NURS 6521 Week 9 Assignment Case Studies

NURS 6521 Week 9 Assignment

Case Studies

Student Name

Walden University

NURS6521

Professor name

Date

Case Studies

SCENARIO 1

Prescription Errors, Corrected Versions, Classifications, and MOAs

• Original: tamsulosin 4 mg po qd 30min qd the same meal daily #30 2 RF

Errors

• Incorrect dose: The recommended dose of tamsulosin is 0.4 mg, not 4 mg.
• Incomplete route and frequency instructions

Corrected: Tamsulosin 0.4 mg PO daily, 30 minutes after an identical meal every day. Dispense #30. Refills: 2.

Classification: Alpha-1 adrenergic antagonist

MOA: Blocks selectively alpha-1 receptors of the bladder neck and prostate, causing smooth muscle relaxation and enhanced urine voiding (Cleveland Clinic, 2022).

• Original: levofloxcin 750 mg po daily for 5 days #5 0 RF 

Errors

• Spelling mistake: it should be levofloxacin instead of levofloxcin
• Unclear instructions (e.g., with/without food, time of day)

Corrected: Levofloxacin 750 mg PO once daily for 5 days. Dispense #5 tablets. Refills: 0.

Classification: Fluoroquinolone antibiotic

MOA: Inhibits DNA gyrase and topoisomerase IV, enzymes necessary for bacterial DNA replication.

• Original: ciprofloxacin 0.3% otic solution (bacterial conjunctivitis); put 1-2 drops into eye every 2 hours when awake during the first 2 days, then 1-2 drops every 4 hours when awake the next 5 days #1 bottle O RF

 Errors:

• Otic formulation (ear) used in ocular conditions
• Abbreviated O RF; it should be 0 refills

Corrected: Ciprofloxacin 0.3% ocular solution, one to two drops into the affected eye every 2 hours when awake during 2 days and then every 4 hours when awake during 5 days. Does 1 bottle. Refills: 0.

Classification: Fluoroquinolone antibiotic

MOA: Inhibits bacterial DNA gyrase.

• Original: Paxlovid 300 mg ritonavir plus 100 mg nirmatrelvir po BID x 5 days #1 dose pack O RF

 Errors

• Dose amounts are reversed; should be 300 mg nirmatrelvir + 100 mg ritonavir
• Spelling and packaging instructions are unclear

Corrected: Paxlovid (nirmatrelvir 300 mg with ritonavir 100 mg) PO BID for 5 days. Dispense: 1 dose pack. Refills: 0.

Classification: Antiviral (protease inhibitor)

MOA: Nirmatrelvir inhibits SARS-CoV-2 protease; ritonavir boosts plasma levels by inhibiting CYP3A metabolism.

• Original: Depo-Provera 150 mg IM inject once monthly #1 3 RF

 Errors

• Depo-Provera is administered every 3 months, not monthly

Corrected: Depo-Provera 150 mg IM every 3 months. Inject 1 mL IM now. Dispense 1 syringe. Refills: 3.

Classification: Progestin contraceptive

MOA: Inhibits ovulation, thickens cervical mucus, and alters endometrial lining.

SCENARIO 2

Diagnosis: Gonorrhea, likely concomitant infection with Chlamydia Latex, Penicillin allergies (CDC, 2021).

First-line Treatment for Gonorrhea in Penicillin-allergic Patients:

The agent of choice is ceftriaxone; however, desensitization is preferred in cases of severe penicillin allergy. In case it is not possible, the following options are available:

Medication Orders:

• Gentamicin 240 mg IM single dose PLUS Azithromycin 2 g PO single dose

• Gentamicin: 240 mg IM 1 dose. Dose 1 vial. No refills.
• Azithromycin: 2 g PO 1 dose. Dose 1. No refills.

Empirical Treatment for Chlamydia:

• Covered by Azithromycin 2 g PO dose

Patient Education:

• Avoid sexual intercourse 7 days after treatment and until all partners receive treatment.
• Talk about safe sex behavior and the need for partner notification and treatment.
• Follow up with any symptoms that are still or have become worse

SCENARIO 3

Problem: Elevated INR (6.9) with minor bruising after warfarin + BactrimDS

Mechanism of Interaction:

• Trimethoprim-sulfamethoxazole is a CYP2C9 inhibitor and raises warfarin and bleeding risk (Vega et al., 2023).

Management:

• Hold warfarin for 1–2 days

• Administer oral vitamin K 1–2.5 mg PO if the risk of bleeding increases
• Recheck INR in 24–48 hours
• Avoid sulfamethoxazole/trimethoprim if alternative antibiotics are available

Adjustment Plan:

• Discontinue Bactrim if possible; switch to nitrofurantoin or fosfomycin if the UTI pathogen is susceptible
• Resume warfarin at a lower dose after INR falls to 2–3

SCENARIO 4

1. Dose Calculation: 15 mg/kg × 70 kg = 1050 mg per dose
2. Volume to Draw:
   • Vial: 1 g (1000 mg) per 20 mL
   • Need: 1050 mg = 21 mL of solution
3. Infusion Time:
   • 1050 mg at 10 mg/min = 105 minutes
4. Trough Level Analysis:
   • Level: 9 mcg/mL
   • Goal for severe infections: 15–20 mcg/mL
   • Recommendation: Increase dose or reduce interval (e.g., 15 mg/kg q8h) depending on renal function
5. Why IV > PO:
   • Oral vancomycin is poorly absorbed systemically
   • Oral form is only effective for GI infections (e.g., C. difficile colitis)

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