Pharmacology Discussion Assignment

Pharmacology Discussion Assignment

Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2).

INSTRUCTIONS:

Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource!

Note: DO NOT CRITIQUE THEIR POSTS, DO NOT AGREE OR DISAGREE, just add informative content regarding to their topic that is validated via citations.

– Utilize at least two scholarly references per peer post.

Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the second one is the reply to my other peer Post #2. Pharmacology Discussion Assignment

ORDER A PLAGIARISM – FREE PAPER NOW           

– Minimum of 300 words per peer reply.

Background: I live in South Florida, I am currently enrolled in the Psych Mental Health Practitioner Program, I am a Registered Nurse, I work in a Psychiatric Hospital.

Gastrointestinal Case Study

CF is a 48-year-old man who presents for evaluation of heartburn. He denies current tobacco use but has a history of one ppd for 15 years. He consumes a glass of wine nightly, more on the weekends. He has a sedentary job.

He reports a burning feeling in his chest after eating. It is worse when he eats spicy foods or tomato sauce. He is sometimes awakened at night with these symptoms. He has tried over-the-counter antacids and histamine H2 receptor antagonists (H2RAs) with partial relief. He is on no regular medications. His examination today is normal. An upper gastrointestinal (GI) X-ray series reveals gastroesophageal reflux.

1. What lifestyle modifications do you recommend for CF?

2. Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also consider interactions and side effects.

3. What counseling points about this medication do you give CF?

POST # 1 AYME

The case of CF (48 y/o man) represents a positive diagnosis of Gastroesophageal Reflux Disease (GERD). In his case, it seems that the GERD has been persistent and there are various aggravators of the condition that feature. For instance, his history of smoking might be blamed for the aggravation of the condition in its early stages. Nevertheless, various factors within his current lifestyle have been associated with the exacerbation of the GERD. These include the use of alcohol, eating spicy foods, and having a sedentary lifestyle (Sethi & Richter, 2017). The management of GERD requires the use of both lifestyle modifications and medications. In this regard, this paper delves deeper into CF’s treatment in light of this diagnosis Pharmacology Discussion Assignment.

1.     What lifestyle modifications do you recommend for CF?

Lifestyle aspects such as a sedentary lifestyle increase the risk of overweight and obesity which are among the risk factors of GERD. Besides, eating spicy foods as well as alcohol use is part of lifestyle factors that exacerbate acid reflux. Therefore, the lifestyle recommendations for this patient include alcohol cessation, avoiding spicy foods, and increased uptake of physical activities, weight management as well as avoiding other foods or drinks that trigger the acid reflux.  Acidic beverages and drinks such as coffee worsen the GERD, therefore, accentuating the need to advise the patient on the right beverages or drinks that do not worsen the reflux. These lifestyle modifications have been associated with the suppression of the acid reflux as well as subduing some of the pathophysiological mechanisms linked to the progression or exacerbation of the condition (Sethi & Richter, 2017)Pharmacology Discussion Assignment. Even though the patient denies any current smoking, it is important to emphasize the necessity of desisting from tobacco smoking. Finally, lifestyle recommendations should insist on the need to take small amounts of foods as well as enhancing self-stress-management and coping skills since stress can worsen the condition.

2.     Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also, consider interactions and side effects.

This case represents a scenario of persistent GERD that has resisted the common OTC medications. In this regard, it is important to up-scale his treatment to include the use of proton-pump-inhibitors and Baclofen. Proton pump inhibitors suppress the parietal production of acids that worsen acid reflux. Baclofen, on the other hand, helps in reducing the frequency of the gastroesophageal sphincter. These medications are largely tolerated and do not cause serious side-effects and if at all, the side-effects are always mild and tolerable. Nevertheless, as a major consideration, it is important to acknowledge that prolonged or long-term use of proton pump inhibitors has been associated with kidney problems (Sethi & Richter, 2017)Pharmacology Discussion Assignment. In this regard, it is important to monitor the patient’s progress throughout the treatment to offer interventional measures in the event of these adverse effects.

3.     What counseling points about this medication do you give CF?

The use of proton pump inhibitors together with other medications can lead to undesired drug interactions. Notably, this effect of proton pump inhibitors of the gut’s acidity levels can affect the efficacy of medications such as protease inhibitors, isoniazids, and ketoconazole (Nehra, Alexander, Loftus & Nehra, 2018). Therefore, medical counseling for this patient should include the need to only use these medications following medical advice or only take them at the end of the proton pump inhibitors dosage interval. Other counseling should focus on the importance of medication adherence as well as reporting any abnormal effects.

References

Nehra, A. K., Alexander, J. A., Loftus, C. G., & Nehra, V. (2018, February). Proton pump inhibitors: review of emerging concerns. In Mayo Clinic Proceedings (Vol. 93, No. 2, pp. 240-246). Elsevier.

Sethi, S., & Richter, J. E. (2017)Pharmacology Discussion Assignment. Diet and gastroesophageal reflux disease: role in pathogenesis and management. Current opinion in gastroenterology33(2), 107-111.

Gastrointestinal Case Study

CF is a 48-year-old man who presents for evaluation of heartburn. He denies current tobacco use but has a history of one ppd for 15 years. He consumes a glass of wine nightly, more on the weekends. He has a sedentary job.

He reports a burning feeling in his chest after eating. It is worse when he eats spicy foods or tomato sauce. He is sometimes awakened at night with these symptoms. He has tried over-the-counter antacids and histamine H2 receptor antagonists (H2RAs) with partial relief. He is on no regular medications. His examination today is normal. An upper gastrointestinal (GI) X-ray series reveals gastroesophageal reflux.

1. What lifestyle modifications do you recommend for CF?

2. Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also consider interactions and side effects.

3. What counseling points about this medication do you give CF?

POST # 2 KAREN

This week’s scenario introduces CF, a 48-year-old male who presents today with a new diagnosis of gastroesophageal reflux disease (GERD). He is a current drinker, a former smoker, and has a sedentary job. He reports burning in his chest after eating, worse with spicy/high acid foods, and is sometimes awakened at night with these symptoms. CF has had some relief from over the counter antiacids and H2 receptor antagonists but takes no regular medications.  The first question to answer is what lifestyle modifications can CF make to improve his symptoms? Studies show that eliminating smoking, alcohol, caffeine, carbonated beverages, and chocolate can help minimize exacerbating factors (Patti, 2016). Other things CF can do include eating smaller meals, avoiding fluids with food, and avoiding food 3-4 hours before going to bed (West, 2019). More general lifestyle modifications include weight loss and elevating the head of the bed 30-40 degrees (West, 2019).  The next question asked is what is a rational drug choice for this patient? A Proton Pump Inhibitor (PPI) is the first lie drug of choice for GERD as they decrease acid secretion almost entirely and improve esophageal healing approximately 80% (Woo & Robinson, 2020), especially since over the counter choices have been only partially effective. Studies show that all types of PPI are equally effective at treating heartburn (Patti, 2016). I would begin this patient on an 8-week course of Lansoprazole at 15 mg daily (Woo & Robinson, 2020)Pharmacology Discussion Assignment. Treatment for more than 8 weeks would be avoided if possible due to the risk of C-Diff infections (FDA 2017), fractures (FDA, 2017), and hypomagnesemia (FDA, 2017). The final question posed is what education we should be providing to patients on a PPI. Patient’s should be educated to take the medication exactly as prescribed, and if they miss a dose it should be taken when they remember unless it is almost time to take the next dose (Woo & Robinson, 2020). Patient’s should be advised to take the medication before a meal, preferably in the morning. Tablets should not be chewed or crushed, and patients should be advised it is safe to take a PPI with antacids (Woo & Robinson, 2020). The patient should also be given education on lifestyle modifications, and potential side effects of this medication.  Patti, M. G. (2016). An Evidence-Based Approach to the Treatment of Gastroesophageal Reflux Disease.  JAMA Surgery, 151(1), 73–78.  https://doi.org/10.1001/jamasurg.2015.4233 U.S. Food and Drug Administration (FDA). (2017). FDA Drug Safety Communication: Clostridium difficile  associated diarrhea can be associated with stomach acid drugs known as proton pump inhibitors  (PPIs).  https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication- clostridium-difficile-associated-diarrhea-can-be-associated-stomach U.S. Food and Drug Administration (FDA). (2017). FDA Drug Safety Communication: Possible increased  risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors.  https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda- drug-safety-communication-possible-increased-risk-fractures-hip-wrist-and-spine-use-proton- pump U.S. Food and Drug Administration (FDA). (2017). FDA Drug Safety Communication: Low magnesium  levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs).  https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-low- magnesium-levels-can-be-associated-long-term-use-proton-pump West, B. (2019)Pharmacology Discussion Assignment. Gastroesophageal Reflux Disease. Nutritional Perspectives: Journal of the Council on  Nutrition, 42(2), 12–13. Woo, T.M. & Robinson, M.V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers (5th  ed.). F. A. Davis.

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