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Date Course Title Nursing Math and Pharmacology Credits 3 credits Course Number NUR 1141 None Pre-requisite (s) MAT0002, DEP 1000, NUR 1889, 1822, 1045, 1025, 1025C, Co-requisite (s) Hours 45 theory hours/45 clock hours Total outside 90 hours hours Note: A minimum of 2 hours of outside work is assigned per clock hour. Place and Time of Class Meeting International College of Health Sciences 2300 S Congress Ave, Suite 105 Boynton Beach, FL 33426 Hybrid Name and Contact Information of Instructor Instructor: Felicia Mallett Email: [email protected] Office Hours: By Appointment Campus Telephone: (561) 202-6333 Method of Delivery: Online Book required Lehne’s Pharmacology for Nursing Care, 9/e, Jacqueline Rosenjack Burchum & Laura D. Rosenthal ©2016 | Pearson | Published: 2/2015 ISBN-9780323322614 Classroom expectations for students Attendance Policy Students must log into their online course prior to the third day of the course as dictated by the drop policy of the college. Failure to log in by end of day three will result in the student being dropped from the course. Attendance in online courses is defined as active participation in the course. Active participation is defined as completion of all expectations outlined in the online courses as contained in lesson plan, syllabi, and other course related documents within the course. These expectations may include but are not limited to participation in discussion forums, submission of completed assignments, and completion of quizzes and exams. NOTE: Plagiarism is defined as the use, without proper acknowledgment, of the ideas, phrases, sentences, or larger units of discourse from another writer or speaker. Plagiarism includes the unauthorized copying of software and the violation of copyright laws. Students who commit plagiarism will obtain a grade of “Failure” on their exam or assignment. A student will not receive credit if found to have plagiarized his/her work and may result in suspension or dismissal from the school. Follow the link for examples of plagiarism, follow the link : http://examples.yourdictionary.com/examples/examples-of-plagiarism.html Course Description This course combines theory and laboratory experiences to allow for mastery of the basic principles of pharmacotherapeutics and the role of the nurse in safe effective administration of medications with emphasis places on dosage calculations. Learning Objectives The primary goal is to establish knowledge and skills for the safety administration of drug therapy within the role of the registered professional nurse. STUDENT LEARNING OUTCOMES (SLO) All students successfully completing this course will be able to: 1.1. Collect, analyze, and prioritize relevant physical, developmental, psychosocial, cultural, spiritual, and functional assessment data to provide individualized patient care. 2 2. Utilize the nursing process, critical thinking, evidence-based information, and knowledge from the arts and sciences to support sound clinical decisions. 3 3. Communicate effectively through verbal, nonverbal, written, and technological means with individuals, families, and health care team members. 4 4. Plan and implement nursing care in a safe, compassionate, culturally sensitive manner that preserves human dignity and promotes growth of individuals and families. 5 5. Manage the efficient, effective use of human, physical, financial, and technological resources in providing continuity of care within and across healthcare settings. 6 6. Collaborate with individuals, families, and healthcare team members in providing comprehensive, individualized patient care. 7 7. Demonstrate accountability in adhering to standards of professional practice within legal and ethical frameworks. 8.8. Participate in activities that promote professional development and personal growth. COURSE OBJECTIVES (CO) All students successfully completing this course will be able to: 1. Describe the mechanism of action, therapeutic uses, side effects, and adverse reactions for each major drug class. (SLO – 1, 2) 2. Discuss basic physiological and pathophysiological mechanisms involved in the rationale for drug therapy. (SLO – 1, 2) 3. 4. 5. Examine recent research findings and developments related to drug therapy. (SLO-2) Demonstrate the ability to accurately calculate drug dosages. (SLO- 3,4, 5) Identify physical, developmental, psychosocial, religious, and cultural factors that impact drug therapy. (SLO-1, 3, 4, 6) 6. Describe the nursing interventions and patient education necessary for safe administration of the major drug classes. (SLO– 2, 3, 5, 7) Explain the nurse’s role in teaching patients receiving drug therapy. (SLO – 3, 5) Identify the legal and ethical standards related to the nurse’s role in drug therapy. (SLO – 3, 7) 9. Recognize the responsibility for continued learning regarding drug therapy. (SLO –3, 8) 7. 8. Topical Outline and Schedule DATE WEEK 1 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Compare and contrast antibody-mediated (humoral) immunity and cellmediated immunity, including in the discussion the general mechanisms of antibody production on the host and how antibodies produce actions or defenses in the host. Identify the origins and roles of helper T lymphocytes (CD4 cells), macrophages, and cytolytic T lymphocytes (CD8 cells). State the main roles of the following cells, which are important in the immune response: B lymphocytes (B cells), cytolytic T lymphocytes (T cells, CD8 cells), helper T lymphocytes, macrophages/monocytes, and mast cells/basophils. Explain the general roles of the immunoglobulins and explain why they are divided into five major classes. Explain the MHC and its main functions, considering the functions in terms of preventing autoimmune diseases and aiding organ/tissue/cell transplantation. Compare and contrast the basic mechanisms and outcomes of delayed and immediate hypersensitivity reactions. In discussing delayed hypersensitivity, integrate general concepts about cell-mediated immunity. Summarize the main purpose of the classical complement pathway and how its activation eventually leads to cell death. Describe the role of vaccines in maintaining health. Differentiate between active and passive immunity and explain how vaccines work. Summarize the three main contraindications that apply to administration of any vaccine. State where to look for current information on required or recommended vaccinations for children, and explain when and how these vaccines should be given. Explain why multiple doses of a vaccine are given for a particular preventable infectious disease, rather than just a single dose. Identify the two most common clinical uses for immunosuppressive drugs. Explain why immunosuppressants can be considered both a blessing and a potential curse to the host. Summarize the main mechanism of action, pharmacokinetics, toxicity, and drug-drug interactions involving calcineurin inhibitors in the context of a holistic care plan that maximizes the drug’s desired effects while minimizing the risks of adverse responses or drug interactions. Name some of the common autoimmune disorders for which immunosuppressants are used. State the richest physiologic source of histamine and name the part or parts of the body where histamine is found in abundance. Also, describe the two main processes by which this chemical can be released from these structures. Summarize the main effects of histamine on airway smooth muscle tone, arteriolar and venular tone, gastric acid secretion, and the heart (e.g., rate), and identify the receptor or receptors involved in these effects. Identify the receptors that are blocked by a typical first-generation H1 antagonist, especially as they relate to clinical uses and precautions for their use. Compare and contrast the effects of first- and second-generation H1 antagonists on the central nervous system (CNS). Summarize the benefits or limitations of antihistamines for managing anaphylaxis, the signs and symptoms of the common cold, allergic rhinitis, and asthma. Describe the similarities or differences between the COX-1 and COX-2 pathways and state which (pathologic) physiologic process is mainly responsible for analgesia, antiinflammatory activity, antipyresis, bleeding tendencies, and gastric mucosal damage. Discuss the beneficial and adverse actions of NSAIDs and the basic mechanisms by which they occur. Identify situations in which aspirin should not be used, even for relief of mild or episodic headache or fever. Also, state which of the alternative over-the-counter (OTC) analgesic/antipyretic drugs would be a more acceptable alternative to aspirin and why. Compare and contrast the signs and symptoms of acute poisoning with aspirin and with acetaminophen; the time course of the signs and symptoms and underlying causes; and the management of these conditions. Describe the feedback loop and its components that regulate physiologic glucocorticoid secretion. Describe the general mechanism by which glucocorticoids cause their biologic effects. Also, compare the cellular site of glucocorticoid receptors with those of typical agonists, such as epinephrine or acetylcholine. State and describe the main therapeutic uses of glucocorticoids for nonendocrine disorders. In terms of mechanisms and targets of action, state why glucocorticoids have greater antiinflammatory activity than nonsteroidal antiinflammatory drugs (NSAIDs). State and describe the physiologic effects of glucose administration on the metabolism, the cardiovascular system, the stress response, fluid and electrolytes, and the respiratory system in neonates. Describe issues related to the timing of glucocorticoid administration, particularly with regard to maximizing therapeutic responses and minimizing adverse responses during corticosteroid administration and discontinuation. Describe the potential risks to and relative glucocorticoid requirements of patients who are under physiologic stress and during discontinuation of systemic glucocorticoids. Discuss issues and concerns related to administering pharmacologic doses of glucocorticoids to women who are pregnant or breast-feeding their infants. Unit 11: Anti-inflammatory, Antiallergic, and Immunologic Drugs TOPIC (S) Review of the Immune System Childhood Immunization Immunosuppressants Antihistamines Cyclooxygenase Inhibitors: Nonsteroidal Anti-inflammatory Drugs and acetaminophen Glucocorticoids in Nonedocrine Disorders READING ASSIGNMENT LEARNING ACTIVITIES Chapter 67: pp 806 – 816 Chapter 68: pp 817 – 833 Chapter 69: pp 834 – 840 Chapter 70: pp 841 – 848 Chapter 71: pp 849 – 868 Chapter 72: pp 869 - 917 DISCUSSION (Choose 1) Develop plans of care for an immunocompromised patient and share yours in this discussion. Measles, mumps, and rubella virus vaccine (MMR) is a combination product composed of three live virus vaccines. Discuss the _current debate over _vaccines. Summarize the three main contraindications that apply to administration of any vaccine. Explain why immunosuppressants can be considered both a blessing and a potential curse to the host. Discuss issues and concerns related to administering pharmacologic doses of glucocorticoids to women who are pregnant or breast-feeding their infants. ASSIGNMENT Review the syllabus Read assignments Post discussion topic by Wednesday at 11:55 pm EST Respond to at least one classmate by Friday at 11:55 pm EST Complete case study ASSESSMENT Discussion & response Case Study: Side Effects Submit signed Syllabus Acceptance Form Homework: Chapter readings: Chapters 73, 74, 75, 76, & 77. DATE WEEK 2 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Discuss the etiology, pathophysiology, clinical presentation, and longterm complications of rheumatoid arthritis (RA). Discuss the three classes of drugs used in the treatment of rheumatoid arthritis and identify the importance of early use of disease-modifying antirheumatic drugs (DMARDs). Compare and contrast the main adverse effects of the nonbiologic and biologic DMARDs used in the treatment of RA. Discuss the role of nonsteroidal antiinflammatory drugs (NSAIDs) and glucocorticoids in the treatment of RA based on current management guidelines. Discuss the etiology, pathophysiology, clinical presentation, and treatment of gouty arthritis. Discuss the first-line agents for relieving the pain of an acute gouty attack and explain when glucocorticoids and colchicine are acceptable alternatives. Give an overview of the metabolic pathway by which uric acid is formed, starting with the original source, adenosine triphosphate (ATP); name the enzyme involved in the conversion of hypoxanthine to xanthine and xanthine to uric acid; and compare and contrast the solubility of hypoxanthine, xanthine, and uric acid in body fluids (e.g., urine, synovial fluid). Summarize the mechanisms of action of allopurinol, probenecid, and colchicine in the context of hyperuricemia, gout, and gouty arthritis. In addition, state where each fits into a treatment plan for asymptomatic hyperuricemia, treatment of acute gout, and prophylaxis of recurrent attacks, and when and why each should not be used. Describe the dose-dependent effects of aspirin on renal handling of uric acid and discuss the roles of this nonsteroidal antiinflammatory drug (NSAID), which is the one most commonly used in the therapy of asymptomatic hyperuricemia and gout. Briefly describe the roles of parathyroid hormone and vitamin D as they affect absorption of dietary calcium and bone mineral metabolism. Briefly describe the roles of osteoblasts and osteoclasts in bone formation and resorption. Compare and contrast the benefits, limitations, and risks of estrogen replacement therapy with those of raloxifene in terms of their effects on bone metabolism and integrity; risks of breast and endometrial cancer; menstrual bleeding; other signs and symptoms of menopause; the incidence of thromboembolism; and fetal development, should the patient receiving the drug be pregnant. Describe the typical etiologies and characteristic signs, symptoms, and laboratory abnormalities associated with hypocalcemia and hypercalcemia. Describe drug therapies and nondrug interventions that are indicated for osteoporosis, making sure to distinguish between prophylaxis and treatment of the disease once it has been diagnosed. State a reasonably accurate definition of asthma that includes an understanding of the roles and involvement of airway smooth muscle hyper-responsiveness and inflammation in the disease. Also, describe the typical signs and symptoms that would lead to the diagnosis of a respiratory disorder as asthma. State the criteria used to classify the severity of asthma based on impairment and risk. Summarize the mechanisms of action, roles, and limitations of the following drugs in the therapy of asthma: beta-adrenergic agonists, glucocorticoids, methylxanthines, mast cell stabilizers, leukotriene modifiers, anticholinergic drugs, and glucocorticoid/LABA combinations. Describe the two basic goals in the treatment of chronic asthma. Compile a list of drugs or drug groups that are relatively or absolutely contraindicated in patients with asthma, and state the main reasons why. Discuss some nondrug interventions that might be used to reduce the frequency and severity of asthma attacks. Review the basic pharmacology of drugs for allergic rhinitis. Summarize the roles of antihistamines, glucocorticoids, and sympathomimetic decongestants in terms of managing the signs, symptoms, and underlying causes of the common cold. Discuss the use of zinc and vitamin C for colds in children and adults. Unit 12: Drugs for Bone and Joint Disorders TOPIC (S) Drug Therapy of Rheumatoid Arthritis Drug Therapy of Gout Drugs Affecting Calcium levels and Bone Mineralization Unit 13: Respiratory Tract Drugs Drugs for Asthma and Chronic Obstructive Pulmonary Disease Drugs for Allergic Rhinitis, Cough, and Colds READING ASSIGNMENT Chapter 73: drug Therapy of Rheumatoid Arthritis – pp 879 – 890 Chapter 74: Drug Therapy of Gout – pp 891 – 895 Chapter 75: Drugs Affecting Calcium Levels and Bone Mineralization – pp 896 – 917 Chapter 76: Drugs for Asthma and Chronic Obstructive Pulmonary Disease – pp 918 – 938 Chapter 77: Drugs for Allergic Rhinitis, Cough, and Colds – pp 939 – 948 DISCUSSION (Choose One) LEARNING ACTIVITIES Discuss the use of zinc and vitamin C for colds in children and adults. Describe the two basic goals in the treatment of chronic asthma. Discuss the etiology, pathophysiology, clinical presentation, and treatment of gouty arthritis. ASSIGNMENT Read assignments Post discussion topic by Wednesday at 11:55 pm EST Respond to at least one classmate by Friday at 11:55 pm EST Complete case study Review Nursing Math Calculations (Although not a required textbook, it may be helpful to reference the following book: Calculation of Drug Dosages: A work Text, by Ogden Fluharty) ASSESSMENT Discussion & response Case study Quiz Homework: Chapter readings: Chapters 78, 79, 80 DATE SPECIFIC OBJECTIVES WEEK 3 At the end of this lesson, you will be able to: Describe peptic ulcer disease as an imbalance between protective and destructive factors on the gastrointestinal (GI) mucosa. Also, state the contributions of histamine, gastrin, and acetylcholine to overall gastric acid secretion and explain why gastric acid is a necessary (but not in itself sufficient) component of the development of peptic ulcers. Summarize the benefits and limitations of drug therapy targeted at the destructive factors on the GI mucosa and identify which drugs or drug groups truly alter the underlying disease processes rather than creating a local environment that is conducive to natural ulcer healing. Discuss short-term and long-term goals of therapy for peptic ulcer disease and identify one or more drugs or drug groups that can meet those goals quicker or better than others. State conditions for which a trial of over-the-counter (OTC) drug therapy might be indicated, either for peptic ulcer disease (PUD) or gastroesophageal reflux disease (GERD). In addition, recommend a treatment plan that involves OTC drugs; also, with regard to this plan, highlight the limitations and potential dangers of self-medication with OTCs and state findings that necessitate a visit to a physician. Identify the four main chemicals in single-ingredient antacid products and the major benefits or limitations of each. State the ingredients typically found in proprietary antacid combination products and give the rationale for using them rather than single-ingredient products. Include the main expected effects of single-ingredient antacids on gut motility. Compare and contrast the H2 blockers in terms of efficacy, side effects, and drug-drug interactions. Also, be able to argue for or against the selection of a particular H2 blocker over another. State the role of antihistamines (e.g., diphenhydramine) in the management of PUD. State the role of proton pump inhibitors in the management of PUD. Prepare a short list of drugs or drug groups (classes) that are ulcerogenic. Describe the principal functions of the colon and what constitutes a normal bowel movement. Define constipation and describe nondrug measures to correct it. Identify indications for the use of a laxative. Describe the basic pharmacology of laxatives and distinguish among surfactant laxatives, stimulant laxatives, and osmotic laxatives. Describe the causes, consequences, and treatment of laxative abuse. Discuss the mechanisms by which emesis is triggered and the main neurotransmitters that participate in the triggering of signs and symptoms. Describe the drugs used as antiemetics and summarize their mechanism of action, if known. Describe a care plan for managing chemotherapy-induced nausea and vomiting, including interventions and drugs that would be suitable for the three main types of emesis seen in this setting (anticipatory, acute, and delayed), as well as considerations for effective routes of administration. Unit 14: Gastrointestinal Drugs TOPIC (S) Drugs for Peptic Ulcer Disease Laxatives Other Gastrointestinal Drugs READING ASSIGNMENT Chapter 78: Drugs for Peptic Ulcer Disease – pp 947 – 962 Chapter 79: Laxatives – pp 963 – 970 Chapter 80: Other Gastrointestinal Drugs – pp 971 – 986 DISCUSSION Discuss the relationship of mucosal defenses and aggressive factors to health and peptic ulcer disease (p. 948) to begin a discussion of the factors that protect against or lead to ulcer formation. You are reminded that the protective factors are the basis for pharmacologic intervention. LEARNING ACTIVITIES ASSIGNMENT Read assignments Post discussion topic by Wednesday at 11:55 pm EST Respond to at least one classmate by Friday at 11:55 pm EST Complete the chapter test by Friday at 11:55 pm EST Use the Math test as a practice exam ASSESSMENT Discussion & response Math quiz( Practice) Quiz Chapters 78, 79, 80 Homework: Chapter readings: 81-82 DATE WEEK 4 At the end of the week, the student will be able to: SPECIFIC OBJECTIVES State the overall functional role of vitamins in maintaining good health. In general terms, compare and contrast the Recommended Dietary Allowance (RDA), Adequate Intake (AI), Tolerable Upper Intake Level (UL), and Estimated Average Requirement (EAR) with regard to vitamin intake. Identify the two major vitamin groups or classifications and the factor or factors that place a vitamin in either of those groups. Recognize the common synonyms or alternative terms (or common pharmaceutical products) for the following vitamins: 1. Niacin ‒ nicotinic acid, nicotinamide; 2. Vitamin A ‒ retinol; 3. Vitamin B1 ‒ thiamine; 4. Vitamin B12 ‒ cyanocobalamin; 5. Vitamin B2 ‒ riboflavin; 6. Vitamin B6 ‒ pyridoxine; 7. Vitamin C ‒ ascorbic acid; 8. Vitamin E ‒ alphatocopherol. State the main biochemical roles of the following vitamins and the clinical findings or consequences of inadequate or excessive levels: vitamins A, C, D, E, K, B1, B2, B6, B12, niacin, and folic acid. State the common comorbidities associated with obesity. Give a general overview of the importance of existing comorbidities in determining whether or how to initiate weight-loss therapy. Discuss the management of obesity, including the benefits, risks, and limitations of lifestyle changes, drug therapy, and surgery. Identify the main pharmacologic classes and mechanisms of appetite suppressants and the common medical or psychologic conditions they may aggravate. Describe serotonin syndrome and the weight-loss medication that is most likely to trigger it; also, identify drugs that increase the risk of this serious response. Summarize the main calorie-lowering actions of and indications for orlistat. Also, identify its main site of action, compare it with that of such drugs as sibutramine or the amphetamines, and explain the clinical consequences of orlistat’s different site of action. TOPIC (S) Identify the main drug used in many over-the-counter (OTC) weight-loss aids, the potential adverse peripheral autonomic effects, and common and important contraindications to its use. Vitamins Drugs for Weight Loss READING ASSIGNMENT Chapter 81: Vitamins – pp 987 – 995 Chapter 82: Drugs for Weight Loss – pp 996 – 1000 DISCUSSION (Choose 1) ASSIGNMENT Read assignments Post discussion topic by Wednesday at 11:55 pm EST LEARNING ACTIVITIES Respond to at least one classmate by Friday at 11:55 pm EST Complete Pharmacology Midterm by Friday at 11:55 pm EST Math Quiz ASSESSMENT Discussion & response Math quiz Quiz Homework: Chapter readings: 83-90. Practice Dosage and Calculations for Math Midterm. DATE SPECIFIC OBJECTIVES WEEK 5 At the end of this lesson, the student will be able to: Define selective toxicity as it applies to the general mechanisms by which antibiotics work against invading pathogens but not against host cells. Give a working definition of narrow-spectrum antibiotics and broadspectrum antibiotics and state when one or the other would be preferred as a therapeutic approach and why. Explain the fundamental difference between bactericidal and bacteriostatic drugs and state the host-related factors required for successful therapy with a bacteriostatic agent. State the main mechanisms by which microbes develop resistance to antimicrobial drugs. Also, address the important issues of spontaneous mutations and R factors. Understand the concept and purpose of the broth dilution procedure and the disk-diffusion test in determining the susceptibility of bacteria to antibiotics. Discuss the general rationale and need for using antibiotics in combination as well as situations in which antibiotic combinations should be avoided. Describe generally accepted indications for prophylactic antimicrobial therapy. Discuss the misuse of antibiotics, its general prevalence, why misuse persists as a major health problem, and the consequences. Give some examples of common situations in which iatrogenic antibiotic misuse occurs. Start preparing a table to be completed in the remaining chapters in this unit. Include (1) the names of each main drug class as well as prototypes and important related drugs; (2) whether and for what infections and infectious organisms the drugs are considered first-line treatment; (3) whether the drugs are bacteriostatic or bactericidal; (4) specific and important contraindications; (5) the relative degree to which resistance develops and a general mechanism by which resistance occurs; (6) the general risk for allergic reactions and whether antibiotics in other classes may cross-react to trigger allergic responses; and (7) any specific host toxicities. Describe the basic mechanism of action of the penicillins. Compare and contrast gram-positive and gram-negative bacteria; state which penicillins are able to penetrate the outer membrane of gramnegative bacteria. Describe the beta-lactam ring. Also, explain why penicillins are part of the family of antibiotics called the beta-lactam antibiotics, and state how that relates to the vulnerability of these antibiotic classes to inactivation by certain bacteria. State the four main classes of penicillins: (1) narrow-spectrum penicillins that are penicillinase sensitive, (2) narrow-spectrum penicillins that are penicillinase resistant, (3) broad-spectrum penicillins, and (4) extendedspectrum penicillins. Also, for each group, identify the prototype and indicate the bacterial types or strains that typically respond to them. Explain the clinical significance of various salts of penicillin G in terms of pharmacokinetics, spectrum of activity, susceptibility to penicillinases, unique side effects, and adverse reactions. Recognize penicillins as a main cause of drug-induced allergic reactions. Also, compare and contrast immediate, accelerated, and delayed hypersensitivity reactions in terms of time of onset and main signs and symptoms. Given a patient’s history of severe hypersensitivity reactions to penicillin, state at least one other group of antibiotics that should not be administered because of the risk of cross-reactivity. Recognize clavulanic acid, sulbactam, and tazobactam as penicillinase inhibitors that are combined with certain broad- or extended-spectrum penicillins and as drugs that lack intrinsic toxicity and antibiotic effects and do nothing to reduce the risk or severity of hypersensitivity reactions in susceptible patients. Describe the general rationale and indications for using both intravenous penicillin and an aminoglycoside. State the practical and correct reason for administering them together. Compare and contrast cephalosporins (as a single large drug class) and penicillins with respect to general mechanisms of action and mechanisms by which resistance develops. Identify a prototype or representative example for each of the four generations of cephalosporins. Differentiate the groups in terms of mechanism of action, spectrum of action, susceptibility to destruction/inactivation by beta-lactamases, and access to the cerebrospinal fluid. Focus on imipenem as the prototype for carbapenems; also, recognize its broad spectrum of activity and explain how it influences when the drug should or should not be used. State the characteristics of vancomycin that make it such a critically important drug, yet one that is not used unless an infection is very serious or other antibiotics fail or cannot be given to a particular patient. Unit 16: Chemotherapy of Infectious Diseases TOPIC (S) Basic Principles of Antimicrobial Therapy Drugs that Weaken the Bacterial Cell Wall 1: Penicillins Drugs that Weaken the Bacterial Cell Wall II: Cephalosporins, Carbapenens, Vancomycin, Telavancin, Aztronaim, and Fosfomycin Bacteriostatic Inhibitors of Protein Synthesis: Tratracyclines, Marolides, and Others Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis Sulfonamides and Trimethoprim Drug Therapy of Urinary Tract Infections Antimycobaterial Agents: Drugs for Tuberculosis, Leprosy, and Mycobacterium avium Complex Infections READING ASSIGNMENT Chapter 83: pp 1001 - 1014 Chapter 84: 1015 – 1024 Chapter 85: pp 1025 – 1036 Chapter 86: 1026-1037 Chapter 87: 1038-1050 Chapter 88: 1051-1058 Chapter 89: 1059-1066 Chapter 90: 1067-1071 DISCUSSION Review the normal cell wall physiology of bacteria and discuss how cephalosporins affect the bacterial cell wall. Visit http://www.emedexpert.com/compare/cephalosporins.shtml LEARNING ACTIVITIES ASSIGNMENT Read assignments Post discussion topic by Wednesday at 11:55 pm EST Respond to at least one classmate by Friday at 11:55 pm EST Complete math midterm by Friday at 11:55 pm EST ASSESSMENT Discussion & response Math midterm Homework: Chapter readings: 91-96 DATE WEEK 6 At the end of this lesson, the student will be able to: SPECIFIC OBJECTIVES Summarize the main clinical uses for the fluoroquinolones, focusing on the organisms or infections for which one of these drugs is considered first-choice therapy. Describe the adverse effects of fluoroquinolones. Recognize that tendon rupture is a rather unusual adverse response associated with ciprofloxacin and other fluoroquinolones. Also, demonstrate understanding of how tendon rupture may occur; point out that the risk means certain patient populations should not use the drug; and explain how to monitor for tendon rupture when the drug is used. Recognize the potential for serious neurotoxicity and nephrotoxicity associated with parenteral use of polymyxin B and the impact of such concerns on the use of this medication. Compare and contrast opportunistic and nonopportunistic infections (the general terms), particularly the patient populations most likely to acquire them. Identify the drug that is the agent of choice for most systemic mycoses; describe its main mechanism of antifungal action; and state whether it is best used for minor or more serious fungal infections and why. Compare and contrast the basic biology, epidemiology, and treatment of fungi with that of bacteria, explaining why amphotericin B is effective against fungi but not against bacteria and why host-centered toxicity of amphotericin B is much greater and more prevalent than with most antibiotics. Discuss the main indications for intravenous amphotericin B; also, identify the drug’s three most common adverse responses and the precautions that should be taken to minimize their effects. Explain what azole antifungal drugs are and give examples; also, recognize that these drugs, when given systemically, can be a major cause of interactions with other drugs by inhibiting their hepatic metabolism. Summarize the main similarities and differences between how a typical antibiotic affects bacterial metabolism, having minimal or no effects on host-cell metabolism, and how antiviral drugs more often affect both the target organisms and the host. Recognize that acyclovir is the drug of choice for most herpes simplex and varicella-zoster virus infections and explain the drug’s main actions, uses, and other key clinical pharmacologic properties. Describe the adverse effects of acyclovir and ganciclovir and how the route of administration affects those responses. Compare and contrast hepatitis B and hepatitis C, the two most common strains of viral hepatitis, in terms of prevalence, mode of transmission, incidence of acute and chronic disease, lethality, and prevention and management (for example, vaccines, treatments for active disease). Summarize current guidelines or recommendations for prophylactic influenza vaccination and identify high-risk populations most likely to benefit from prophylaxis. Also, explain why the vaccines seem to keep changing from one flu season to the next. Define a retrovirus in terms of the transcription of information between viral deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). Also, compare the sequence of the basic events in retroviruses with what goes on in a typical host cell. Recognize that helper T-lymphocyte (CD4) cells are the main target of HIV. Also, explain what CD4 cells do to/for the human immunodeficiency virus (HIV), why they are important to the host, and how these facts relate to the opportunistic infections that accompany acquired immunodeficiency syndrome (AIDS). Describe the three phases of HIV infection and the likely levels of CD4 cells and HIV in each. Also, explain why the CD4 and HIV levels change as they do. In simple terms, explain what the main classes of antiretroviral drugs do to impair viral replication or function biochemically. (Understanding what these drugs do ensures a good grasp of how retroviruses such as HIV cause infections and damage host cells.) Give a reasonable explanation of why HIV infection does not kill people directly, pointing out that infected individuals die of the consequences of other events that develop when the infection turns into AIDS. Briefly summarize the antiretroviral mechanism of action of the protease inhibitors and recognize hyperglycemia and its consequences, a pseudoCushing’s syndrome, and hyperlipidemias as key adverse responses to these drugs. Also, state the main monitoring methods or interventions for these adverse responses. Explain highly active antiretroviral therapy (HAART) and indicate why multidrug therapy for HIV/AIDS is important. Also, explain drug or drug class selection and the merits of combination therapy. Recognize that the blood levels, effects, and toxicity of saquinavir as the prototype protease inhibitor are very dependent on the level of activity of the liver’s P450 drug-metabolizing system. Recognize that the proteases, in general, inhibit the P450 system. Identify some of the key drugs that interact with protease inhibitors, either by inhibiting or inducing the P450 system, and predict the consequences of such interactions. Identify the three main reasons for changing antiretroviral therapy and summarize some reasonable guidelines for the process of changing treatment. Identify some of the common opportunistic infections in patients with HIV/AIDS. Also, identify and describe some of the common modalities for prophylaxis and treatment of these opportunistic infections. Explain some of the main impediments to proper, optimal therapy of HIV/AIDS, including not only pharmacologic considerations but also economic and compliance factors. Describe the special therapeutic and preventive approaches that must be taken for pregnant HIV/AIDS patients, for adolescents with active infection, and for infected neonates and infants. Give an accurate definition of sexually transmitted diseases (STDs) and explain how the term encompasses more than one clinical presentation. Make an accurate statement about the overall incidence of an individual STD in the context of diseases likely to be encountered in clinical practice. Describe the various treatments and prophylactic measures for STDs and explain how and why previously effective antibiotic therapies have become outmoded because of resistance. Describe the symptoms and time courses of the three main stages of syphilis, as well as the typically recommended therapies for syphilis in adults, during pregnancy, and in newborns with congenital exposure to Treponema pallidum. Summarize a general drug plan for a patient with syphilis who also has a history of severe hypersensitivity reaction to penicillin. State the most common route by which neonatal gonococcal infection occurs and the most common and handicapping consequence of that neonatal infection; also, describe the usual prophylactic measures taken with neonates and why they must be done. State the main criterion that differentiates an antiseptic from a disinfectant. Discuss how healthcare providers can use antiseptics and disinfectants to protect patients and themselves from infections. Describe the preferred treatments for established local cutaneous infections. Unit 16: Chemotherapy of Infectious Diseases, continued TOPIC (S) Chapters 91-96 READING ASSIGNMENT Chapter 91: pp 1086-1092 Chapter 92: pp. 1093-1105 Chapter 93: pp 1106 - 1123 Chapter 94: pp 1124 - 1166 Chapter 95: pp: 1167-1174 Chapter 96:, pp: 1175-1181 DISCUSSION (Choose 1) Describe the adverse effects of fluoroquinolones Describe the three phases of HIV infection and the likely levels of CD4 cells and HIV in each. Also, explain why the CD4 and HIV levels change as they do. Describe the preferred treatments for established local cutaneous infections. LEARNING ACTIVITIES ASSIGNMENT Read assignments Post discussion topic by Wednesday at 11:55 pm EST Respond to at least one classmate by Friday at 11:55 pm EST Complete math quiz by Friday at 11:55 pm EST ASSESSMENT Discussion & response Math quiz Quiz Chapters, 91-96 Homework: Chapter readings: Chapters 97-100 DATE WEEK 7 At the end of this lesson, the student will be able to: SPECIFIC OBJECTIVES TOPIC (S) Give an accurate definition of sexually transmitted diseases (STDs) and explain how the term encompasses more than one clinical presentation. Make an accurate statement about the overall incidence of an individual STD in the context of diseases likely to be encountered in clinical practice. Describe the various treatments and prophylactic measures for STDs and explain how and why previously effective antibiotic therapies have become outmoded because of resistance. Describe the symptoms and time courses of the three main stages of syphilis, as well as the typically recommended therapies for syphilis in adults, during pregnancy, and in newborns with congenital exposure to Treponema pallidum. Summarize a general drug plan for a patient with syphilis who also has a history of severe hypersensitivity reaction to penicillin. State the most common route by which neonatal gonococcal infection occurs and the most common and handicapping c Unit 17: Chemotherapy of Parasitic Diseases READING ASSIGNMENT Chapter 97: pp: 1182-1186 Chapter 98: pp: 1187-1194 Chapter 99: pp 1195 - 1200 Chapter 100: pp 1201 – 1205 DISCUSSION (Choose 1) LEARNING ACTIVITIES Discuss the adverse effects of the various drug therapies used for the different forms and stages of malaria. Discuss drug therapies for the various protozoal infections Summarize the differences between scabies and the three main types of pediculosis so as to clarify them to a layperson. ASSIGNMENT Read assignments Post discussion topic by Wednesday at 11:55 pm EST Respond to at least one classmate by Friday at 11:55 pm EST Complete case study ASSESSMENT Discussion & response Case study Quiz Chapters 97-100 Homework: Chapter readings: Chapters 101-103 ; Call Michelle, order your Pharm HESI exam and schedule your testing date. DATE WEEK 8 At the end of this lesson, the student will be able to: SPECIFIC OBJECTIVES Describe why the three main treatment approaches to cancer (drugs, surgery, and radiation) can be considered and often are used as adjuvants to one another. Also, state the general types of cancers for which surgery and radiation therapy generally are not the primary approaches and for which pharmacologic treatment therefore is mainly used. Summarize the main states of the cell cycle (G0, G1, S, G2, M) and briefly describe what occurs in each stage. Also, explain the following: whether or why the cell cycle state is in affects a cell’s response to anticancer drugs; how this relates to the concept of growth fraction; and how, in general, solid tumors differ from disseminated cancers in terms of their responsiveness to cancer chemotherapy. In general terms, compare and contrast the typical cancer chemotherapeutic drug with the typical antibiotic with respect to the concept of selective toxicity. Recognize that cancer cells tend to develop resistance to anticancer drugs through random mutation and that these mutations can have the following consequences in terms of the cancer cells’ response to a specific drug. The cells may do any of the following: become less able to take up the drug, improve their ability to pump the drug out of the cells, lose their ability to transform the drug into an active and cytotoxic metabolite, or develop better or faster ways to repair the damage caused by the chemotherapeutic agent. Summarize the basic principles and concepts that apply to how and why multidrug therapy is preferred for treating cancers. Give a succinct but accurate explanation of why drug therapy of disseminated cancers usually is more successful than drug treatment of solid tumors. Identify and describe the main classes of anticancer drugs in terms of their main mechanisms of action. Differentiate between cell-cycle phase–specific and cell-cycle phase– nonspecific anticancer drugs in terms of their mechanisms of action on cell growth and replication. Also, state the main advantages or limitations of drugs in these two groups in terms of general efficacy against cancer cells. Summarize the main roles of deoxyribonucleic acid (DNA) replication, transfer of DNA’s genetic message to ribonucleic acid (RNA) and onto protein synthesis, and the role of mitosis and microtubular formation as they affect cancer cell growth and reproduction. Identify the side effects and adverse responses that are generally common to all anticancer drugs and explain why they occur. Identify the anticancer drugs that exert selective toxicities that are not shared by many or any other anticancer agents, focusing on pulmonary, cardiac, renal, and hepatic toxicity and neurotoxicity. Compare and contrast the basic mechanisms of action, clinical indications, and general toxicities of anticancer drugs discussed in this chapter. Summarize the likely benefits of glucocorticoids, not merely as anticancer drugs per se, but also as useful adjuncts in management of cancers with other drugs or nondrug modalities. Consider the main systemic adverse responses that almost always occur, along with the beneficial effects. State the precautions and related risk factors that should go into a decision about whether to administer tamoxifen either to prevent or treat estrogensensitive breast cancers in women. Summarize the desired and unwanted effects of antiestrogens and selective estrogen receptor modifiers (SERMs) when used for cancer. Describe the paradoxic effects of leuprolide on androgen-dependent advanced prostatic cancer, and name the adjunctive intervention that might prevent the drug’s unwanted effects on the cancer. TOPIC (S) Unit 18: Cancer Chemotherapy READING ASSIGNMENT Chapter 101: Chapter 102: Chapter 103: DISCUSSION (Choose 1) Review the most common toxicities of chemotherapy and discuss prevention and treatment options for patients being treated with chemotherapy. List nursing interventions for each option. Identify and describe the main classes of anticancer drugs in terms of their main mechanisms of action. ASSIGNMENT LEARNING ACTIVITIES Read assignments Post discussion topic by Wednesday at 11:55 pm EST Respond to at least one classmate by Friday at 11:55 pm EST Complete math quiz by Friday at 11:55 pm EST ASSESSMENT Discussion & response Math quiz Take your Hesi Pharm Exam and pass with a minimum score of 850 Homework: Read Chapters 104-108 DATE WEEK 9 At the end of this lesson, the student will be able to: SPECIFIC OBJECTIVES Compare and contrast open-angle glaucoma and angle-closure glaucoma in terms of etiology, prevalence, and management. Summarize how the sympathetic and parasympathetic branches of the autonomic nervous system control pupil size, and explain why pupil size is important for narrow-angle glaucoma. Also state the classes of autonomic drugs that cause miosis and mydriasis, and explain whether the effects of these drugs are beneficial or harmful in glaucoma and why. State the fundamental mechanism of all drugs that have been shown to be effective for managing glaucoma, regardless of their particular mechanism of action or class. Give a description of how the following may help lessen IOP: adrenergic agonists, muscarinic agonists, acetylcholinesterase inhibitors, carbonic anhydrase inhibitors, and prostaglandin F2 alpha or its analogs. State comorbidities that might be aggravated by stated drugs or drug groups that are suitable for managing glaucoma. Conversely, name the drugs or drug classes (and the main indications for their use) that might raise the IOP and aggravate glaucoma. Summarize the basic etiology and pathophysiology of common acne. Also, explain the benefits and limitations of and indications for the main drugs used for acne. Identify the main drugs or other factors that can increase the risk for local or systemic toxicity of topical retinoic acid derivatives. Summarize the main adverse responses associated with isotretinoin therapy and the precautions that should be taken to prevent them or to deal with adverse responses that may occur. Include comments on the drug’s common adverse effects, the potential for psychiatric depression, concerns related to pregnancy and breast-feeding, and interactions with other drugs and vitamins. Compare and contrast acute otitis media (AOM), otitis media with effusion (OME), and antibiotic-resistant otitis media (OM) in terms of the most common pathogenic causes, typical signs and symptoms, and treatment. Comment on the pros and cons of routinely treating all causes of acute otitis media with antibiotics, rather than waiting for a short time and seeing whether the signs and symptoms of the condition resolve spontaneously before treating with antibiotics. Comment on the use of antibiotic prophylaxis for recurrent otitis media in children. For example, demonstrate talking with a mother who has brought her daughter to the pediatrics office three times in the past year with an ear infection and who wants a prescription for antibiotics to prevent another infection. Describe pulmonary arterial hypertension (PAH) and identify the drugs used to treat the condition, their mechanism of action, and significant side effects. State the likely consequences of administering bosentan or sildenafil with drugs that inhibit the liver’s cytochrome P450 system. Also, identify the main groups of these drugs. TOPIC (S) Discuss the drugs used for neonatal respiratory distress syndrome (RDS) and include time frames for their administration. Describe the pathophysiologic process of cystic fibrosis and explain the effect of the disorder on the pancreas, lungs, and reproductive organs. Discuss the pathophysiologic process of amyotrophic lateral sclerosis (ALS) and describe the only medication approved for its treatment. Define the terms dietary supplement and complementary and alternative medicine. Recognize that herbal products usually do contain active ingredients, some of which can cause desired effects and some that can cause serious adverse effects or interact beneficially or not with prescribed FDAapproved drugs. List and describe some of the main reasons patients may turn to herbal products, either as supplements or as alternatives to traditional medicines and medical practice. Recognize what the German Commission E is as it applies to herbal products. Summarize what the Dietary Supplement Health and Education Act (DSHEA-1994) permits (and does not permit) in the way of manufacturing, advertising, and labeling herbal products. Compare and contrast this with the general criteria that a potential manufacturer of a prescription medication must prove before the drug can be marketed. Explain how calling products dietary supplements, rather than drugs, may allow the manufacturers of these products to circumvent standards of purity, efficacy, and safety that apply to FDA-approved drugs, and describe how that ability to skirt more stringent regulations and requirements can be harmful. Recognize that an array of ostensibly equal herbal products, prepared and sold by various individuals or companies, are likely to have very large differences in the amounts of active substance, impurities, and adulterants, thus providing little uniformity. State the main reasons that some practitioners of traditional Western medicine are skeptical of herbal products and nutritional supplements. Unit 19: Miscellaneous Drugs and Therapies READING ASSIGNMENT LEARNING ACTIVITIES Chapter 104: pp 1267 – 1277 Chapter 105: pp 1278 – 1295 Chapter 106: 1296 – 1301 Chapter 107: pp 1302 – 1317 Chapter 108: pp 1318 – 1329 ASSIGNMENT Read assignments Post discussion topic by Wednesday at 11:55 pm EST Respond to at least one classmate by Friday at 11:55 pm EST Complete math quiz by Friday at 11:55 pm EST Complete case study Discussion: Compare and contrast open-angle glaucoma and angle-closure glaucoma in terms of etiology, prevalence, and management. Compare and contrast acute otitis media (AOM), otitis media with effusion (OME), and antibiotic-resistant otitis media (OM) in terms of the most common pathogenic causes, typical signs and symptoms, and treatment. ASSESSMENT Quiz Chapters 104, 105, 106, 107, 108 HESI Remediation if necessary Homework: Read chapters 109-110 DATE WEEK 10 At the end of this lesson, the student will be able to: SPECIFIC OBJECTIVES Describe the five basic elements of managing poisonings. Identify five mechanisms for reducing the absorption of toxicants, commenting on the pros and cons, benefits and limitations, and settings for appropriate use of each. Describe methods (including drugs) that can be used to accelerate the removal of absorbed poisons. Discuss the general mechanism of action by which chelating agents work, why no single chelator is effective for all heavy metal poisonings, and other properties that chelators should have to cause their desired effects. TOPIC (S) Identify the main biotoxins, as discussed in this chapter, and the common properties that make this diverse group of agents suitable for their malevolent uses. Discuss the controversies surrounding the prophylactic use of antibiotics for anthrax by the general population, which is not likely to be exposed to the causative bacterium. Describe the signs, symptoms, and typical times to onset (after exposure) of cutaneous and inhalational anthrax. Summarize the general approaches to treating the infection and preventing the spread to others. Identify agents for which toxicity can be transmitted from person to person via exposure to body fluids, thereby constituting an infectious disease. Discuss the controversies surrounding the issue of vaccinating healthcare workers and first responders against smallpox, including some concept of the estimated risks from the vaccination itself. Also, compare and contrast these risks with the potential risks of being exposed (or of caring for an exposed patient) without being vaccinated beforehand. Discuss chemical weapons and describe the signs and symptoms of exposure and of treatment after exposure to these weapons. Discuss treatments used after radiation exposure, including how soon treatment must be implemented and the factors that determine the choice of treatment. Unit 20: Toxicology READING ASSIGNMENT Chapter 109: pp 1330 – 1335 Chapter 110: pp 1336 - 1345 ASSIGNMENT Read assignments LEARNING ACTIVITIES Post discussion topic by Wednesday at 11:55 pm EST Respond to at least one classmate by Friday at 11:55 pm EST Discussion: Reflect on your feelings of safety and security since the events of September 11, 2001. Discuss what you see as the nurse’s role in times of disaster. ASSESSMENT Hesi vs.2 if necessary. Pass with a minimum score of 900 Instructional Methods The following strategies may be used in this class: 1. 2. 3. 4. 5. Threaded Discussions Case studies . Quizzes . Readings . Exams . .. Academic Honesty: When learners fail to complete their own work, they are cheating themselves out of their education and are committing plagiarism. Plagiarism, or failing to meet the academic honesty policy, will result in disciplinary actions by the institution. APA Format: All of your writing must be done following APA format. For more information regarding this format, go to Purdue Owl or follow this link:https://owl.english.purdue.edu/owl/resource/560/01/ Late work & Educational Responsibility: All assignments must be completed by the last day of the schedule unless an alternate due date has been previously approved by your instructor or documentation has been provided regarding extreme circumstances. It is the learner's responsibility to communicate with the instructor about extreme circumstances or ask questions concerning the assignment and their due dates. Threaded discussions: Students are to respond to the instructor’s weekly discussion post by Wednesday at 1159 PM (EST). The responses must be substantial (at least 125 words in length using correct grammar). These are intended to stimulate discussion and re-enforce course content. The student must also respond to one classmate posts by Friday at 11:59 PM (EST). Please refer to the assignment calendar for assignment due dates. ASSESSMENT TESTING FOR NURSING PROGRAM REQUIREMENT: As part of certain nursing courses, students are required to take third-party computerized assessments, These assessments are intended to provide students with the tools they need to be successful in the Nursing program and on the NCLEX; as well as increase confidence and familiarity with computerized testing, The assessments typically include various types of formats, including multiple choice items, multiple response items, fill-in-the-blank items, dragand drop items, hot spots items, chart/exhibit items, and other items,. The assessments help identify deficit areas and provide students opportunities to practice and learn. Each assessment can represent up to the percent (30%) of a student’s course grade. Failure to achieve the minimum assessment score may result in a loss of points on an examination, or required remediation or retesting (as outlined in the course syllabus). Students who do not successfully complete the remediation or retest associated with an assessment examination (as outlined in the course syllabus) may receive an incomplete in a course and may be required to repeat the course in its entirety. An incomplete due to failure to successfully complete the assessment testing remediation or successfully retest is considered a failure for the course. References and Resources Medline Plus http://www.nlm.nih.gov/medlineplus/ Health information from the National Library of Medicine National Institutes of Health. Easy access to health topics, medical dictionaries, directories, drug information, videos and more. Full-text electronic journal articles at lirn.net Click on “Databases” access code 40149 select “Connect to ProQuest” There you will find full text health and medical information from Joanna Briggs Institute, the Nursing and Allied Health Collection, Health & Medical Complete, and Psychology Journals. PALM BEACH COUNTY LIBRARY ONLINE RESOURCES You need a free Palm Beach County Library card to access, or register for a free “Temporary Research Access Code” at http://edb.pbclibrary.org/TRAC/ If you need help using any of the library websites, click on the “Ask a Librarian” icon and “chat” with a librarian. Consumer Health http://www.pbclibrary.org/consumer-health.htm CINAHL® with Full Text - full text articles for more than 610 nursing and allied health journals as well as health care books, nursing dissertations, selected conference proceedings, and more. http://www.pbclibrary.org/online-research LearningExpress - Take online practice tests for Health Careers, Radiography, NCLEX-PN and NCLEX-RN. Learn techniques for job searching, resumes, interviewing and workplace skills. http://www.pbclibrary.org/online-research Health and Wellness Resource Center http://www.pbclibrary.org/online-research Assessment Criteria and Methods of Evaluating Students 90 – 100% A 80 – 89% B 75 – 79% C < 75% F Do not count on a curve! Generally, the grades “A” through “C-” are considered passing grades. Grades "W" and "I" indicate that no grades were earned for the course. A "W" grade indicates that the student withdrew from the course. An "I" grade indicates that the student was passing the course, but failed to complete all the required course work. The instructor, in his/her discretion may grant an "I" grade instead of an "F", pending completion of the course work by the student within a specified time arranged by the instructor and told to the student. It is the student's responsibility to follow-up with the instructor to complete the course work. If the course work is not completed by the arranged time, the “I” grade becomes an “F". Distribution of Grade Elements Discussions 10% Case Studies: 15% Quizzes/Chapter exams: 15% Math Final: 30% Final: 30% Total: 100 % Revised: May 27, 2016