Sample Answer NURS 6501 Pharmacology_CASE_STUDY_WEEK_2.-1 for Included After Question
Week 2: Altered Physiology
With a place squarely in the spotlight for patients diagnosed with all manner of disease, APRNs must demonstrate not only support and compassion, but expertise to guide patients’ understanding of diagnoses and treatment plans.
This expertise goes beyond an understanding of disease and sciences, such as cellular pathophysiology. APRNs must become experts in their patients, understanding their medical backgrounds, pertinent characteristics, and other variables that can be factors in their diagnoses and treatments.
This week, you examine alterations in the immune system and the resultant disease processes. You consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.
Learning Objectives
Students will:
- Evaluate cellular processes and alterations within cellular processes
- Analyze alterations in the immune system that result in disease processes
- Identify racial/ethnic variables that may impact physiological functioning
- Evaluate the impact of patient characteristics on disorders and altered physiology
Learning Resources
Required Readings (click to expand/reduce)
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 1: Cellular Biology; Summary Review
- Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents(pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
- Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases,
- Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
- Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
- Chapter 7: Innate Immunity: Inflammation and Wound Healing
- Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
- Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
- Chapter 10: Infection (stop at Infectious parasites and protozoans); (start at HIV); Summary Review
- Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
- Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
- Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review
Note: You previously read these chapters in Week 1 and you are encouraged to review once again for this week.
Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls.
Note: This article was presented in the Week 1 resources. If you read it previously you are encouraged to review it this week.
Required Media (click to expand/reduce)
Immunity and Inflammation
Note: The approximate length of the media program is 14 minutes.

Note: The approximate length of the media program is 37 minutes.
Acid-Base Balance #1
Note: The approximate length of the media program is 13 minutes.
Acid-Base Balance #2
Note: The approximate length of the media program is 15 minutes.
Hyponatremia
Note: The approximate length of the media program is 15 minutes.
Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 3, 7, and 8 that relate to alterations in immunity, hyponatremia, and acid/base balance.
Note: To access the online resources included with the text, you need to complete the FREE online registration that is located at https://evolve.elsevier.com/cs/store?role=student
To Register to View the Content
- Enter the name of the textbook, Pathophysiology: The Biologic Basis for Disease in Adults and Children, or ISBN 9780323654395 (name of text without the edition number) in the Search textbox.
- Complete the registration process.
To View the Content for This Text
- Click on Student Site.
- Type in your username and password.
- Click on the Login button.
- Click on the plus sign icon for Resources on the left side of the screen.
- Click on the name of the textbook for this course.
- Expand the menu on the left to locate all the chapters.
- Navigate to the desired content (checklists, videos, animations, etc.).
Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.
A Sample Answer For the Assignment: NURS 6501 Pharmacology_CASE_STUDY_WEEK_2.-1
Title: NURS 6501 Pharmacology_CASE_STUDY_WEEK_2.-1
Pharmacology Case Study
The case study is of patient AO with a history of obesity and recent weight gain of 9 pounds. The patient has a diagnosis of hypertension and hyperlipidemia. The currently prescribed drugs include, Atenolol 12.5 mg daily, Doxazosin 8 mg daily, Hydralazine 10 mg QID, Sertraline 25 mg daily and Simvastatin 80 mg daily. This paper will discuss how age might influence the patient’s pharmacokinetic and pharmacodynamic processes and how changes in the processes might affect the patient’s recommended drug therapy.
How Age Influence the Pharmacokinetic and Pharmacodynamic Processes
Old age is associated with impairment in the function of various regulatory processes that facilitate the integration of functions between cells and organs. Pharmacokinetic changes that occur with age include decreased absorption of oral drugs and time of onset of action is delayed with advanced age due to decreased gastric secretion, gastrointestinal motility, gastrointestinal flow and increased pH (Schlender et al., 2016). Moreover, there is a decrease in renal and hepatic clearance and an increase in distribution of lipid-soluble drugs resulting in a prolonged elimination half-life in people with advanced age (Schlender et al., 2016). As a result, dosage should be decreased for drugs eliminated through the hepatic system in elderly patients. Pharmacodynamic changes include increased sensitivity to various classes of drugs such as cardiovascular, anticoagulant and psychotropic drugs.
Atenolol is a Beta-1 selective blocker indicated in the management of hypertension. The drug should be used with caution in geriatric patients to prevent toxicity as a result of high concentrations of Atenolol in the blood (Sarfraz et al., 2015). Besides, the dose of Atenolol should be prescribed with caution in an elderly patient by starting with a low dose due to decreased renal, hepatic and cardiac function in old age (Mukker, Singh & Derendorf, 2016). Doxazosin is an alpha blocker used in the treatment of hypertension and also in benign prostatic hyperplasia. The drug should be avoided in individuals above the age of 60 years in treatment of hypertension. Doxazosin use is associated with a high risk of orthostatic hypotension (Mukker, Singh, & Derendorf, 2016). If Doxazosin has to be used in geriatric patients, the initial dose should have a low dosage and it is recommended that the dosage is gradually adjusted.
Sertraline is an antidepressant in the class of Selective Serotonin Reuptake Inhibitors (SSRIs). Old age influences Sertraline pharmacodynamic processes. Geriatric patients may develop hyponatremia and hence a patient’s sodium levels should be closely monitored (Bhat, Thanusubramanian & Balaji, 2017). Furthermore, advanced age is associated with decreased clearance and a prolonged half-life of Sertraline and long-term administration of the drug in geriatric patients would result in late achievement of steady state concentrations.
How Changes in the Pharmacokinetic and Pharmacodynamic Processes Might Impact the Patient’s Recommended Drug Therapy
Atenolol is highly dependent on hepatic metabolism and a decrease in hepatic clearance can result in an increased drug concentration and eventually toxicity. The drug regimen with Atenolol may need to be altered by stopping the drug if the patient has hepatic impairment. In addition, Atenolol is excreted via the kidneys and severe impairment of renal function in the patient may result in eliminating the drug from the treatment plan (Goeres, Williams, Eckstrom & Lee, 2014). Doxazosin is extensively metabolized in the liver and a condition affecting the liver such as liver impairment may result in the dosage of Doxazosin being reduced or the drug being eliminated from the treatment plan.
Hydralazine is primarily metabolized in the liver and the drug’s metabolism may be affected by liver impairment. As a result, if the patient develops liver impairment, the dose may have to be reduced or the drug withdrawn (Goeres et al., 2014). Sertraline is metabolized by cytochrome P450 hepatic enzymes. It is recommended that the dose of Sertraline be decreased by 50% in patients with mild hepatic impairment. In patients with moderate to severe hepatic impairment, the drug is not recommended. Consequently, Sertraline dose may have to be reduced by half if the patient develops mild hepatic impairment or stopped if there is moderate to severe hepatic impairment. Simvastatin is converted to its active metabolite by hepatic enzymes thus its dose may require to be altered in a patient with liver impairment.
How I Might Improve the Patient’s Drug Therapy Plan
The patient is experiencing weight gain despite being in a moderate intensity statin therapy with Simvastatin 80 mg to manage hyperlipidemia. I will improve the hyperlipidemia treatment poll by changing to Atorvastatin 40 mg daily dose. Atorvastatin will also help in lowering the risk of stroke, diabetes type 2 and coronary heart disease in the patient since he has a history of hypertension (Wilmot et al., 2015). Beta blockers are associated with elevated lipid levels and Atenolol could be contributing to the patient’s weight gain (Goeres et al., 2014). I would remove Atenolol from the therapy plan and substitute it with Amlodipine 5 mg daily dose. Atenolol has drug interactions with Hydralazine that require close monitoring and may be contributing to ineffective control of high blood pressure (Goeres et al., 2014). Consequently, I will substitute Atenolol with Amlodipine.
Amlodipine will facilitate lowering blood pressure as well as the risk of fatal and non-fatal myocardial infarctions, strokes and cardiovascular events. Moreover, the drug is associated with improving the lipid profile and may contribute in lowering the low-density lipid cholesterol levels and promoting weight loss (Goeres et al., 2014). Lastly, I will remove Sertraline from the treatment plan since the patient has no history of depression or anxiety disorder. Besides, Sertraline is associated with fluid retention, and increased appetite, resulting in weight gain (Bhat, Thanusubramanian & Balaji, 2017). Stopping the drug might help in preventing weight gain in the patient.
References
Bhat, H. D., Thanusubramanian, H., & Balaji, O. (2017). Sertraline induced hyponatremia. Asian Journal of Pharmaceutical and Clinical Research, 1-2.
Goeres, L. M., Williams, C. D., Eckstrom, E., & Lee, D. S. (2014). Pharmacotherapy for hypertension in older adults: a systematic review. Drugs & aging, 31(12), 897-910.
Mukker, J. K., Singh, R. S. P., & Derendorf, H. (2016). Pharmacokinetic and pharmacodynamic considerations in elderly population. In Developing Drug Products in an Aging Society (pp. 139-151). Springer, Cham.
Sarfraz, R. M., Khan, H. U., Mahmood, A., Ahmad, M., Maheen, S., & Sher, M. (2015). Formulation and evaluation of mouth disintegrating tablets of atenolol and atorvastatin. Indian journal of pharmaceutical sciences, 77(1), 83.
Schlender, J. F., Meyer, M., Thelen, K., Krauss, M., Willmann, S., Eissing, T., & Jaehde, U. (2016). Development of a whole-body physiologically based pharmacokinetic approach to assess the pharmacokinetics of drugs in elderly individuals. Clinical pharmacokinetics, 55(12), 1573-1589.
Wilmot, K. A., Khan, A., Krishnan, S., Eapen, D. J., & Sperling, L. (2015). Statins in the elderly: a patient‐focused approach. Clinical cardiology, 38(1), 56-61.
A Sample Answer 2 For the Assignment: NURS 6501 Pharmacology_CASE_STUDY_WEEK_2.-1
Title: NURS 6501 Pharmacology_CASE_STUDY_WEEK_2.-1
The patient presented with those symptoms because the wound got infected and he developed sepsis. The redness seen in the wound is caused by increased blood flow to the area. Because more neutrophils, white blood cells, nutrient factors, and enzymes are deposited in the infected area to help fight the infection, the area will present with swelling (Hughes, 2016). Chemicals expelled by the white blood cells together with the increased activity at the site may cause hotness at the site and tenderness. Interleukin 10(IL 10) is a cytokine with strong anti-inflammatory properties that protect the host from damage and promote normal tissue homeostasis. It is also referred to as Cytokine Synthesis Inhibitory Factor (CSIF).
NNatural Resistance-Associated Macrophage Protein 1(NRAMP1) is primarily expressed in macrophages and monocytes and is involved in iron metabolism and host resistance to specific pathogens and controls natural resistance to infection. IL 4 is a cytokine that induces differentiation of young helper T cells to Th2 cells (Cianfarani, Zambruno, Castiglia, & Odorisio, 2017). Interleukin 4 has anti-inflammatory properties and they suppress the production of tumor necrosis factor.
Immunosuppression can cause increased susceptibility to opportunistic infections because there is an immune deficiency in the body and even the smallest of pathogens that normally wouldn’t cause an infection in the body but become pathogenic when the immune system is compromised (Larouche, Sheoran, Maruyama, & Martino, 2018). Immunosuppression may be induced in the body to reduce the risk of allograft rejection and increase the chances of survival after the transplant, Allograft vasculopathy may develop.
References
Hughes, M. A. (March 24, 2016). Wound infection: a knowledge deficit that needs addressing. British Journal of Nursing, 25, 6.) DOI: 10.12968/bjon.2016.25.6.S46
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Cianfarani, F., Zambruno, G., Castiglia, D., & Odorisio, T. (July 01, 2017). Patho mechanisms of Altered Wound Healing in Recessive Dystrophic Epidermolysis Bullosa. The American Journal of Pathology, 187, 7, 1445-1453. https://doi.org/10.1016/j.ajpath.2017.03.003
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Larouche, J., Sheoran, S., Maruyama, K., & Martino, M. M. (July 01, 2018). Immune Regulation of Skin Wound Healing: Mechanisms and Novel Therapeutic Targets. Advances in Wound Care, 7, 7, 209-231. https://doi.org/10.1089/wound.2017.0761