Clinical Pharmacology in the Geriatric Patient Hilmer, S. N., McLachlan, A. J., & Le Couteur, D. G. (2007). Clinical pharmacology in the geriatric patient. Fundamental & Clinical Pharmacology, 21(3), 217–230.
Note: Retrieved from the Walden Library databases.
Clinical Pharmacology in the Geriatric Patient
This article explores issues that health care providers consider when prescribing drug treatment to geriatric patients. It also examines the role of polypharmacy in adverse drug reactions and the importance of managing patient response to drug treatment.
Scott, S. A. (2011). Personalizing medicine with clinical pharmacogenetics. Genetics in Medicine, 13(12), 987–995. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290900/
This article examines pharmacogenetic testing in relation to personalized drug therapy plans and explores evidence-based guidelines and recommendations on pharmacogenetic testing.
Drugs.com. (2012). Retrieved August 22, 2012, from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology. Baltimore, MD: Author.
Note: The approximate length of this media piece is 8 minutes.
In this media presentation, Dr. Terry Buttaro, Associate Professor of Practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse.
The following document provides credit for Laureate-produced media within this course:
Credits (PDF)
Optional Resources
The following resources are highly recommended for your professional library. You are encouraged to review these resources each week.
Centers for Disease Control and Prevention. (n.d.). Retrieved August 22, 2012, from http://www.cdc.gov/
Haymarket Media, Inc. (2012). Retrieved from http://www.empr.com/
Institute for Safe Medication Practices. (2012). Retrieved from http://www.ismp.org/
WebMD. (2012). Medscape. Retrieved from http://www.medscape.com/
Basic Pharmacotherapeutic Concepts In 2011, more than 3.7 billion drug prescriptions were filled at pharmacies in the United States (The Kaiser Family Foundation, 2011).
Basic Pharmacotherapeutic Concepts
With billions of drugs prescribed each year for the treatment and management of various disorders, it is essential for advanced practice nurses to familiarize themselves with common drug treatments and effects of these treatments on patients. When prescribing drugs, ensuring patient safety is the major concern. In many clinical settings, nurses work more closely with patients than any other health care provider, making it their responsibility to assist physicians with this task. As an advanced practice nurse maintaining patient safety, you must consider the many patient factors that impact pharmacotherapeutics.
This week you explore factors that influence pharmacokinetic and pharmacodynamic processes in patients. You also examine patient factors that advanced practice nurses must consider when developing drug therapy plans.
students will:
Analyze factors that influence pharmacokinetic and pharmacodynamics processes in patients
Assess patient factors and history to develop personalized plans of care
Understand and apply key terms, concepts, and principles related to pharmacotherapeutics
Understand and apply key terms, concepts, and principles related to prescribing drugs to treat geriatric patients
Photo Credit: Daniel Kaesler/EyeEm/EyeEm/Getty Images
Learning Resources for Basic Pharmacotherapeutic Concepts
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 2, “Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles” (pp. 17-31)
This chapter examines concepts related to pharmacokinetics and pharmacodynamics. It also explores patient factors that health care providers consider when prescribing drug therapy to patients.
Chapter 3, “Impact of Drug Interactions and Adverse Events on Therapeutics” (pp. 33-51)
This chapter explains drug-drug, drug-food, drug-herb, and drug-disease interactions. It also reviews patient factors that influence drug interactions and then covers adverse drug reactions.
Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 53-63)
This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.
Chapter 6, “Principles of Pharmacotherapy in Elderly Patients” (pp. 73-89)
This chapter describes issues and factors that affect drug therapy for elderly patients. It then explores concepts relating to drug selection, administration, and management for elderly patients.
Advance Pharmacology and the Affordable Care Act Describe the advanced practice nursing role in the pharmacological management of patients with viral diseases, infectious diseases.
Advance Pharmacology and the Affordable Care Act
Affordable Care Act
Advance Pharmacology and the Affordable Care Act Essay Paper Description
Topic: Should the Affordable Care Act be modified to exclude the pre-existing conditions of patients? Why or why not?
Judicial process
The primary writing assignment for this class will take the form of a critical review. As will become
apparent throughout the course, films, television programs, and documentaries regularly feature
elements of the judicial process. While potentially interesting subject matter, the judicial process is a
complex and nuanced component of the broader political system, and fictionalized media portrayals
have the potential to warp public understanding of an otherwise largely unfamiliar process. The goal of
this paper is to critically assess an example of a media portrayal of the judicial process and compare that
portrayal to reality.
Advance Pharmacology and the Affordable Care Act Suggested Media Portrayals
The following are suggested media portrayals. Some take the form of documentaries (both in film and
in series), some are “based on a true story,” and others are totally fiction.
– Frontline: The Plea (available at Watch Frontline The Plea).
– Hot Coffee (available on Netflix among others)
– Making a Murderer* (available on Netflix)
– To Kill a Mockingbird (available on Netflix among others)
– 12 Angry Men (1957) (available to rent through Amazon.com, iTunes, among others)
– Gideon’s Trumpet (available to rent through Amazon.com, iTunes, among others)
– A Civil Action (available to rent through Amazon.com, iTunes, among others)
Health and Illness in Contemporary Society
Directions/General Guidelines: Your final paper must be well organized in standard paragraph form. The paper, as noted on the syllabus, should be approximately 5-6 pages in length (double-spaced, 12 point font) and should include at least three academic references (i.e. no popular literature references, no Wikipedia, and no websites) that you will need to cite in a bibliography. One of these references must be a journal article. Additional references (beyond the first three) can include your textbook and class films. Because the paper length is short, try to avoid using direct quotations. Instead, you should generally try to paraphrase citations. See Syllabus for due date. I Be sure to keep a copy of the final paper for your own records.
Option One: Cross Cultural Variations in Health The goal of the first paper option is to expand your sociological understanding of the impact of culture on health. For this option, you will choose a health issue, such as menopause, and compare this across at least three different cultures. Depending on the extent of information on a given topic, you may decide to research additional cultures as well. Be very careful if you choose this option to remember that this is not a book report about three different countries. Critical to your analysis will be a discussion of how cultures and societies influence social experiences of health.
Dantes Inferno
What is “darkness” and what does it symbolize in Dantes Inferno? Refer to two different cantos, from two different circles. Discuss and make sure to include any quotation to support.
Watch The Ballad of Buster Scruggs
Watch The Ballad of Buster Scruggs by Coen Brothers and write which passages you find interesting and explain why.
Pneumonia Pathophysiology
Discuss the disease process related to Pneumonia to include bronchopneumonia. Include background on the disease process, treatment options, medications, lab work or any diagnostic test related to the condition.
Right to bear Arms
How the right to bear arms relates to constitutional law.
Past Supreme Court Cases, Current Practices, Properties of the issue, and thoroughly argued.
Down Syndrome
Down syndrome is a chromosomal disorder caused when an error in cell division results in an extra 21st chromosome. There can be impairments in cognitive ability and physical growth, mild to moderate developmental disabilities, and a higher risk of some health problems.
Advance Pharmacology and the Affordable Care Act in Substance Abuse
Imagine you are the head of a local, non-profit, substance abuse treatment facility and you have just received a grant that will allow you to expand the different types of treatment offered at your facility. You have the option of either hiring a psychoanalytic therapist, a cognitive behavioral therapist, or you can use the money to acquire more medication that can be used to treat your clients (i.e. methadone, suboxone, etc.). Also, you can instead choose to donate the money to local agencies that provide aid in the form of food, clothing and shelter to the underprivileged members of the population in the area.
Nutrition
Write a paper about the factors that contribute to a senior’s inability to maintain a safe and sanitary environment for food preparation. Address the senior’s limitations and potential hazards that can impact their food preparation practices and potential dangers for safe preparation and storage.
Pharmacodynamics and pharmacokinetics of Atorvastatin
Pharmacodynamics and pharmacokinetics of Atorvastatin in relation Ischaemic heart disease and hypertension to
Order Instructions:
The essay is to look at the pharmacodynamics and pharmacokinetics of the drug Atorvastatin in relationa to a patient (Simon) with a past medical history of Ischaemic heart disease and hypertension. The essay is also to explore/discuss the anatomy & physiology, pathophysiology associated with the drug’s action. Furthermore, what would this mean to you as a nurse in relation to the patient.
SAMPLE ANSWER
Pharmacodynamics and pharmacokinetics of Atorvastatin
Ischemic heart disease is one of the common chronic ailments identified among a large percentage of individuals in different countries around the world. It refers to an illness characterized by minimal blood supply to the human heart. This heart complication is one of the key causes of demise among the citizens of such western nations as the United States. The coronary arteries are responsible for supplying blood to the muscles situated within the heart. For this reason, a blockage in these blood vessels will reduce blood supply to the heart and the subsequent attainment of the ischemic heart disease (Parker & Parker 2003, p 39). A large number of such health-related cases occur due to atherosclerosis, which is observable despite the normal appearance of the artery lumens. The narrowing of these blood vessels results in rupturing and a subsequent heart attack.
Another common health complication related to the crucial functioning of the human heart is high blood pressure. This ailment, which is also referred to as hypertension, is a chronic disease caused by the elevation of the blood pressure within the arteries. The blood pressure of a normally functioning heart ranges between 100 and 140 mmHg and 60-90 mmHg systolic and diastolic respectively. Hypertension occurs when the readings surpass 140/90 mmHg (Grundy 2007, p 114). Owing to the severity of this health condition, patients suffering from high blood pressure often exhibit other complications including the coronary artery disease or the hypertensive heart ailment. High blood pressure is also one of the key factors that put patients at the risk of suffering from stroke, chronic kidney illness, or the peripheral arterial ailment. Nonetheless, there exists certain treatment approaches used to improve the health condition of patients suffering from high blood pressure or the ischemic heart disease.
One of these effective treatments that may be applicable in Simon’s case entails Atorvastatin as part of the prescription. This drug is a calcium salt branded as Lipitor. It belongs to the class of statins and is used to reduce blood cholesterol in addition to the prevention of such heart complications as the cardiovascular disease. Similar to other drugs under this classification, Atorvastatin functions by interfering with the capability of the HMG-CoA reductase (Atorvastatin Global Investigators Meeting, Larosa & Pedersen 2004, p 27). This is an enzyme situated with the liver tissue, which is crucial in the production of cholesterol within the human body. In line with its efficacy in handling such health complications as those exhibited by Simon in this case study, Atorvastatin is used as a primary medical approach of preventing stroke, heart disease, and the requirement for certain revascularization proceedings on patients with such risk factors as high blood pressure, a family history of heart complications, or a developed coronary heart ailment (Mohammad 2012, p 55). In line with the health condition of Simon, such a drug will aid in preventing further bodily complications associated with hypertension and the ischemic heart disease.
With reference to Simon’s health condition and the pharmacodynamics of Atorvastatin, the key site of action of this drug is the liver. This is because the liver is the main site for the production of cholesterol and clearance of LDL. However, medical practitioners focus on the dosage of Atorvastatin as opposed to the systemic drug concentration in order to attain a significant reduction of LDL-C (Purcell & Schachter 2007, p 61). The absorption aspect of the drug’s pharmacokinetics is also a crucial element that highlights the effectiveness of Atorvastatin with reference to improving Simon’s health condition. This drug undergoes hasty absorption when administered orally with the period of maximum plasma concentration being between 1 and 2 hours. Atorvastatin’s absolute bioavailability and the systematic accessibility for the activity of HMG-CoA reductase is 14 % and 30 % correspondingly (Wong 2005, p 15). The main trigger for the reduced systemic availability entails the drug’s high intestinal clearance as well as its fast-pass metabolism. Although food stuffs do not have a noteworthy effect on the drug’s efficacy of lowering LDL-C, administering this prescription with food results in 25 % and 9 % of its rate and extent of absorption respectively. In addition, administering the drug in the evening lowers by AUC and Cmax by 30 % correspondingly (Wong 2005, p 20). With reference to the drug’s distribution, the mean distribution volume of this medication is 381 liters. Since it is substantially protein-bound, it is often released through human breast milk. Furthermore, its metabolism is often through cytochrome P450 3A4 hydroxylation in order to produce ortho, parahydroxylated, and beta-oxidation metabolites. It is mainly excreted through hepatic biliary with approximately 2 5 being identifiable in urine (Wong 2005, p 23).
Owing to the key elements regarding the action of Atorvastatin and my skills as a nurse, I would recommend Lipitor to Simon in order to improve his health condition. This is addition to the consideration of other key factors such as exercise, healthy diets, and the avoidance of obesity (Ebdrup 2008, p 44). This will not only be useful in lowering the patient’s blood pressure and managing the ischemic heart disease but it will also be a valuable approach of preventing other heart complications and stroke. For this reason, it is rational for most medical practitioners to recommend this form of medication to such patients as Simon.
References
Atorvastatin Global Investigators Meeting, Larosa, J. C, & Pedersen, T. R, 2004, Second Atorvastatin Global Investigators Meeting, Paris, France, April 28-30, 2002, New York, EscardioContent.org.
Ebdrup, L, 2008, LPS-induced acute inflammation in a large animal model and the impact of atorvastatin treatment: PhD thesis, [Aarhus], Faculty of Health Sciences, University of Aarhus.
Grundy, S, 2007, Atorvastatin in the management of cardiovascular risk: from pharmacology to clinical evidence, Auckland [u.a.], Adis Internat.
Mohammad, M, 2012, Rosuvastatin versus a combination of Atorvastatin and Ezetimibe The Better Choice in Metabolic Syndrome, Saarbrücken, LAP LAMBERT Academic Publishing.
Purcell, H., & Schachter, M, 2007, Amlodipine and atorvastatin in the treatment and prevention of cardiovascular disease, Edgbaston, Sherborne Gibbs Limited.
Wong, V. S. C, 2005, Mechanisms of insulin sensitization by omapatrilat, a vasopeptidase inhibitor, and atorvastatin, a 3-hydroxyl-3-methylglutaryl coenzyme A reductase inhibitor, Thesis (M. Sc.)–University of Toronto, 2005.
We can write this or a similar paper for you! Simply fill the order form!
HTN and hyperlipidemia are two of the most common issues in primary care. Children, adults, and elders are all affected and the prevalence of these
disorders seems to be increasing. This week think about: 1). What is the medication of choice for a 35 year old female with significant hyperlipidemia and a
significant FH CAD (two siblings had MIs in their 30’s). 2). What medication could be used for a child with hyperlipidemia? 3). Should an elderly person be
continued on a statin drug forever?
Example
According to (Mulders et al., 2012), a daily regimen including vitamins C. and E, with atorvastatin 20 mg in individuals with a significant family history of
coronary artery disease at an early onset demonstrated a remarkable reduction in the rate of acquired coronary artery disease (p. 257)
The current recommendation for children is to place an emphasis on diet and lifestyle changes not just for the child, but for the family as well (O’Gorman,
O’Neill, & Conwell, 2011, p. 5). Patients with a significant family history of coronary artery disease and a low- density lipoprotein (LDL) of greater than
or equal to 160 mmol/l or LDL greater than or equal to 190 mmol/l can be started on statins in conjunction with diet and lifestyle modification (O’Gorman et al., 2011, pp. 8,9).
In my experiences in managing hyperlipidemia in adolescents, it is critical to emphasize the importance of maintaining a healthy lifestyle in terms that they can relate to. They are generally less receptive to prevention of health concerns like CAD that could occur later in life. Focusing on maintaining a healthy lifestyle of diet and exercise in relation to improved physical performance, mood stability, and a healthier appearance, are aspects that are of more
immediate concern to this age group. It is also important when considering a statin, to emphasize that taking a cholesterol-lowering drug is not a license to engage in poor eating habits in the false assumption that the medication will make them impervious to the effects of eating unhealthy food.
(Edmunds, Mayhew, & Setter, 2017, p. 300) recommends that children who are taking statins should be managed by a specialist (p.300). The majority of our patients are on Medicaid. Medicaid requires that simvastatin is the drug used for initiating therapy. The basic tenants of prescribing should be followed with considerations to cost, effectiveness and lowest potential for adverse effects. The rationale of treatment must also be considered with the goal of short-term therapy logically being a primary goal.
According to (Edmunds et al., 2015) states that “no data are available on patients older than 75, and lipid-lowering therapy is controversial” (p. 300). It
is important to always assess the risk against the benefits when considering therapy at any age. Some of the adverse effects of statins can include
confusion, amnesia, muscle aches, liver dysfunction, and potentially diabetes (p. 301). These are all serious considerations in the geriatric population due
to the potential for comorbidities such as falls, and damage to organs that already may demonstrate a diminishing function. (LaRosa, 2014) state that many of the side effects of statins can be addressed and prevention of stroke and CAD should be a high concern.
Edmunds, M. W., Mayhew, M. S., & Setter, S. M. (2013). Pharmacology for the primary care provider (Fourth edition. ed.). St. Louis, Missouri: Elsevier Mosby.
LaRosa, J. C. (2014). Treatment of cholesterol in the elderly: statins and beyond. Curr Atheroscler Rep, 16(2), 385. doi: 10.1007/s11883-013-0385-x
Mulders, T. A., Sivapalaratnam, S., Stroes, E. S., Kastelein, J. J., Guerci, A. D., & Pinto-Sietsma, S. J. (2016). Asymptomatic individuals with a positive
family history for premature coronary artery disease and elevated coronary calcium scores benefit from statin treatment: a post hoc analysis from the St.
Francis Heart Study. JACC Cardiovasc Imaging, 5(3), 252-260. http://www.doi:10.1016/j.jcmg.2011.11.014
O’Gorman, C. S., O’Neill, M. B., & Conwell, L. S. (2014). Considering statins for cholesterol-reduction in children if lifestyle and diet changes do not
improve their health: a review of the risks and benefits. Vasc Health Risk Manag, 7, 1-14.
The paper must follow the specific outline for the drug Prozac:
1) Medication/drug name (brand and generic, common street names)
2) Type (and sub-types, as applicable) of substance
3) Discussion of development
4) FDA indication, common off-label use, reason why abused
5) Route(s) of administration, dosages, etc.
6) Describe the specific population for which the drug was developed, and how the drug use differs in other populations (e.g. children, elderly, ethnopsychopharmacological issues, etc.)
7) Pharmacokinetics
8) Pharmacodynamics
9) Desired effects vs. adverse effects
10) Discussion of efficacy
11) Conclusions
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Read chapters 2, 4, 5 and 6 of the text and the case studies at the end of these chapters. Then answer the questions about the Rocky Mountain Outfitters and the Reliable Pharmaceutical Service case studies at the end of these chapters. Make your answers short (2-3 sentences).
Suggestions and Guidelines:
• Use your own words and Thoughts. Plagiarism and/or cheating will result in a grade of Zero.
• Give short answers to each question (not more than 3-4 lines)
• Total page length (not more than 3 pages, 300 words per page)
• 1-inch margins, Double spaced, 12-point, Times New Roman font
SAMPLE ANSWER
CHAPTER 2: RMO CASE
How extensive would the training needs be for the RMO staff?
The new RMO staff will need very extensive training in system design, requirements identification, analytical skills and project management.
What type of training would be required?
Training in project management, programming language and technical skills would be required.
Is it just about new programming languages, or is it broader than that?
The developer not only need to be knowledgeable on programming languages, which should include java and C++, but also be technical and know how to use tools.
How far can the project progress before the decision is made?
The project can progress through all the phases because regardless of the approach used, planning, analysis, designing and implementation activities are vital in each approach.
Do you think she is correct? Why or why not?
Yes, because both are approaches to designing a system. However, most systems that are being designed today employ both approaches.
Do some types of projects require an OO approach?
Yes, especially the customer oriented ones need to be natural and intuitive, benefits which are derived from object oriented approach.
What life cycle variations are under consideration?
Barbra may need to consider including the analysis phase, system design phase, and system testing.
What else might she do to speed up the development process?
She might need to define what the system’s requirements are and then find possible solutions that fit the system and plan on gradual release of the system parts that are complete.
What else might she consider adapting from the United Process, from Extreme Programming, or from Scrum?
She might adapt the responsive nature of scum to change since the environment is rapidly changing.
CHAPTER 2: FOCUSING ON RELIABLE PHARMACEUTICAL SERVICE.
What are some of the risks of taking this approach?
High possibilities in making mistakes, difficulties in making corrections, and impossible to add forgotten components into the system.
What planning and management difficulties would this approach entail?
Rigidity, ineffectiveness, and generalized assumptions. The approach is rigid in that once a plan is made it cannot be reversed and requires too much planning.
What are some of the risks of taking this approach?
High likelihood of committing mistakes that cannot be reversed, and it may be difficult to meet original requirements.
What planning and management difficulties would this approach entail?
Planning needs to be very thorough and it may overburden an analyst since analysis and designing may need to be done at the same time.
Briefly describe what you would include in each iteration?
The four parts that may be included in iteration include the inception, elaboration, construction and finally transition.
Describe how incremental development might apply to this project.
This approach involves finishing several parts and then releasing them to the end users. When more parts are complete, they are integrated with other parts and made operational. In this project, reliable may complete designing the system dealing with basic patient information, then make it operational as it still designs other information systems.
How would an iterative approach decrease project risks compared with the first approach?
By breaking the risks from their complex nature to simple ones that solutions can be provided with ease. It also offers opportunity for changing plans in case a fault is noticed.
How might it decrease risks compared with the second approach?
It ensures the most vital components of a system are implemented by giving them priority unlike the second approach where phases are overlapped.
What are some risks the iterative approach might add to the project?
Early release of a system part may cause rejection from the end users and distort the whole system since it may require developers to rethink or re-strategize.
CHAPTER 4: ROCKY MOUNTAIN OUTFITTERS CASE
What advice would you give your project team to help it manage the user expectations?
The project team should treat user information with seriousness and adjust to changes as per user expectation. All the users’ views should be incorporated into the system being developed.
What early planning can you do now to ensure that the scope is realistic—to meet the need but within the time and budget allotted?
A feasibility plan will be necessary in ensuring that the scope is not only realistic but also attainable within the allotted time and budget. This will be achieved by clearly defining the content of the project, its intended purpose, and the extent of project work that the team is to cover.
CHAPTER 4: RELIABLE PHARMACEUTICALS
What information-gathering methods are most appropriate to learn about requirements from Reliable own management staff and other employees?
Through interviewing them or observing them while they are using the system.
From client health-care organizations?
By talking to them or interviewing them.
From suppliers?
Through talking to them and interviewing them, and studying what other companies do.
Should patients in client health-care facilities participate in the information-gathering process? If so, why, and in what ways should they participate?
Yes, the patients should participate. This is because in system development and design, excellent outcome will be achieved if all stakeholders are involved.
3. With respect to gathering information from suppliers and clients, how deeply within those organizations should systems analysts look when defining requirements?
They need an in-depth knowledge not only of how the system should function, but also be knowledgeable of the organizations core business in order to fully come up with the appropriate system requirement.
How might Reliable deal with supplier and client reluctance to provide detailed information about their internal operations?
Reliable might consider providing incentive for them to participate such as bonuses or discounts.
4. For which user community or communities (internal, supplier, or client) are prototypes likely to be most beneficial? Why?
Prototypes are most useful to the internal users because it enables them to identify areas that need changes. Necessary adjustments are then implemented to improve the final system so that the final system will be very efficient.
CAPTER 5: RMO CASE
QN 1 Discuss the implications that such a change would have on the scope of the project. How might this new capability change the list of stakeholders the team would involve when collecting information and defining the requirements?
If ROM decides to incorporate customer charge and payment plan, then it will have to be included in their system and not be a research item in the RMO initial list of things. In the scope, the project will now have to stretch and even include customer account, details on customer purchase history, and payment plan details.
Would the change have any effect on other RMO systems or system projects planned or under way?
The changes will have insignificant effect on the plan underway since adjustments can be made along the way to achieve the most desired and efficient system.
Would the change have any effect on the project plan originally developed by Barbara Halifax?
The changes will have no effect on Barbra’s original plan.
In other words, is this a minor change or a major change?
This makes the changes minor and insignificant.
What events need to be added to the event table?
What needs to be added in the event table include
• customer wants order delivered
• customer wants to recommend orders to friends.
QN. 2 Complete the event table entries for these additional events.
Event Trigger Source Use case Response Destination
Customer wants order delivered
Delivery request
Customer Look up delivery options Delivery details customer
Customer wants to recommend to friends
What activities or use cases for existing events might be changed because of a charge account and payment plan? Explain.
If charge account and payment plan are incorporated into the system, then the charge adjustment might be merged with the charge account. The payment plan will cause changes in ‘update customer account’ use case.
3. What are some additional things and relationships among things that the system would be required to store because of the charge account and payment plan?
Things to be stored include payment plan options and customer account details.
Modify the entity-relationship diagram and the class diagram to reflect these charges.
Order
Order ID
Order date
Order amount
Customer
Customer name
Customer I.D
Account details
Address
Telephone
Customer charge
Purchase history
Charge adjustments
Payment plan.
Cash
1st installment
2nd installment
Chapter 5: FOCUSING ON RELIABLE PHARMACEUTICALS
QN.1 Create an event table that lists information about system Requirements
Event Trigger Source Use case Response Destination
Nursing homes(clients)needs prescription order Order inquiry Nursing homes (clients) Place New order Order details Clients
Management wants to record prescription orders Record orders Management Update records
Time to produce order summaries Start of each 12 hour Produce order summary reports Order summary reports management
Need to update patient information
Patient information update Nursing home/clients Update patient records
Need to generate order fulfillment forms End of week Create order fulfillment Order fulfillment report Management
Management need to update drug inventory Update drug inventory Management Update inventory
QN.2 Create an entity-relationship diagram that shows the data storage requirements for the following portion of the system:
Order Item
Price
Item I.D
Quantity
Price
Prescription order
Order ID
Order date
Order amount
Nursing home (Client)
Patient’s name
Address
Age
CHAPTER 6 : ROCK MOUNTAIN OUTFITTERS CASE STUDY
QN. 1 Develop DFD fragments for all of the events not documented
Order status inquiry 6
Order status details
Order status inquiry
7
Order
Fulfillment
notice
8
Back order notification
Back order notice
Catalog request 11
C
QN. 2
QN.3 Customer order form
Customer
Requests
Order
CHAPTER 6. RELIABLE PHARMACEUTICALS
QN.1
End week report Order fulfillment report
Order inquiry
New order update drug inventory
Update patient details
QN.2
Monthly
report
QN.3
patient
Requests
Update
QN.4
Order request
Place new order
QN.5. Physical billing procedure does not have to be developed because it can be automated in the system.
Reference
John W. Satzinger, Robert B. Jackson & Stephen D. Burd, (2010). System analysis and design in a changing world. Fifth Edition.
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Drug Treatments for HIV/AIDS
While HIV/AIDS is still currently incurable, the prognosis for patients with this infectious disease has improved due to advancements in drug treatments. Consider the case of Kristy Aney. Kristy was diagnosed with HIV in 1992 and was told she would survive, at most, 10 more years. Despite unfavorable odds, Kristy is still alive 20 years later. Since her diagnosis, she has witnessed tremendous improvements in HIV/AIDS treatments which have helped patients live longer with fewer side effects. While she acknowledges that these drug treatments have kept her alive, she fears that improvements in drug therapy have led to more people becoming complacent about the disease (Idaho Statesmen, 2012). In fact, the number of people living with HIV/AIDS in the United States is higher than it has ever been (CDC, 2012). This poses the question: Is there a relationship between drug advancements, societal complacency, and infection?
To prepare:
• Review Chapter 48 of the Arcangelo and Peterson text, as well as the Krummenacher et al. and Scourfield articles in the Learning Resources.
• Reflect on whether or not the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options for HIV/AIDS.
• Consider how health care professionals can help to change perceptions and make people more aware of the realities of the disease.
• Think about strategies to educate HIV positive patients on medication adherence, as well as safe practices to reduce the risk of infecting others.
ASSIGNMENT PAPER:
WRITE
1) An explanation of whether or not you think the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options.
2) Explain how health care professionals can help to change perceptions and increase awareness of the realities of the disease.
3) Describe strategies to educate HIV positive patients on medication adherence.
4) What are the safety practices to reduce the risk of infecting others?
Readings/Recommended References (you may choose your own textbook or article for this paper
• Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
o Chapter 8, “Principles of Antimicrobial Therapy” (pp. 96–117)
This chapter covers factors that impact the selection of an antimicrobial treatment regimen. It also examines the clinical uses, adverse events, and drug interactions of various antimicrobial agents such as penicillin.
o Chapter 12, “Fungal Infections of the Skin” (pp. 141–149)
this chapter explores the pathophysiology of several fungal infections of the skin as well as related drug treatments and examines the importance of patient education when managing these infections.
o Chapter 14, “Bacterial Infections of the Skin” (pp. 158–172)
this chapter begins by examining causes of bacterial infections. It then explores the importance of selecting an appropriate agent for treating bacterial infections.
o Chapter 32, “Urinary Tract Infection” (pp. 474–480)
This chapter covers drugs used to treat urinary tract infections and identifies special considerations when treating geriatric patients, pediatric patients, and women.
o Chapter 35, “Sexually Transmitted Infections” (pp. 512–535)
this chapter outlines the causes, pathophysiology, and drug treatment of six sexually transmitted infections, including gonorrhea, syphilis, and human papilloma virus infection (HPV). It also examines the importance of selecting the proper agent and monitoring patient response to treatment.
o Chapter 48, “Human Immunodeficiency Virus” (pp. 748–762)
this chapter presents the causes, pathophysiology, diagnostic criteria, and prevention methods for HIV. It also covers various methods of drug treatment and patient factors to consider when selecting, administering, and managing drug treatments.
• Krummenacher, I., Cavassini, M., Bugnon, O., & Schneider, M. (2011). An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 23(5), 550–561.
Retrieved from a collage Library databases.
This article analyzes medication adherence in HIV patients and examines factors that increase adherence as well as factors that contribute to termination or discontinuation of treatment.
• Drugs.com. (2012). Retrieved from http://www.drugs.com/
this website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
• Scourfield, A., Waters, L., & Nelson, M. (2011). Drug combinations for HIV: What’s new? Expert Review of Anti-Infective Therapy, 9(11), 1001–1011. Retrieved from a collage Library databases
this article examines current therapies and strategies for treating HIV patients. It also examines factors that impact selection of therapy, including drug interactions, personalization of therapy, costs, management of comorbidities, and patient response.
• Mayer, K. H., & Krakower, D. (2012). Antiretroviral medication and HIV prevention: New steps forward and New Questions. Annals of Internal Medicine, 156(4), 312–314. Retrieved from a collage Library databases.
SAMPLE ANSWER
Drug Treatment for HIV/AIDS
When HIV/AIDS was first discovered, many people in the United States were dying in large numbers. Due to advancements in treatment of the disease in later years, patients infected with HIV/AIDS can now live longer. Proponents to drug treatment to HIV/AIDS have pointed out that the impact from drug advancement is phenomenal, as it gives a vision of having a free HIV/AIDS world. However, some critics point out that these advancements in treatment lead to complacency. Therefore, the paper will engage in discussing critical issues emanating from the overall drug treatment to HIV/AIDS.
The increasing number of cases of HIV/AIDS is attributed to the increased complacency due to more advanced drug treatment options. This is because, health professionals have quit creating awareness of the possible adverse effects of the disease. The people of the United States have the illusion that, due to continuous advancement in drug treatment against HIV/AIDS, they are likely not to contact the disease (Arcangelo & Peterson, 2013). The advertisements that were used to encourage youths to use contraceptives such as condoms to save them from the epidemic are no longer used, or are used in minimal magnitude. Advancement in drug treatment has also led to more emergence of homosexual and heterosexual relationships that have led people to indulge in sexual activities not knowing well that they are actually making themselves susceptible to the epidemic.
Health care professionals can diminish the perception and increase awareness of the realities of the disease by taking a stand in creating awareness on same-sex affairs that greatly spread HIV/AIDS. This is because, same sex relationships increases transmission of the sexual-related disorder such as syphilis and gonorrhea, which gives a means for more transmission of HIV /AIDS. Medical practitioners should increase awareness on drug abuse. Anyone who abuses drugs should be counseled and treated to help them stop using the drugs and preventing HIV/AIDS infections (Arcangelo & Peterson, 2013). This is because contracting the disease is faster in people who abuse drugs. Most preferably, health professionals should formulate programs that give each and every generation of young people with information and intervention that aid them to develop life-long skills for avoiding behaviors that could lead to HIV/AIDS infections (Mayer & Krakower, 2012). Strategies to educate HIV/AIDS patients on medication adherence are crucial as far as drug treatment on HIV/AIDs is concerned. The strategy includes self-assessment tools that include questions about mental health status, substance abuse, environmental factors that may influence a patient’s ability to adhere to ART (Antiretroviral therapy) (Arcangelo & Peterson, 2013). Another strategy that can be used is assessment on cognitive functioning and a patient’s attitude towards taking ART. The final strategy that can be used is assessment of all those areas paints of a patient’s overall readiness to begin and maintain ART.
There are safety practices to reduce the risk of infecting others with HIV/AIDS. One of the safety practices is use of condoms consistently and correctly. The practice extends to choosing less risky sexual behaviors. This is because anal sex is the highest-risk sexual activity more than oral sex. Use of pre-exposure prophylaxis daily can also prevent intensity of spreading the disease to other people (Krummenacher, Cavassini, Bugnon, & Schneider, 2011). If a partner is infected with the disease, he or she should be advised to get and stay on treatment. ART is medically recommended to reduce the amount of HIV virus (viral load) in blood and body fluids, which can greatly reduce chances of transmitting HIV to sex partners if taken consistently and correctly.
In summary, continuous improvement in drug treatment to HIV/AIDS will continue to pose dangers of HIV/AIDS to people as neglect and irresponsibility are brought by the improvements. However, this trend can be reversed if medical practitioners engage in strategies and programs to create awareness of the adverse effects of the disease, and to install and educate on best safety measures to prevent widespread of HIV/AIDS.
References
Arcangelo, V., & Peterson, A. (Eds). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Krummenacher, I., Cavassini, M., Bugnon, O., & Schneider, M. (2011). An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 23(5), 550–561.
Mayer, K. H., & Krakower, D. (2012). Antiretroviral medication and HIV prevention: New steps forward and New Questions. Annals of Internal Medicine. 156(4), 312–314.
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Name
Instructions
Mr. Hightower is a 52 year old male with a PMH Type 2 DM, Hyperlipidemia, and HTN. He is a new patient to your office stating he stopped his meds several
months ago and he cannot remember what he took in the past. His BP is 150/90. HR 88, RR 20 BMI 35. HGB A1C is 9.6, Total chol 225, LDLs 183, HDL 35. CBC,
CHem, LFTs are wnl. Discuss the focused pertinent physical exam for this patient as well as what further diagnostics are needed in providing evidenced based
care. What medications are important to start for this patient to treat his co-morbidities. Include the follow-up for this gentleman along with pertinent
diagnostics. needed at time of follow-up and written prescriptions to treat this gentleman’s HTN, hyperlipidemia, and Type 2 DM. References should be
evidenced based and include current guidelines for the treatment of his co-morbidities.
INSTRUCTIONS
The midterm is a case study. You have information about a patient and then prescribe the appropriate medications and explain your rationale. You will need to use the literature to defend your care plan and medications changes. The case study references should have at least five evidenced based references from the past five years. The paper should have an opening paragraph that includes a statement about the purpose of this paper,as well as a closing paragraph.
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Please follow the instructions on the document that I will upload. I want the teaching plan to be 2 pages long. Do not worry about the extra article I will
do that myself. There is a template and everything attached to the document. Use the following book as a reference: Abram’s Clinical Drug Therapy Rationales for Nursing Practice. It is by Lippincott. Make sure the sources are professional please.
Use at least three (3) quality references Note: Wikipedia and other related websites do not qualify as academic resources.
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