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DIRECTIONS: 

For each of the scenarios below, answer the questions using your learning resources, Medscape, and clinical practice guidelines (ie JNC 8, AHA, ACC etc). Lecturio is an optional resource but highly recommended. Be sure to thoroughly answer ALL questions. When recommending medications, write out a complete medication order. What would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply) and refill information. Also state if you would continue, discontinue or taper the patient’s current medications. Review and discuss ALL labs and possible interactions. Use at least 3 sources for each scenario and cite sources using APA format; include in-text citations. You do not need an introduction or conclusion paragraph. Please also review assignment rubric.  

SCENARIO 1

What are the  errors in the following prescriptions (1 per prescription)? Rewrite each prescription correctly. What is each medication’s classification and mechanism of action (MOA)?

· Repatha 140 mg IV every 2 weeks #1 1 RF

· Hyzaar (losartan/hydrochlorothiazide) 50/25 mg PO daily #30 3 RF

· digoxin 1.25 mg PO daily #30 1 RF

· hydralazine/isosorbide mononitrate (BiDil) 37.5 mg/20 mg PO every 8 hours #90 1 RF

· clonidine 0.3 mg patch PO once weekly #4 1 RF

 

SCENARIO 2

A patient with stable angina is prescribed nitroglycerin. The provider avoids oral tablets and instead chooses a sublingual or transdermal formulation. Why is oral nitroglycerin not clinically useful? Discuss how first-pass metabolism affects nitroglycerin’s bioavailability and define both terms. Identify the route of administration with 100% bioavailability and explain how alternative routes overcome the first pass effect. Include a sample prescription for nitroglycerin.

 

SCENARIO 3

Where are the majority of cytochrome P450 (CYP) enzymes located? Using the Drugs.com pill identifier, enter the following characteristics to identify the medication AND strength. What CYP enzyme metabolizes this medication? How can this information be applied to medication therapy management? Write a sample prescription for the identified medication and strength.

Imprint (E 137)  Shape (Round)  Color (Pink)  Form (Tablet)  Scoring (None) 

 

SCENARIO 4

KU is a 47-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on lisinopril 40 mg po daily, liraglutide (Victoza) 0.6 mg subcutaneously once daily and St. John’s Wort. Fasting lipid profile shows total cholesterol 260 mg/dL, LDL 180 mg/dL, HDL 43 mg/dL, and TG 185 mg/dL. He is 5’9” and weighs 204 lbs. What treatment plan would you implement for KU? What are GOAL Total Cholesterol (TC), HDL, LDL, and Triglyceride levels for KU? What is his BMI per Medscape calculator? What patient monitoring and education would you provide? How many risk factors for coronary artery disease does this patient have? Identify them specifically.

To Prepare:

· Review the information provided and answer questions posed in the case study

· When recommending a medication, write out a complete prescription for the medication

· Whenever possible, use clinical practice guidelines in developing your answers when possible

· Include at least three references to support your answer and cite them in APA format.

Rubric:

NURS_6521_Week2_Assignment_Rubric

NURS_6521_Week2_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeScenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation

3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.

2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.

1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.

0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

This criterion is linked to a Learning OutcomeScenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation

3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.

2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.

1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.

0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

This criterion is linked to a Learning OutcomeScenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation

3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.

2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.

1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.

0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

This criterion is linked to a Learning OutcomeScenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation

3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.

2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.

1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.

0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3 pts

Total Points: 100