Advanced Pharmacology Week 3, 4, Shadow Health Community Acquired Pneumonia Discussion Essay

Advanced Pharmacology Week 3, 4, Shadow Health Community Acquired Pneumonia Discussion Essay

Advanced Pharmacology Week 3, 4, Shadow Health Community Acquired Pneumonia Discussion Essay

Advanced Pharmacology Week 3 Sample paper

This week we focused on anti-infective agents and their role in the management of Covid-19. Various anti-infective agents were discussed; however, the major focus was put on azithromycin, an antibiotic used in care for patients with covid 19. The review article Azithromycin in the management of Covid-19 discussed the effectiveness of Azithromycin in the treatment of Covid-19. The evidence provided is based on expert opinions and various experimentations based on a literature search from PubMed.

Coronavirus disease-19 is a viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) that was declared a pandemic in august 2019. The virus spreads quickly through respiratory droplets and presents with symptoms or no symptoms (Lotfi et al., 2020). Common signs and symptoms include cough, fever, chest pain, running nose, sore throat, shortness of breath, fatigue, headache, nausea, and vomiting (Echeverría-Esnal et al., 2021). Other symptoms include body aches and loss of smell. The pandemic had a profound impact on the social, economic, and caused business closures and lockdowns. Despite the various studies conducted, there is no single medication that has been proven to treat Covid-19 with most people adopting prevention measures such as social distancing, mask-wearing, handwashing, and self-isolation as well as offering symptom relief treatment. Trials using virus anti-infective agents such as antibiotics and antiviral continue. According to Lotfi et al. (2020), World health organization recommends prevention strategies as well as symptomatic treatment of patients with severe symptoms.

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According to Echeverría-Esnal et al. (2021), azithromycin is effective in the treatment of respiratory viral infections when combined with antiviral or used singly leading to significant resolution of sore throat and fever. Unlike other antibiotics, azithromycin has the concentrate in the lung with additional chemotactic drug delivery allowing achievement of therapeutic and sustained concentrations thus being recommended for Covid-19 treatment. Therefore, understanding the best therapy for a patient is essential for healthcare providers to enable them to choose the best medications for patients. However, patient considerations should be factored in every situation.

Week 4

Pulmonary Medications

This week`s module focused on medications used for various pulmonary disorders. Among the various medications discussed, albuterol, a short-acting beta agonist was the medication that stuck in my mind. Albuterol is a medication I have interacted with on most occasions as I have witnessed some of my friends use it. According to Chipps et al. (2021), albuterol is a medication is a bronchodilator and is commonly used in relieving breathing difficulties in patients with bronchospasm associated with chronic obstructive pulmonary disease (COPD) and asthma. For its delivery, either metered-dose inhalers or nebulization can be used.

To understand the efficacy and reliability of either delivery method, I reviewed an article by Payares-Salamanca et al., a systematic review and meta-analysis that compared metered-dose inhalers versus nebulization of albuterol for acute exacerbations of wheezing or asthma in children. The researchers reviewed 15 randomized control studies of 2057 patients that compared the response to treatment when either of the delivery methods was used. In terms of hospital admission, there was no significant difference, however, there was a reduction in pulmonary index score and a smaller increase in heart rate when using metered dose compared to nebulization (Payares-Salamanca et al., 2020). Asthma exacerbation is a common condition among pediatrics and one of the leading causes of emergency visits in my facility. Therefore, the findings of this study will help in future practice to choose the best delivery method when administering albuterol to patients with albuterol to enhance bronchodilation.

Patients’ education when using albuterol is important. For instance, patients must understand the common side effects of albuterol such as headache, nervousness, tachycardia, and muscle cramps. Severe side effects such as shortness of breath, chest pain, or worsening breathing require urgent treatment and discontinuation (Payares-Salamanca et al., 2020). Additionally, understanding various drug interactions with beta-blockers and diuretics is essential for every patient. Finally, patients should use the medication as directed by healthcare providers to enhance outcomes.

Case study 1

The case study is about Mrs. Douglas, a 72-year-old African American female with chronic kidney disease (CKD) and hypertension, who complains of chest pain, productive cough, nasal congestion, fever, and fatigue. Further history, clinical examination, and laboratory tests were done. A diagnosis of community-acquired pneumonia (CAP) was made for Mrs. Douglas. She was started on doxycycline and amoxicillin/clavulanate for seven days. She was provided with education about her diagnosis, prescribed antibiotics, side effects, and anticipated response. She was also directed on how to take her medications. She verbalized understanding of the directives.

This case study taught me several things which I can use to educate others. First, I learned the importance of educating patients about their diagnoses. For instance, Mrs. Douglas had to understand that CAP is a respiratory infection caused by viruses, fungi, or bacteria that cause inflammation of the parenchyma. Risk factors include weakened immunity, cigarette smoking, and chronic pulmonary diseases (Lee et al., 2021). Common presenting symptoms include chest pain, cough, fever, and difficulty in breathing similar to Mrs. Douglas. Essentially, educating patients about their diagnosis improves satisfaction and increases adherence to care. As a result, I will make it a habit to educate all of my patients about their diagnoses.

I also learned about the principles of selecting medications based on patient history, medical conditions, and prescribed medications. For instance, Mrs. Douglas could only benefit from doxycycline and amoxicillin clavulanate as she had hypertension and CKD while taking medications for the same. Doxycycline is a tetracycline, a class of antibacterial that inhibits bacterial growth thus eliminating infection (Lee et al., 2021). Mrs. Douglas was advised to take the medication with or without food, take plenty of water, and take medication as prescribed without overdosing or underdosing. She was also advised to wear a hat and long sleeves as doxycycline increases sensitivity to sunlight. Finally, she was also advised to be watchful of side effects such as chest pain, difficulty in breathing, abnormal swelling, and a rash which may warrant medication discontinuations. As an advanced practice nurse, I will continue educating my patients while caring for them.

References

Echeverría-Esnal, D., Martin-Ontiyuelo, C., Navarrete-Rouco, M. E., De-Antonio Cuscó, M., Ferrández, O., Horcajada, J. P., & Grau, S. (2021). Azithromycin in the treatment of COVID-19: a review. Expert Review of Anti-Infective Therapy, 19(2), 147–163. https://doi.org/10.1080/14787210.2020.1813024

Chipps, B. E., Albers, F. C., Reilly, L., Johnsson, E., Cappelletti, C., & Papi, A. (2021). Efficacy and safety of as-needed albuterol/budesonide versus albuterol in adults and children aged ≥4 years with moderate-to-severe asthma: rationale and design of the randomised, double-blind, active-controlled MANDALA study. BMJ Open Respiratory Research, 8(1), e001077. https://doi.org/10.1136/bmjresp-2021-001077

Lee, H., Choi, Y. Y., Sohn, Y. J., Kim, Y. K., Han, M. S., Yun, K. W., Kim, K., Park, J. Y., Choi, J. H., Cho, E. Y., & Choi, E. H. (2021). Clinical efficacy of doxycycline for treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. Antibiotics (Basel, Switzerland), 10(2), 192. https://doi.org/10.3390/antibiotics10020192

Lotfi, M., Hamblin, M. R., & Rezaei, N. (2020). COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clinica Chimica Acta; International Journal of Clinical Chemistry, 508, 254–266. https://doi.org/10.1016/j.cca.2020.05.044

Payares-Salamanca, L., Contreras-Arrieta, S., Florez-García, V., Barrios-Sanjuanelo, A., Stand-Niño, I., & Rodriguez-Martinez, C. E. (2020). Metered-dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta-analysis. Pediatric Pulmonology, 55(12), 3268–3278. https://doi.org/10.1002/ppul.25077

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Write a peer reviewed research article that corresponds to Week 3 (a peer reviewed research article that corresponds to the COVID-19 pandemic and anti-infective treatments topics. This can be a review article on a disease, research study, qualitative analysis etc. ) and Week 4 (pulmonary meds). This can be a review article on a disease, research study, qualitative analysis etc. Summarize the article and discuss how it relates to your practice as an Advanced Practice Nurse. (Does not need a cover page. Just need the paragraphs for each week’s topics and references. I would prefer week3 paper to be on page 1, week4 paper to be on page 2, and case study 1 discussion to be on page 3. Thank you) On Page 3, Case Study 1 Discussion. Create your post on the Case Study 1 (Shadow Health: Community Acquired Pneumonia. Patient name -Anita Douglas) in response to the following: What did you learn from case study 1 that you can bring back to your peers or work environment?

** Please see attached sample papers. Thank you.

WEEK 3 Topic: Anti-infective agents (antibacterial -Aminoglycosides, Cephalosporins, Beta Lactams, Chloramphenicol, Macrolides, Penicillins, Quinolones, Sulfonamides, Tetracyclines, Glycylcylines. Antiretrovials- efavirenz, tenofovir, rilpvirine, emtricitabine, elvitegravir, covicistat, raltegravir, ritonavir, lamivudine) interferon alfla, peginterferon alfa, oseltamivir, acyclovir, ribavirin, valacyclovir, Antimicrobacterial agents- Isoniazid, Rifampin, Amikacin, Ciprofloxacin, Clarithromycin, Levofloxacin, Moxifloxacin, Streptomycin..)

Post a peer reviewed research article that corresponds to the COVID-19 pandemic and anti-infective treatments topics. This can be a review article on a disease, research study, qualitative analysis etc.

· WEEK 3 Objectives: Identify medications for specific infections

· Address patient-specific characteristics

· Define adverse drug reactions and drug interactions

· Provide patient education resources to ensure medication understanding and compliance

WEEK 4 Topic: Pulmonary medications ô€€€ LABA (Long-Acting Beta Agonists) Formoterol, Salmeterol ô€€€ LAMA (long-acting muscarinic antagonist) tiotropium, Aclidinium, Umeclidinium ô€€€ SABA (short acting beta agonists) albuterol, ICS (inhaled corticosteroids), Fluticasone/salmerterol, Mometasone/formoterol, Budesonide/formoterol, Antitussives ( Benzonatate, Dextromethorphan, Codeine, Hydrocodone, Diphenhydramine), Expectorant: guaifenesin, Mucolytic: acetylcysteine

· WEEK 4 Objectives: Identify pulmonary medications that are utilized for the various respiratory diseases.

· Identify interventions based on the patient population and specifics

· Provide patient education as it relates to pulmonary medications

CASE STUDY 1 Community Acquired Pneumonia (It’s from the program that my prof uses called ‘Shadow Health.’ We take this simulation test and have to write about it approx. 240 words -what we learned and what can I bring to workplace as RN (homecare agency private duty nursing case manager)/or as future Advanced Practice Nurse)

*Subjective Data: Anita Douglas is a 72-year-old African-American female presenting with chest pain, nasal congestion, a productive cough, fatigue, and fever. Her symptoms began three days ago. She attempted to relieve her symptoms at home by taking aspirin and resting. She states fever began one day ago. She is having constant fatigue, congestion, and fever. Her chest pain is characterized as dull and only occurs with coughing. Deep breathing and speaking aggravates her chest pain. Chest pain with coughing is 5 out of 10. She is taking her medications as prescribed. Allergies: No allergies to medications, latex, food or environment PMH: Chronic kidney disease type II, hypertension PFH: Reports paternal hypertension Social History: • Retired veterinarian • Lives with husband • Eats ovo-lacto vegetarian diet, and usually eats pasta or salad • Reports 1-2 glasses of wine per week • Denies tobacco or illicit drug use Health Promotion/Vaccines: Reports pneumococcal vaccine 12 years ago and influenza vaccine 3 months ago Review of Systems: • Constitutional: Reports fever, fatigue, muscle soreness • HEENT: Reports sinus congestion • Cardiovascular: Reports chest pain • Respiratory: Reports productive cough.

*Assessment: Anita Douglas is a 72-year-old African-American woman presenting with signs of Community-Acquired Pneumonia. CURB-65 score is 1. She has chest pain, nasal congestion, a productive cough, fatigue, and fever. Her symptoms began three days ago. She attempted to relieve her symptoms at home by resting and taking aspirin. She has two chronic conditions, hypertension, and chronic kidney disease stage 2.

*She takes two medications at home: a trandolapril/verapamil combination drug, and chlorothiazide. I prescribed Dr. Douglas a five-day course of doxycycline antibiotics and a seven-day course of amoxicillin / clavulanate antibiotics to treat the CAP Dr. Douglas will need to return once the infection is cleared up so she can receive her pneumococcal vaccine.

*Education done to patient: Take with a meal to avoid stomach upset. Finish all of this medication as prescribed. If you forget to take a dose, take the next scheduled dose as soon as you remember, but do not double dose. If you experience significant abdominal pain or severe diarrhea, stop taking the medication and call your provider. If you develop any trouble breathing or chest pain or chest tightness, rash, or abnormal swelling in the body, you may be experiencing an allergic reaction. Stop taking this medication and call your provider. Doxycycline -This medication may cause sensitivity to sunlight. While you are taking this medication, wear a hat and long sleeves outdoors to prevent a possible sunburn. Other symptom- Take acetaminophen for pain and fever. Take guaifenesin for congestion and cough relief. Follow up in 24 to 48 hours to report progress. Drink plenty of fluids.

*Antibiotics prescribed: Doxycycline 100mg BID 5 days. Amoxicillin / clavulanate 875mg/125mg BID 7 days.

*What I learned (I missed points from medication selection and I learned why the medication I chose was inappropriate): You have selected a medication that is not the best choice for Dr. Douglas’s community-acquired pneumonia. Choose a drug that complies with the treatment algorithm and does not present dangers to her pre-existing health conditions or home medications. You have one more attempt, so try again. Fluoroquinolones such as levofloxacin are approved for the treatment of community-acquired pneumonia in patients with comorbidities such as renal disease; however, due to the patient’s age and because of the risk of serious adverse reactions such as cardiac arrhythmia, this is not the best selection for Dr. Douglas. / Amoxicillin / clavulanate and azithromycin is an inappropriate selection due to the high local rate of macrolide resistance where Dr. Douglas lives./ Amoxicillin / clavulunate and doxycycline is a correct choice for Dr. Douglas’s community-acquired pneumonia; it is the best-choice treatment option and does not interact dangerously with Dr. Douglas’s home medications, her hypertension, or her chronic kidney disease

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***Rubric

Response is at least 250 words and addresses all elements of the discussion activity. Includes 2 scholarly references within the past 5 years (1 reference must be a source outside of the course textbook and materials). Response demonstrates an excellent understanding of the topic(s) through well-reasoned and thoughtful reflections; it is factually correct and substantive, with relevant references and examples and demonstrates a clear connection to the reading. Contributes regularly and on a timely basis, meets or exceeds the minimum requirement for replying to classmates, and always observes proper online etiquette (are respectful, courteous, and professional). Responses use correct APA format when indicated, are grammatically correct, and use proper sentence structure. May have 1-2 errors.