NUR 635 Topic 12 DQ 2

Sample Answer for NUR 635 Topic 12 DQ 2 Included After Question

Select one of the three scenarios below. Select a medication, and discuss the ethnic, cultural, or genetic differences in the uses for the treatment of that infection. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions. In addition, share a clinical trial that supports the use of this agent. Include the name of the medication in the subject line so that the medications can be followed. Include references in APA format.

Scenario 1: A 21-year-old female with no past medical history comes in complaining of frequency and urgency upon urination. Her HCG is negative. Choose a medication that has a mechanism of action of disruption of bacterial synthesis.

Scenario 2: An 85-year-old female was recently discharged from the hospital after being treated for pneumonia. Now she comes in complaining of “burning when I urinate.” She reports having a catheter placed while in the hospital last week. Her daughter reports finding her mother’s cell phone in the refrigerator and her car keys in the microwave, which the daughter states is “very out of character for my mom.” Which type of urinary tract infection do you diagnose this patient with? Choose a medication that is used to treat urinary tract infections. Document indication for the medication, along with mechanism of action of the medication and what results you expect in order to determine if the infection has resolved.

Scenario 3: A 35-year-old male recently immigrated from the Asia to the United States. He was diagnosed with tuberculosis overseas and comes to you for treatment of this condition. Choose a medication that is used to treat tuberculosis. Describe the medication’s mechanism of action. What are the contraindications for this medication? Document the challenges that you may encounter when prescribing this medication.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education 

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 12 DQ 2

Title: NUR 635 Topic 12 DQ 2NUR 635 Topic 12 DQ 2

Scenario 3: A 35-year-old male recently immigrated from the Asia to the United States. He was diagnosed with tuberculosis overseas and comes to you for treatment of this condition. Choose a medication that is used to treat tuberculosis. Describe the medication’s mechanism of action. What are the contraindications for this medication? Document the challenges that you may encounter when prescribing this medication.

Medication: Isoniazid (INH) for Tuberculosis

Mechanism of Action:

Isoniazid (INH) is a first-line medication used in the treatment of tuberculosis (TB). It is a prodrug that requires activation by the bacterial enzyme KatG (Vilchèze & Jacobs Jr, 2019). Once activated, it inhibits the synthesis of mycolic acids, essential components of the mycobacterial cell wall. This disruption leads to the death of the actively replicating bacteria.

Ethnic, Cultural, or Genetic Differences

Isoniazid metabolism can be influenced by genetic factors, specifically related to acetylation. The acetylation process converts INH into its active and inactive metabolites. There are two acetylator phenotypes: fast acetylators and slow acetylators. Genetic polymorphisms in NAT2 (N-acetyltransferase 2) influence acetylation rates. Certain ethnic groups, such as Asians, may have a higher prevalence of slow acetylators. This could impact the rate at which INH is metabolized in the body, affecting drug efficacy and side effects.

Contraindications

While isoniazid is generally well-tolerated, there are contraindications and precautions to consider. These include a history of hypersensitivity to isoniazid, severe hepatic impairment, and acute liver disease (Prasad et al., 2019). Caution is advised in patients with a history of alcoholism, as isoniazid can contribute to hepatotoxicity, especially in those who consume alcohol regularly.

Challenges in Prescribing

Prescribing isoniazid to individuals from different ethnic backgrounds, such as the Asian population, may present challenges due to variations in acetylation rates. Slow acetylators may be at an increased risk of developing adverse effects, particularly hepatotoxicity. Monitoring liver function is crucial during isoniazid therapy, especially in populations with a higher risk of drug-induced liver injury.

Clinical Trial

A relevant clinical trial supporting the use of isoniazid is the “International Multicentre Randomised Placebo-Controlled Trial of Short-Course Chemotherapy for Tuberculosis Based on Initial Drug Sensitivity” (1972) (Menzies et al., 2009). This landmark trial demonstrated the effectiveness of isoniazid as part of short-course chemotherapy for tuberculosis, highlighting its role in reducing the duration of treatment and improving outcomes.

References

Menzies, D., Benedetti, A., Paydar, A., Martin, I., Royce, S., Pai, M., … & Burman, W. (2009). Effect of duration and intermittency of rifampin on tuberculosis treatment outcomes: a systematic review and meta-analysis. PLoS medicine6(9), e1000146.

Prasad, R., Singh, A., & Gupta, N. (2019). Adverse drug reactions in tuberculosis and management. indian journal of tuberculosis66(4), 520-532.

Vilchèze, C., & Jacobs Jr, W. R. (2019). The isoniazid paradigm of killing, resistance, and persistence in Mycobacterium tuberculosis. Journal of molecular biology431(18), 3450-3461.

A Sample Answer 2 For the Assignment: NUR 635 Topic 12 DQ 2

Title: NUR 635 Topic 12 DQ 2

Scenario 1: A 21-year-old female with no past medical history comes in complaining of frequency and urgency upon urination. Her HCG is negative. Choose a medication that has a mechanism of action of disruption of bacterial synthesis

Ciprofloxacin (fluoroquinolones) prevents DNA gyrase, an enzyme necessary for bacterial DNA replication and repair. Ciprofloxacin stops bacterial DNA from unwinding and replicating by blocking this enzyme, which ultimately results in bacterial death (Rosenthal & Burchum, 2020). In addition, the susceptibility patterns of the individual bacterial strains producing the illnesses in various populations when analyzing ethnic, cultural, or genetic differences in the usage of ciprofloxacin for urinary tract infections and depending on how common bacterial resistance is in a given place, a different antibiotic may be chosen. For instance, some groups might have a higher prevalence of strains that are resistant to antibiotics, which would limit the effectiveness of ciprofloxacin in those populations (Cao, 2021).

Furthermore, clinical evaluation of the patient’s response to treatment regarding monitoring is essential for how quickly UTI symptoms like pelvic discomfort, frequency, urgency, and hesitancy symptoms improve. A further urine culture may be carried out to ensure the elimination of the bacteria and to check for the emergence of antibiotic resistance (Cao, 2021).

Constipation, nausea, and diarrhea are typical gastrointestinal adverse effects of ciprofloxacin. It may also result in central nervous system side effects such as headache, vertigo, and sleeplessness. Tendon rupture, peripheral neuropathy, and hypersensitivity reactions are uncommon but serious adverse effects. If any of these serious adverse effects occur, patients should be educated before starting to take the medication (Rosenthal & Burchum, 2020).

Several medication interactions with ciprofloxacin need to be taken into account. Antacids, sucralfate, and metal cations (such as iron, zinc, or magnesium) shouldn’t be taken with them because they can decrease ciprofloxacin’s absorption. Additionally, certain antiarrhythmics, antidepressants, and antipsychotic drugs, such as ciprofloxacin, may interact with one another to lengthen the QT interval, raising the risk of cardiac arrhythmias (Rosenthal & Burchum, 2020).

References:

Cao, D., Shen, Y., Huang, Y., Chen, B., Chen, Z., Ai, J., Liu, L., Yang, L., & Wei, Q. (2021). Levofloxacin Versus Ciprofloxacin in the Treatment of Urinary Tract Infections: Evidence-Based Analysis. Frontiers in pharmacology12, 658095. https://doi.org/10.3389/fphar.2021.658095

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.