SF Pharma Case Study

PHARMACOLOGY // Dr. Posadas // 01.17.16 Page 1

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PHARMACOLOGY

CASE STUDY SEMI-FINALS

I. DRUGS AFFECTING BLOOD PRESSURE

Mr. David was admitted to the intensive care unit in a hypertensive crisis. His

blood pressure is 220/170. He is started on introprusside infusion. The orders

read to start the infusion at 0.3 mcg per kg of weight per min and titrate

upward until blood pressure is no greater than 130/80, the patients previous

known blood pressure. After the first 15 minutes, the blood pressure is

200/160, and the nurse increases the rate of the infusion. After another 15

minutes, the blood pressure 190/156. The nurse again increases the rate of

infusion. In 15 minutes, the blood pressure is 126/70. Mr. David is now

complaining of abdominal pain and nausea.

1. What nursing actions would be most appropriate at this time?

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2. Why?

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II. DRUGS AFFECTING DIURESIS

Mickey Mouse, 70 years old, was in a car accident and hit his head on the

interior side of the car. He is admitted to the hospital with increased

intracranial pressure from cerebral edema. He is to be started on mannitol 1.5

g/kg of weight, infused over 60 minutes. When the vial of mannitol is taken

form the medication cart, the nurse notices many clear crystals in the solution.

1. What actions of the nurse would be appropriate to prepare the mannitol

for the infusion?

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2. Why is the drug administered by an IV route?

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3. How will the nurse determine whether the drug therapy is effective?

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III. DRUGS AFFECTING COAGULATION

Daisy Duck is 30 years old and pregnant. She develops a DVT in her right leg

and is hospitalized. Her medication orders are as follows:

> Heparin 35 units per kg of body weight IV push followed by 20,000

units per 24 hours per IV infusion

Additional orders read:

> Bed rest

> aPTT before starting heparin; repeat every 6 hours for 24 hours

> Contact physician if aPTT is not in therapeutic range

1. Why is heparin used as the anticoagulant for Daisy Duck?

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2. Why is some heparin ordered to be given by IV push and some heparin

ordered to be given by IV infusion?

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3. What is the purpose of the repeated drawing of the aPTT?

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4. What is the rationale for bed rest while receiving heparin?

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IV. DRUGS AFFECTING LIPID LEVELS

Jake Pirate has a family history of cardiovascular disease. His LDL cholesterol

levels are elevated (160), and he starts on lovastatin. His baseline AST is 15 (n

= 7-27 U/L) and ALT is 10 (n = 1 to 21 U/L). After 6 weeks, he returns for

follow up blood work. His LDL levels are now 150. His AST is now 54, and his

ALT is now 42. He is instructed to continue on the same dose of lovastatin and

return in 6 weeks.

1. Why was he continued on the same dose of lovastatin?

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2. What is the rationale for having him return for more blood work in

another 6 weeks?

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V. DRUGS FOR TREATING ANGINA

Rob Pattinson is 40 years old. He has a family history of CAD (both parents

died in their fifties of MI). He is an insulin-controlled diabetic. He had angina

for 3 months, before being admitted to the hospital with MI. He is stabilized

now and is to be discharged on transdermal NTG patch, worn 14 h a day; SL

NTG PRN; propranolol, and oral beta blocker BID; and aspirin, orally, OD.

1. Discuss the rationale for this combination drug therapy.

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V. DRUGS AFFECTING CARDIAC OUTPUT AND RHYTHM

Sofia Dafurst is to receive oral verapamil, a calcium channel blocker, class IV

antiarrhythmic, to treat recurrent paroxysmal supraventricular tachycardia.

She has history of renal disease.

1. What physical parameters need to be assessed before each dose of

verapamil?

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2. What is the impact of renal disease on verapamil therapy?

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VI. DRUGS FOR TREATING CONGESTIVE HEART FAILURE

Tyra Banks, 81 years old, is admitted at 7 AM with acute CHF. She has right-

and left-sided failure. Her pulse on admission is 122 bpm. Her BP is 166/110.

Her medication orders are:

> furosemide 20 mg IV push STAT; may repeat the dose after 2 hours if

UO is 30 cc/hr or less or if respiratory symptoms worsen

> captopril 25 mg PO TID

> hydrochlorthiazide 50 mg PO BID

> digoxin 0.375 m PO STAT as loading dose

> digoxin 0.125 mg PO 6 hours and 12 hours after the loading dose

> digoxin 0.25 mg PO daily beginning 24 hours after the loading dose

The night nurse tells you in report that she has administered the STAT dose of

furosemide and the STAT dose of digoxin. You will be caring for Mrs. Banks

today until 7 PM. At 9 AM, you complete a physical assessment to learn if the

drug therapy is being effective in managing Mrs. Banks CHF.


Mrs. Banks wants to know why she is getting so many different medicines.

Describe the patient education you will provide regarding the rationale for her

drug regimen.

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After 24 hours, Mrs. Banks still has crackles and wheezes in her lungs, +3

edema in her hands and feet, a pulse of 96, and BP of 150/96. You consult will

her physician regarding these findings.

What additional orders might you seek, or might expect the physician to order?

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SF Pharma Case Study