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Pharmacological Nursing Management Project
Pharmacological Nursing Management Project
Order ID 53003233773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Pharmacological Nursing Management Project
Assigned Disease: Primary Biliary Cholangitis
Pathophysiology: Primary biliary cholangitis (PBC, formerly known as primary biliary cirrhosis) is an uncommon cholestatic liver disease characterized by immune-mediated destruction of biliary epithelial cells. PBC is female preponderant and typically presents in the fifth or sixth decade of life.
The clinical presentation may include generalized pruritus, dryness of eyes and mouth, fatigue, and upper abdominal discomfort; patients may be asymptomatic. Typical laboratory findings are elevations in serum alkaline phosphatase levels, increased serum immunoglobulin M levels, and the presence of antimitochondrial antibodies or specific subtypes of antinuclear antibodies.
A diagnosis of PBC is usually made without histologic examination. When used, liver biopsy typically reveals nonsuppurative granulomatous cholangitis with loss of small bile ducts and lymphocytic portal inflammation. Patients who do not achieve an adequate biochemical response to first-line therapy have a greater risk of disease progression to cirrhosis and may ultimately require liver transplantation.
Definition of the two assigned drug Classifications
Classification 1: Bile Acid Analog
Bile acids aid in the digestion and solubilization of lipophilic nutrients and drugs in the small intestine, they signal endocrine molecules that regulate the glucose, lipid, and energy metabolism through complex and intertwined pathways that are largely mediated by activation of nuclear receptor farnesoid X receptor (FXR) and cell surface G protein-coupled receptor 1, TGR5 (also known as GPBAR1).
Classification 2: Immunomodulatory therapy
Immunomodulatory drugs modify the response of the immune system by increasing (immunostimulators) or decreasing (immunosuppressives) the production of serum antibodies. Immunostimulators are prescribed to enhance the immune response against infectious diseases, tumours, primary or secondary immunodeficiency, and alterations in antibody transfer, among others. Immunosuppressive drugs are used to reduce the immune response against transplanted organs and to treat autoimmune diseases.
Discussion of 4 medications – 2 from each drug classification (you are to choose the drugs – they must belong to the drug class)
Classification 1: Bile Acid analog
Drug 1: Actigall (ursodiol)
13 – 15 mg/kg/day orally given in 2 – 4 divided doses
Give with food
Drug 2: Obeticholic acid
5 – 10 mg PO qD
Start 5mg PO qd x 3 months, then may increase to 10mg PO qd if needed
Classification 1: immunomodulatory therapy
Drug 1: prednisone
20 – 30 mg PO qd initially for one month, titrate downward according to IgG concentration
Drug 2: Mycophenolate mofetil
500 – 1000 mg PO qd BID
Pharmacokinetics, Pharmacodynamics, safety/monitoring & pregnancy/lactation of the 4 Medications you discussed earlier
Drug 1: actigall (ursodiol)
Metabolism: Liver, GI Tract, CYP450; half-life unknown
Excretion: feces primarily; urine
Mechanism of Action: decreases cholesterol synthesis, secretion, and absorption; alters bile cholesterol composition
Monitoring Parameters: liver function tests q months x 3months, then q6 months
Pregnancy: may use during pregnancy; no known risk of fetal harm based on human data
Lactation: may use while breastfeeding; no known risk of infant harm based on limited human data
Drug 1: obeticholic
Metabolism: live; no CYP450; enterohepatically recirculated; active metabolites
Excretion: feces 87%; urine <3%; half-life 24 hours
Mechanism of Action: agonizes farnesoid X receptor, decreasing intracellular hepatocyte concentrations of bile acids
Monitoring Parameters: liver function tests at baseline, then frequently, especially if there is an increase in risk of hepatic decompensation or before dose adjustment; lipid panel
Pregnancy: caution advised during pregnancy; inadequate human data available to assess risk
Lactation: caution advised while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Drug 1: prednisone
Metabolism: liver; CYP450 – 3A4 substrate; prodrug converted to prednisolone
Excretion: urine; half-life: 2-4 hours (plasma); 18-36 hours (biological)
Mechanism of Action: exact mechanism of anti-inflammatory action unknown; inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects
Monitoring Parameters: electrolytes; BP; weight; 2 hours postprandial glucose; chest x-ray if prolonged treatment; ophthalmic exam if treatment >6weeks
Pregnancy: weight risk/benefit during pregnancy, especially in 1st trimester; risk of orofacial cleft based on limited human data; possible risk of teratogenicity based on animal data
Lactation: may use while breastfeeding, consider breastfeeding at least 4 hours after high-dose prednisone use; no known risk of infant harm
Drug 1: mycophenolate mofetil
Metabolism: liver; CYP450-unknown; UGT: 1A9 substrate; info: prodrug converted to mycophenolic acid
Excretion: urine 93%, feces 6%, half-life: 17.9 hour (PO route), 16.6h (IV route)
Mechanism of Action: inhibits B- and T-lymphocyte proliferation
Monitoring Parameters: pregnancy test immediately prior to treatment start, then 8-10 days later, then continue at routine visits, creatinine at baseline, CBC qwk x 1 month, then 2x/mo x 2mo, then q month during 1st year of treatment
Pregnancy: avoid use during pregnancy; risk of fetal harm; included teratogenicity and spontaneous abortion, based on human data
Lactation: weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm though possible drug excretion into milk
Contraindications of the 4 medications discussed earlier
Actigall (ursodiol)
Hypersensitivity to drug, unremitting acute cholecystitis, acute cholangitis, biliary obstruction, gallstone pancreatitis
Obeticholic acid
Hypersensitivity to drug; complete biliary obstruction, caution if Child-Pugh Class B or C hepatic impairment, caution if prior hepatic decompensation event
prednisone
Systemic fungal infection, cerebral malaria, avoid abrupt withdrawal, caution in pediatrics, pregnancy, if immunosuppressed, if active infection, if TB infection, if hypertensive, if diabetic
Mycophenolate mofetil
Hypersensitivity to polysorbate 80, pregnancy, avoid donating blood during treatment and 6 weeks after d/c, avoid semen donation during treatment and 90 days after d/c, caution HBV or HCV infection, caution if CrCl <50
conclusion
Summarize what you learned on this slide – what are the important things to know about the disease, the classifications, drugs and risks
references
Pharmacological Nursing Management Project
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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