Response – Asthma Management and Prescriptive Authority in Nursing

Response – Asthma Management and Prescriptive Authority in Nursing

Hello,

Thank you for your post. I quite agree with every response you have given to the discussion questions. To begin with, as you have noted, managing asthma requires utilising both pharmacologic and nonpharmacologic approaches. Managing exercise-induced asthma may be a bit complicated as it is majorly triggered by physical activity. Although the intensity of the physical activity that triggers the asthma may vary, the patient is always at risk of developing the symptoms with minimum levels of activity, especially if carried out in cold, dry weather. Cold and dry weather has been identified as a major trigger of exercise-induced asthma (Dreßler et al., 2019). Therefore, besides providing short-acting beta2 agonists (SABA) such as Albuterol (Ventolin HFA) before exercise and the onset of symptoms, it is also important to consider the nature of the environment in which the exercises occur. This may not only reduce the risk of developing exercise-induced bronchoconstriction symptoms, but it may also improve the efficiency of the medications and the intensity of the symptoms. Agreeably, evidence shows a combination therapy of salmeterol and fluticasone is effective both as a preventive and maintenance treatment for asthma in the long term (Jentzsch et al., 2019).

Subsequently, the other four questions, I believe, as per my interpretation, focus on testing an individual’s understanding of their prescriptive authority in nurses with a prescriptive authority. The questions also test an individual’s understanding of the factors to consider during drug selection and prescription writing. For instance, in all four questions, the individual is expected to select a drug out of the available options to meet the various needs of each case scenario. Rosenthal and Burchum (2021) note that an individual with prescriptive authority must consider various aspects such as side effects, availability, cost, current guidelines, drug interactions, renal function, and the patient’s allergies before selecting and prescribing a drug.

References

Dreßler, M., Friedrich, T., Lasowski, N., Herrmann, E., Zielen, S., & Schulze, J. (2019). Predictors and reproducibility of exercise-induced bronchoconstriction in cold air. BMC Pulmonary Medicine, 19(1), 1–10. https://doi.org/10.1186/S12890-019-0845-3/TABLES/4

Jentzsch, N. S., Silva, G. C. G., Mendes, G. M. S., Brand, P. L. P., & Camargos, P. (2019). Treatment adherence and level of control in moderate persistent asthma in children and adolescents treated with fluticasone and salmeterol^. Jornal de Pediatria, 95(1), 69–75. https://doi.org/10.1016/J.JPED.2017.10.008

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). Elsevier.

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PEER RESPONSE 2

A 12-year-old boy has occasional episodes of mild asthma while playing soccer with his friends.

Q1. What treatment should this patient receive to relieve symptoms during an asthma attack?

Asthma Management and Prescriptive Authority in Nursing

Exercise-induced asthma is a transient contraction of the bronchial smooth muscles during physical activity, often accompanied by symptoms such as shortness of breath, wheezing, and coughing. Non-pharmacological and pharmacological approaches are important in managing this condition. The American Thoracic Society (ATS) guidelines from 2013 strongly recommend the use of short-acting beta2 agonists (SABA) such as Albuterol (Ventolin HFA) about 15 minutes before exercise and when symptoms occur (Gerow & Bruner, 2022). Albuterol nebulizer will help relax the bronchial smooth muscles in the airway and help the patient to breathe better (Chipps et al., 2021). Non-pharmacological approaches to prevent asthma attacks during exercise include warming up before exercise by doing stretching activities, increasing the intensity of exercise gradually to how much can be tolerated, wearing a mask when exercising in cold weather to help warm up inhaled air, avoiding exercising in environments where there is dust, pollen, or other allergens as these can trigger asthma exacerbation (Gerow & Bruner, 2022).

Q2. If the patient’s asthma attacks occur more frequently, what changes in therapy might be appropriate?

If symptoms are not controlled with SABA and the patient is having more frequent attacks, the patient’s medication can be modified to include a long-acting beta2 agonist (LABA) like Salmeterol plus inhaled corticosteroids such as Fluticasone. Salmeterol/Fluticasone (Advair Diskus) can help prevent asthma attacks and alleviate symptoms. With this combination drug, Fluticasone prevents swelling in the airway while Salmeterol relaxes the bronchial smooth muscles and enhances optimal breathing (Rosenthal & Burchum, 2021).

A 19-year-old college student is asking for contraceptives. 

Q3. What will you assess to determine if this patient is a good candidate for contraceptives, and what will you prescribe? (Include brand and generic name, route, frequency, and dose). What is the mechanism of action of the contraceptive you prescribed and the adverse effects?

To determine if the patient is a good candidate for contraceptives, it is important to assess her family planning goals and this entails whether or not she plans to bear children and also discussing different contraceptive options including their cost and side effects to help the patient choose the option that is convenient for her. In addition, it is also important to assess the patient’s blood pressure or any thrombolytic disorder if hormonal contraceptive methods are to be considered to prevent adverse cardiovascular events (Rosenthal & Burchum, 2021). A combination oral contraceptive will be prescribed to help prevent pregnancy.

Drug generic name: Desogestrel/Ethinyl estradiol

Brand names: Azurette, desogen, viorele, and kariva

Dose: 0.15mg/0.02mg

Route of administration: by mouth

Frequency: medication is taken once daily at the same time each day.

Mechanism of action: this medication contains progestin (desogestrel) and estrogen (ethinyl estradiol) and works by preventing ovulation during the menstrual cycle by inducing the thickening of vaginal secretion which makes it difficult for sperms to penetrate the ovum and cause fertilization. Adverse effects: some of the adverse effects of this medication include nausea, vomiting, headache, breast tenderness, and fluid retention that may cause swelling in the ankles and feet, and irregular periods (National Institute of Health (n.d)).

Q4.  The patient states she heard a pill can help her acne. What would you prescribe and what is your rationale? (Include brand and generic name, dose, route, and frequency).

I will prescribe a low dose of doxycycline (generic name) or Vibramycin (brand name) 100mg by mouth twice daily for 14 days. This is because during puberty increased production of androgens stimulates the production of sebum by the sebaceous glands which clog pores and hair follicles causing inflammation and bacterial growth. The low dose of doxycycline has been found to be safe and effective in treating a bacterial infection in acne (Veltri, 2013). I will also prescribe a 5% Benzoyl peroxide (Acnecide) topical to cleanse the face twice daily in order to unclog the pores, remove dead cells, and reduce inflammation (Matin & Goodman, 2022).

Q5. The patient is concerned because her mother and sister developed fractures in their legs and vertebra after menopause. She wants to know what medication and other advice will prevent osteoporosis. You discuss bisphosphonates. How are they used in the prevention and treatment of osteoporosis?

Bisphosphonates constitute a group of drugs such as risedronate, alendronate, ibandronate, zoledronic acid, and pamidronate that are used to treat or prevent osteoporosis often resulting from loss of calcium in bones and bone demineralization and reduce the risk for hip and spine fractures. They inhibit bone resorption, and calcification and increase bone mineralization and density which reduce the risk of fractures in osteoporosis due to aging, estrogen deficiency in menopause, or corticosteroid use (Rosenthal & Burchum, 2021).

A 48-year-old man has occasional episodes of gout that are painful and debilitating. He requires drugs to treat the symptoms of acute gout attacks and prevent recurrent attacks.

Q6. How would you treat this patient’s acute gout attack? Please list the trade and generic name and the dose of therapy. What is the mechanism of action of your choice of prescription?

The goal of treatment will be to alleviate pain and inflammation. The following medications will be prescribed:

• Colchicine (generic name) or Colcrys (brand name) 1.2mg by mouth at the initial attack followed by 0.6mg one hour after the onset of an attack and then 0.6mg PO twice daily until the gout attack is resolved. This medication works by alleviating inflammation in the affected joint and also prevents the accumulation of uric acid crystals in the affected joint which helps in preventing gout attacks (Coburn & Mikuls, 2016)
• Prednisone (generic name) or Prelone, Deltasone (brand names) 0.5mg/kg PO daily for two to five days of full dose and then taper over seven to ten days. This medication works by reducing swelling at the affected joint (Coburn & Mikuls, 2016)
• NSAIDS such as Naproxen (generic name) or Aleve, Anaprox, or Naprelan (brand names) 500mg PO twice daily. This medication works by inhibiting both COX-1 and COX-2 resulting in analgesic and anti-inflammatory effects which helps alleviate pain (Coburn & Mikuls, 2016).