Category Archives: NR 508

NR 508 Week 1 Discussions 1 (Part 1) NEW

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NR 508 Week 1 Discussions 1 (Part 1) NEW

Discussion part one 

emily, a relatively healthy 5’5”, 32-year-old young woman weighing 190 pounds, presents to your clinic with hirsutism, anovulation, oligomenorrhea, and at times amenorrhea. biochemical blood tests reveal elevated luteinizing hormone (lh, without a mid-cycle surge) and androgen elevation.

she mentions that she also has a family history of irregular cycles, and that her grandmother experienced early menopause. she also states that she is sexually active, occasionally smokes (1 pack/month), and desires to be prescribed one medication to mitigate her symptoms, as well as, prevent her from becoming pregnant.

please provide a list of differential diagnoses, as well as an indication of your primary diagnosis.
once this has been completed, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.

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NR 508 Week 1 Discussions 1 (Part Two) NEW

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NR 508 Week 1 Discussions 1 (Part Two) NEW

discussion part two

you diagnose emily with polycystic ovarian syndrome (pcos) and decide to prescribe drospirenone-ethinyl-estradiol as a way to control both the pcos symptoms, as well as to act as an oral contraceptive.

at what dose should this be prescribed?
what is the mechanism of drospirenone-ethinyl-estradiol, and why would, because of its mechanism, it be a good choice for her pcos symptoms (include the medication-altered physiology)?
how would you monitor for efficacy and toxicity?
at what dose should this be prescribed?

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NR​ 508 Week 1 Discussions 1 (Part Three) NEW

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NR​ 508 Week 1 Discussions 1 (Part Three) NEW

discussion part three

emily subsequently returns to your clinic 5 months later, and decides to inform you that within the first 3 months after treatment, she struggled with a severe bout of depression. instead of returning to your clinic to be prescribed, yet another pharmaceutical, she consulted her herbalist who told her about the anti-depressant, over-the-counter, herbal formulation, st. john’s wort. she decided to begin taking st. john’s wort in conjunction with her prescribed oral contraceptive medication, and she has now reappeared at your clinic because she is pregnant, and is distraught about how this occurred since she took her oral contraceptive compliantly since its prescription.

why then, is she pregnant?
please include detailed pharmacological mechanisms of how this occurred, and your subsequent steps in her management.

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NR 508 Week 2 Discussions 1 (Part One) NEW

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NR 508 Week 2 Discussions 1 (Part One) NEW

discussion part one 

cynthia is a 65-year-old african american female who presents to the clinic for a check-up. her last examination was ~5 years ago. she has no specific, significant, or urgent complaint. she explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. you decide to do a physical exam, as well as draw labs and receive the following results:

 social history: no smoking or alcohol consumption.

physical examination:

gen: well nourished, slightly obese female

vs: bp 180/103 hr 73 rr 13 t 98.4 weight 90 kg, height 5’6”

heent: perrla

cor: rrr, nmrg

chest: cta

neuro: monofilament test shows decreased peripheral sensation

ext: normal

laboratory (fasting):

na 139 meq/l

k 3.8 meq/l

alt 34 u/l

ca 9.1 mg/dl

cl 102 mmol/l

hco3 22 meq/l

ast 39 u/l

tp 6 g/dl

bun 33 mg/dl

scr 2.0 mg/dl

alb 4.1 g/dl

cholesterol 254 mg/dl

bg 300 mg/dl

tsh 0.12 mu/ml

ua: sg 1.013 mg/24h, ph 6.5, +++ protein

what are the major problems in this patient, and what diagnoses do these values indicate?

additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action?

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NR 508 Week 2 Discussions 1 (Part Two) NEW

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NR 508 Week 2 Discussions 1 (Part Two) NEW

discussion part two

cynthia has been prescribed a plethora of medications. how will you properly monitor each medication for efficacy and toxicity? are you concerned with any drug-drug interactions? if so, what are they, and what is the mechanism of the interaction?

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NR 508 Week 2 Discussions 1 (Part Three) NEW

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NR 508 Week 2 Discussions 1 (Part Three) NEW

discussion part three

given cynthia’s increased creatinine and renal deterioration, metformin is probably not optimal in this case. therefore, upon subsequent visits, you decide to start her on a sulfonylurea. she reappears in your clinic fairly soon thereafter with complaints of shakiness, sweating, chills, clamminess, lightheadedness, and a moderately severe headache.

• what is the diagnosis given these symptoms and the medications she is currently taking from parts one and two, and how would you proceed?

• at this point, please also be sure to also provide an accurate summary of cynthia’s medication plan.

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NR 508 Week 3 Discussions NEW

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NR 508 Week 3 Discussions NEW

discussion part one 

elliot is a 74 year-old male who presents to your clinic with complaints of frequent nosebleeds (4 in the past week) and several severe bruises scattered variously throughout his anatomy. the patient is also complaining of a runny nose, cough, and head/chest congestion. he has a history of chronic atrial fibrillation and is currently prescribed and taking warfarin. approximately 3 weeks previously, he started taking over-the-counter cimetidine for heartburn he was experiencing.  below is a list of the patient’s medications, his physical examination, and his laboratory findings:

medications

digoxin 0.25 mg qd cimetidine otc bid

pseudoephedrine sr 120 bid warfarin 7 mg qd

allergies: nkda 

physical examination

vs: bp: 180/95, hr 75, irregularly irregular, rr 17

weight: 95 kg

heent: wnl

abd: + bowel sounds ext: bruising on arms and legs

neuro: alert & oriented x 3 gen: well developed, well-nourished male

ecg: atrial fibrillation 

laboratory

na 143 meq/l k 4.5 meq/l

cl 99 mmol/l co2 25 meq/l

bun 18 mg/dl scr 0.9 mg/dl

inr 4.8 hct 42%

hbg 15 mg/dl digoxin 3.8 ng/ml

what problems should be identified in this patient?

what are the precise mechanisms of action of each drug?

what do you think is contributing to the patient’s hypertension?

are there any drug interactions that you can identify as associated with this current drug regimen, and if so how, mechanistically, are they occurring?

what is the clinical significance of these interactions?

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NR 508 Week 3 Discussions 1 (Part Two) NEW

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NR 508 Week 3 Discussions 1 (Part Two) NEW 

discussion part two

you have decided to have him stop the pseudoephedrine related to his hypertension, as well as the cimetidine related to its interaction with warfarin. the patient returns for his monthly follow-up appointment, and it is noticed that his blood pressure (195/80) has not come under control. you decide to start him on hydrochlorothiazide.

is there a better medication than a thiazide, and if so what dose should you initiate this medication?
how would you proceed, and how you would monitor for efficacy and toxicity?

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NR 508 Week 3 Discussions 1 (Part Three) NEW

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NR 508 Week 3 Discussions 1 (Part Three) NEW

discussion part three

he returns a month later complaining of increased fatigue, visual disturbances, weakness, and nausea; however, his ecg is normal.

based on this information, what is occurring in this patient? include precise mechanism(s) of how it is occurring.

additionally, please include any drug interactions associated with any new medications initiated keeping in mind the current regimen.

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NR 508 Week 4 Discussions 1 (Part One) NEW

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NR 508 Week 4 Discussions 1 (Part One) NEW

discussion part one 

barbara is a married 39-year-old woman with no children, smokes 1 pack/day, and weighs 180 pounds who has scheduled an appointment with you to discuss feelings of anhedonia that she has been experiencing for the past few months. she has a history of depression as a teenager, but has not needed or received therapy for ~20 years. at the appointment, she relays that she has been experiencing chronic fatigue/loss of energy, feelings of worthlessness, appetite disturbances, weight gain, inability to concentrate, psychomotor disturbances, and insomnia.

please provide a list of differential diagnoses, as well as an indication of your primary diagnosis.
once this has been completed, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.

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