NUR 641E Topic 1 Discussions 1 and 2 Papers

NUR 641E

Topic 1: General Physiological And Pathophysiological Concepts

Objectives:

Describe principles of immunology in disease processes.
Evaluate the inflammatory response as a defense mechanism.
Evaluate the principles of cellular alterations in infection and the medications that treat infection.
Describe a pharmacological intervention using an evidence-based treatment guideline.

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NUR 641E Topic 1 Discussions 1 and 2 Papers Topic 1 DQ 1

Assessment Description

Part 1

What are the differences between primary and secondary line of defense? What factors interfere with these mechanisms? How are these levels of immunity affected in a child, an elderly person, or a person with a chronic disease? Include active, passive, innate, and acquired immunity.

Part 2

Choose an inflammatory or infectious process and explain the pathophysiology changes that may occur. What patient education would need to be included related to this disorder? Make sure that you select a different medical condition than your peers. Include the name of the medical condition in the subject line so that the medical condition can be followed. Include your references in APA style.

Cristina Alimon

Posted Date

Mar 12, 2022, 8:21 PM

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Replies to Vanessa Brown

Proton Pump Inhibitor (Omeprazole)

Proton-pump inhibitors (PPIs) are a family of medications best recognized for their use in treating acid-related illnesses. When used as part of an all-natural treatment plan with other medicines, this effect can help heal a peptic ulcer, treat gastroesophageal reflux disease, treat Barrett’s esophagus, and even get rid of Helicobacter pylori (Ahmed & Clarke, 2021). With my experience in home health nursing before, most older patients take Omeprazole, especially if they have multiple drug maintenance. Some of the patients were prescribed maybe eight or more medications, and one of those is Omeprazole. Most of the time, they are discharged from hospital admission new medication will be added. It was always a struggle to coordinate with multiple physicians that the patient is seeing to verify the necessary medication they need to take as long term, and that is only short term. There was a patient that during the initial intake visit I asked him about why he is taking Omeprazole, he said because of GERD from all the medications that he is taking. Therefore, it is essential to be careful about our older patients’ medications. Because the more medications they are taking, the more susceptible they are to the adverse reactions from medications. Therefore, it is essential to educate the patient, give them an updated medication list, and instruct them or the family that they bring all the medication they are taking each time they see a physician to avoid duplication or unnecessary medication prescription.

Pharmacokinetics of Proton Pump Inhibitor

Absorption

The proximal small bowel absorbs these drugs, and when they reach the stomach’s parietal cells, they influence the cells (Ahmed & Clarke, 2021). The proton pump is an enzyme in the parietal cells that PPIs stop. This enzyme is the last step in releasing acid into the stomach, and it does this job very well.

Metabolism

Omeprazole is broken down by the hepatic cytochrome P450 enzyme system, mainly through CYP2C19 and CYP3A4 isozymes. It has a short half-life of a half-hour to an hour in healthy people and about three hours for people who have a problem with their liver (Shah, 2020).

Distribution

Within an hour of taking Omeprazole, the drug’s effects start to slow down. It takes two hours for the drug’s full effects to kick in. The effects of the drug last for about 72 hours after it is taken, and they usually wear off in 3 to 5 days. It will take four days for the effects to level off when taking medicine every day (Shah, 2020). NUR 641E Topic 1 Discussions 1 and 2 Papers

Excretion

Urinary excretion is the principal mechanism of omeprazole metabolite elimination (Shah, 2020).

Reference

Ahmed, A., & Clarke, J. O. (2021, August 1). Proton pump inhibitors (PPI) – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK557385/

Shah, G. W. (2020, October 17). Omeprazole – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK539786/

Topic 1 DQ 2

Assessment Description

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style.

Topic 1 DQ 2

Mar 3-7, 2022

Cyclophosphamide

Cyclophosphamide, with the brand name of Cytoxan, is one of the medications given for Goodpasture disease to suppress the immune system in making anti-glomerular basement membrane (GBM) antibodies. Primarily this medication is for cancer like ovaries, breasts, blood, and others.

Mechanism of action

Cyclophosphamide is a cancer drug under a class of alkylating agents. The CYP450 system converts cyclophosphamide and ifosfamide to hydroxylated intermediates in the liver. The active chemicals phosphoramide mustard, and acrolein, are formed from the hydroxylated intermediates. The phosphoramide mustard reacts with DNA, causing cytotoxicity (LaPlant, & May 2019). Cyclophosphamide slows the development of cancer cells, which the body eventually destroys. Other side effects may develop because cyclophosphamide affects normal cell growth.

Hints for monitoring

Cyclophosphamide can temporarily reduce white blood cell counts, increasing the risk of infection and reducing the platelet count required for blood clotting (Mayo Clinic, 2022). Particular care must be taken to avoid infection or bleeding. Therefore, it is essential to instruct the patient to follow bleeding precautions. Avoiding contact sports and other circumstances that might cause bruising, cuts, and brushing or flossing teeth; monitor for signs of bleeding like bruises, blood in the urine or stools, or tiny red patches on the skin. Cyclophosphamide may reduce the body’s resistance, causing the vaccination to fail or the illness to occur; the patient should also avoid others who have received live virus vaccinations since they may spread the infection to the patient (Mayo Clinic, 2022).

Side effects

More common side effects are cough or hoarseness, fever or chills; lower back or side pain; missing menstrual periods; and painful or difficult urination (Mayo Clinic, 2022). The following side effects with high doses and long-term treatment are blood in the urine; dizziness, confusion, or agitation; fast heartbeat; joint pain; shortness of breath; swelling of the feet or lower legs; and unusual tiredness or weakness. Studies on nursing mothers show detrimental impacts on babies. It should be provided an alternative or discontinue nursing while using it.

Drug interaction

Cyclophosphamide has notable drug interactions with phenobarbital, phenytoin, digoxin, and anticoagulants (LaPlant, & May 2019). Chronic high dosages of phenobarbital enhance the metabolism and leukopenic action of cyclophosphamide. Therefore, warfarin’s impact is enhanced or decreased in individuals receiving warfarin plus cyclophosphamide (U.S. National Library of Medicine, 2021).

References:

LaPlant, K., & May, P. (2019). Anticancer Drugs. In K. Whalen (Ed.), Lippincott® illustrated reviews: Pharmacology (7th ed.). Wolters Kluwer.

Mayo Clinic. (2022, February 14). Cyclophosphamide (Oral route, intravenous route) description and brand names – Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/cyclophosphamide-oral-route-intravenous-route/description/drg-20063307

U.S. National Library of Medicine. (2021, September 28). Cyclophosphamide injection, solution. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a0e99679-f939-4fb3-9d38-dfdb824f89bc