmitter at the specific receptor. For example, cholinergic drugs work at cholinergic receptors, and can either imitate or halt the action of acetylcholine.(PNS) On the other hand, adrenergic drugs act on adrenergic receptors and influence or block responses to epinephrine or norepinephrine. (SNS) Cholinergic agonists work like acetylcholine to reduce heart rate, increase gastric secretions, increase sweating and salivation, etc… Or, they can have the opposite effect as antagonists. Adrenergic agonists increase blood pressure and heart rate, dilate the pupils, dilate the bronchi in your lungs to enhance oxygenation, and also provide glucose to create more energy for the body. These drugs can also be antagonists.

I want to give one example from this discussion. When I was reading in our textbook about different kinds of cholinergic agonists, I came across Cevimeline. Cevimeline is a prescription cholinergic agonist. I noticed that it was used to help treat Sjogren’s syndrome. Sjogren’s syndrome is a disorder of your immune system characterized by dry eyes and dry mouth. Cevimeline treats this disease by stimulating the production of saliva by acting on muscarinic receptors on tissue inside salivary glands, and it can also improve lacrimation. I was very interested in learning about Sjogren’s syndrome and how Cevimeline treats it because I remembered my grandpa has this disease. He told me all about his deliberating diagnosis, and how this drug did not work for him. It is important to note that the whole purpose of this discussion was to see how prescription drugs can cause unwanted side effects and adverse reactions. One side effect this drug can cause is blurry vision. I think it is very important for people to be aware of this. Blurry vision can affect a person when driving, and can cause them to get in an automobile accident. In my grandfather’s case, the terrible side effect he experienced was a slow heart rate. He already had bradycardia before taking this drug, and after he began taking it, it caused his heart rate to become dangerously low and the doctors immediately took him off of it. We have to be so careful nowadays with prescription drugs. They can have nasty side effects that you may not know about, and can turn bad in an instant, just like it did for my grandpa.

I learned that it is very important to consult with a physician before taking any prescription drug. You need to be cautious when taking these drugs, and educate yourself about all of the known potential side effects. As with certain OTC drugs, you need to be careful about unwanted side effects that you may or may not know about. The side effects from an over-the-counter drug can be just as powerful as any prescription drug, so you must be careful when taking them. I feel like I researched the most for this discussion board, and I feel confident talking about the new knowledge I have.

The next thing I would like to discuss is the case study involving a seizure disorder in a pregnant patient. This was for sure my favorite case study. I am so happy that you chose to incorporate case studies into our grade, due to the fact that it gives a chance to really figure out how to diagnose/treat the patient based on their history, present condition, and symptoms.

In this case study, our patient admitted that she was drinking alcohol. The clinic gave her a pregnancy test and it came back positive. I knew you should not consume alcohol while pregnant, but this case study really extended my knowledge about the drug interactions that can occur if you drink alcohol. I thought it was so important to discuss this with the patient. Not only can alcohol affect her baby, but it can cause some serious side effects with Dilantin, the drug she was on when she came into the clinic.

I had no idea there were pregnancy risk categories for drugs. These categories range from A (the least risk) to B,C,D and then to X (the extreme risk). I had to research the categories for: phenytoin, oxcarbazepine, lamotrigine and levetiracetam. I discovered that phenytoin was in category D. This made me weary about having the patient continue this medication. The other three drugs were in category C.

When I was asked to choose the drug to give this pregnant woman who has seizures, I did a process of elimination approach. Phenytoin was the most expensive, had the highest risk for MCM’s, is a category D drug, and has several side effects and drug interactions. This is why I crossed this one off the list. I chose not to prescribe oxcarbazepine just because it is not approved to use when you are already pregnant. This patient is pregnant, so I crossed this one off the list. I chose not to pick levetiracetam because there is no proof that it is safe to use during pregnancy. When I prescribe any drug for a patient, I want to make sure it is safe for them. Not only that, but this patient was pregnant, and you want to make sure the health of the baby is perfect. So, I chose lamotrigine to give to my pregnant patient with epilepsy. After researching, it was a category C drug, had the least number of side effects, the least risk for MCM’s, and it was the least expensive.

The next top thing I learned in this class was when we were assigned the module reflection regarding COVID and Remdesivir. COVID is affecting us in a very negative way. This is the first pandemic I have been able to experience and understand. In this module reflection, I talked about what the coronavirus is, and how we treat it. Since it is a virus, antibiotics will not treat it. I knew before this class that if you have a viral infection antibiotics will not work, however I thought this virus was a little bit different. I figured antibiotics might work, but after reading Chapter 93, I realized only antiviral drugs will work.

The antiviral drug I discussed in this reflection was Remdesivir. Remdesivir basically tricks the virus into thinking it is a piece of the viral RNA, then when the drug comes in contact with the enzyme RdRp, the replication is blocked. I had no idea that Remdesivir could cause a side effect such as an increase in liver enzyme levels. It can even lead to liver damage. Before this assignment, I had barely heard of Remdesivir. Also, when doing the COVID and Remdesivir assignment, I found out that Remdesivir really was not that effective. The recovery time with someone taking Remdesivir versus someone with a placebo was a minor difference. Also, the mortality rate for people taking Remdesivir versus those with the placebo was only a 4% difference. This assignment furthered my knowledge about what COVID 19 was, and how it affects our bodies. I never even thought about using an antiviral drug for this virus, but I am very hopeful. I am so glad you let us do an assignment on this, because I did not know much about Remdesivir before this class. I would love to see if Remdesivir is proven to work if more trials can be done. I am also highly interested in seeing if a vaccine can be proven effective.

The last top thing I learned in this class involves a course objective/module objective. In every module, you wanted us to be able to match the major classifications of drugs with their prototype drugs. I was able to do this very well in module 2. I think one of the most important concepts of this class is matching the classification of drugs with its prototype. I also think it is highly important to be able to know the side effects, drug interactions, and how each drug affects the body. For example, in module 2, I learned that the prototype drug for the muscarinic agonists is bethanechol. The prototype drug for the muscarinic antagonists is atropine. The prototype drug for the cholinesterase inhibitors is neostigmine. I discovered the prototype for the adrenergic agonists is epinephrine. The prototype for the beta-selective adrenergic agonists is isoproterenol. A prototype drug for the selective beta adrenergic antagonists (beta blocker) is metoprolol. After I learned about metoprolol in Chapter 18, I used my knowledge of this drug to help in the case study about a patient with heart failure. I ended up prescribing a beta blocker to the patient.These are just a few of the examples.

I studied about the neuromuscular blocking agent succinylcholine. It is a depolarizing drug. This drug binds to nicotinic receptors and creates depolarization. It makes the end-plate be in a constant state of depolarizing. Because it can do this, it creates paralysis. Succinylcholine is used for muscle relaxation, and it can create paralysis without feeling pain or being unconscious. It has a very short duration period. After the drug is injected through IV, it peaks and then loses its effectiveness 4-10 minutes later because it is degraded by the enzyme pseudocholinesterase. This drug is mainly to relax the patient’s muscles during endotracheal intubation. It can also be used to lessen the muscle contractions when electroconvulsive therapy is used. It can cause adverse side effects like: prolonged apnea, malignant hyperthermia, high potassium levels, and even postoperative pain in the patient’s muscles. You want to make sure you do not use this drug with cholinesterase inhibitors or antibiotics.

I really felt like I knew every single module front and back. However, it seems like I know module 2 the most. Every single time I read a module objective telling me I needed to match the classification of a drug with the prototype, I memorized it. I think this is a very important skill to have going into nursing school. Like I mentioned before, for every single module, 1-5, I learned the drug, how it worked in the body, its therapeutic effects, side effects, and drug interactions. This concept is for sure one of the top five things I learned in the class.

Indeed, the top five things I learned in this pharmacology class that I did not know prior to taking the class is: dosage calculation problems, prescription and OTC cholinergic and adrenergic drugs and the unwanted side effects and adverse reactions they cause, the case study involving how to treat a pregnant patient with epilepsy, how to treat COVID with the new antiviral drug Remdesvir (this included the social implications and side effects), and the module objectives regarding matching the classification of the drug to the prototype (also learning about the way drugs work in the body, their therapeutic effects, side effects, and even drug interactions). Thank you for the opportunity to be in your online pharmacology class. I truly enjoyed having you as a professor. I did my best with the circumstances, and I know that I have gained a lot of knowledge from pharmacology that I can apply to my life.