Directions:

For each of the scenarios below, answer the questions using your required learning resources, Medscape, and clinical practice guidelines (ie AHA, ACC, ADA, GINA). When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, # dispensed (days supply), refills, special instructions etc. Also state if you would continue, discontinue or taper the patients current medications (if applicable). Use at least 3 sources for each scenario and cite sources using APA format. LIST REFERENCES AFTER EACH SCENARIO.

• References for the scenarios are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

REQUIRED READING BOOK IS IN THE ATTACHMENTS :

• Rosenthal, L. D., & Burchum, J. R. (2025). Lehnes pharmacotherapeutics for advanced practice nurses and physician assistants (3rd ed.). Elsevier.
• Chapter 37, Diuretics (pp. 285292)
• Chapter 38, Drugs Acting on the Renin-Angiotensin-Aldosterone System (pp. 292303)
• Chapter 39, Calcium Channel Blockers (pp. 303308)
• Chapter 40, Vasodilators (pp. 308311)
• Chapter 41, Drugs for Hypertension (pp. 311320)
• Chapter 42, Drugs for Heart Failure (pp. 321332)
• Chapter 43, Antidysrhythmic Drugs (pp. 333344)
• Chapter 44, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 345359)
• Chapter 45, Drugs for Angina Pectoris (pp. 360367)
• Chapter 46, Anticoagulant and Antiplatelet Drugs (pp. 368384)

WEEK 2 SCENARIO

SCENARIO 2

A patient with stable angina is prescribed nitroglycerin. The provider avoids oral tablets and instead chooses a sublingual or transdermal formulation. Why is oral nitroglycerin not clinically useful? Discuss how first-pass metabolism affects nitroglycerins bioavailability and define both terms. Identify the route of administration with 100% bioavailability and explain how alternative routes overcome the first pass effect. Include a sample prescription for nitroglycerin.

SCENARIO 3

Where are the majority of cytochrome P450 (CYP) enzymes located? Using the Drugs.com pill identifier, enter the following characteristics to identify the medication AND strength. What CYP enzyme metabolizes this medication? How can this information be applied to medication therapy management? Write a sample prescription for the identified medication and strength.

Imprint (E 137) Shape (Round) Color (Pink) Form (Tablet) Scoring (None)

SCENARIO 4

KU is a 47-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on lisinopril 40 mg po daily, liraglutide (Victoza) 0.6 mg subcutaneously once daily and St. Johns Wort. Fasting lipid profile shows total cholesterol 260 mg/dL, LDL 180 mg/dL, HDL 43 mg/dL, and TG 185 mg/dL. He is 59 and weighs 204 lbs. What treatment plan would you implement for KU? What are GOAL Total Cholesterol (TC), HDL, LDL, and Triglyceride levels for KU? What is his BMI per Medscape calculator? What patient monitoring and education would you provide? How many risk factors for coronary artery disease does this patient have? Identify them specifically.