NUR 635 Topic 2 DQ 2

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

Based on the first letter of your last name, complete the case to which you are assigned:

  • If your last name starts with A through M: Case 1 Adrenergic Antagonist.
  • If your last name starts with N through Z: Case 2 Adrenergic Agonist.

Case 1 Adrenergic Antagonist

Deb is a 32-year-old female who struggles to maintain her blood pressure. Deb is currently using lifestyle modifications to decrease her blood pressure. She is not interested in taking antihypertensives. Upon completing her medication reconciliation, you determine she consistently uses pseudoephedrine for nasal congestion. You suspect this pseudoephedrine is contributing to the patient’s hypertension. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • Based on the JNC-8 guidelines in the topic Resources, list the various blood pressure goals. Include when pharmacologic intervention is needed.
  • Describe the non-pharmacologic approach (lifestyle modifications) to treat hypertension.
  • Based on the mechanism of action of pseudoephedrine, describe how this can contribute to Deb’s hypertension and congestion relief.
  • Compare and contrast the difference between phenylephrine and pseudoephedrine. Include modes of action, efficacy, and other relevant information in your response.
  • What may be an alternative to adrenergic agonist when treating congestion in hypertension, explain your rationale?

Case 2 Adrenergic Agonist

Daniel, a 23-year-old male, is nervous for performing at his concert tonight. His friend offers him propranolol as treatment because it is considered relatively safe. More than 2 days a week but not daily, Daniel suffers from asthma symptoms that require an inhaler. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • Based on the asthma guidelines, how would categorize Daniel’s asthma? 
  • Summarize the diagnostic criteria associated with social anxiety disorder. 
  • Describe the mechanism of action of propranolol and how it differs from metoprolol. 
  • Compare and contrast the difference in propranolol and albuterol’s effect on the lungs. 
  • Explain your rationale for discouraging the use of propranolol in this patient (e.g., pathophysiology and guideline recommendations). 

Participate in follow-up discussion by reviewing the case discussed by classmates that is different than the one assigned to you.

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 2 DQ 2

Title: NUR 635 Topic 2 DQ 2

 Hypertension is often referred to as a silent killer due to the wide range of devastating diseases that may occur. Hypertension is preventable due to the wide availability of screening and modifiable risk factors. Still, up to 37% of the American population falls in the pre-hypertension category (systolic blood pressure 120-129mmHg or diastolic blood pressure > 80mmHg) (McCance et al., 2018). According to the JNC-8 guidelines, drug therapy should be initiated in patients over 60 years old if blood pressure is sustained at 150/90 mmHg or higher. In patients under 60 years old and patients over 18 with chronic kidney disease or diabetes, drug therapy should be initiated for sustained over 140/90 mmHg (Armstrong, 2014).

However, thresholds may be higher for certain patients with kidney disease. Lifestyle changes benefit cardiovascular health in many ways that can be done safely and cost-effectively for most people. Cardiovascular exercise several times a week may eliminate the need for medications, particularly early in the disease. Additionally, there are dietary considerations for patients to take seriously at diagnosis. Sodium reduction, low saturated fat intake, and sugar intake reduction (insulin resistance is common in hypertension) can improve outcomes for patients (Rosenthal & Burchum, 2020). Other modifications are restriction of alcohol, smoking, and maintaining a healthy body weight. 

Pseudoephedrine (Sudafed) reduces inflammation caused by decongestants. The mechanism is activating the α1-adrenergic receptors on the nasal blood vessels, vasoconstricting swollen membranes, and promoting nasal drainage (Rosenthal & Burchum, 2020). Pseudoephedrine and Phenylephrine are common drugs used for nasal decongestants. Pseudoephedrine is more effective with a longer half-life. Phenylephrine is more effective topically and in large oral doses, can have cardiovascular effects (Rosenthal & Burchum, 2020). Intravenous Phenylephrine infusions are used to activate systemic α1 receptors to elevate blood pressure.

This is most often used in anesthesia and critical care settings. Deb is taking Pseudoephedrine that has better oral absorption than Phenylephrine. Both may induce hypertension. A different regimen accompanied with her lifestyle modifications could help control her hypertension. Phenylephrine topically still carries risk of hypertension and lack of data. Propylhexedrine (e.g., Benzedrex Inhaler) is not required to carry a warning against unsupervised use with hypertension and may be effective for decongestion. Another option is nasal strips, humidified air, and saline sprays. 

References

Armstrong, C. (2014). JNC 8 Guidelines for the management of hypertension in adults. American Family Physician, 90(7), 503–504.

McCance, K. L., & Huether, S. E. (2018). Pathophysiology (8th ed.). Elsevier Health Sciences.

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (second ed.). Elsevier – Health Sciences Division.

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

Title: NUR 635 Topic 2 DQ 2

Hello Sierra. I appreciate your post and the details you provided on phenylephrine. Richards, Lopez, and Maani (2023) state that the approved indication by the Food and Drug Administration (FDA) for intravenous (IV) phenylephrine hydrochloride is to elevate blood pressure in people who have clinically significant hypotension predominantly caused by vasodilation in conditions such septic shock or anesthesia. Phenylephrine hydrochloride is utilized in non-prescription ocular formulations to induce mydriasis and vasoconstriction of conjunctival blood vessels. It is also administered intranasally to alleviate uncomplicated nasal congestion and is added as an over-the-counter component to topical hemorrhoid treatments.

Phenylephrine is infrequently employed off-label as a supplementary component in neuraxial/peripheral nerve blockade, for the purpose of managing priapism and other medical illnesses that necessitate localized vasoconstrictive effects and diminished blood flow. Phenylephrine is frequently employed as an anesthetic vasopressor in the context of intravenous administration. It is particularly suitable for patients who possess normal cardiac function and are experiencing hypotension due to the vasodilatory impact of anesthetic drugs or non-cardiac shock conditions. Phenylephrine exhibits a predominant affinity for alpha-1 adrenergic receptors and lacks significant beta-adrenergic activity. Consequently, it is well-suited for the purpose of increasing mean arterial pressure.

This mechanism is achieved through the induction of vasoconstriction in both venous and arterial vessels, as well as the augmentation of ventricular preload. Notably, it does not exert any substantial direct influence on cardiac myocytes. In the context of my experience in the Intensive Care Unit (ICU), the utilization of Phenylephrine, an intravenous vasopressor, was limited. This was primarily attributed to the increased volume required for its administration, which posed challenges for patients with congestive heart failure (CHF) as a comorbidity. Consequently, our practice was the sequential administration of higher concentration formulations of Levophed and Epinephrine, following the exhaustion of alternative options. One of the initial encounters I had involved a patient presenting with priapism. The urologist prescribed intravenous administration of phenylephrine at a specified rate, as well as subcutaneous administration of phenylephrine for an intracavernous procedure performed at the bedside.

Regrettably, these interventions did not yield any desired effects. Subsequently, the patient received Sudafed PE as per standard protocol. Eventually, the patient underwent open surgery to address the priapism. Moreover, I became intrigued and decided to inquire with the urologist regarding the administration of Phenylephrine intravenously, subcutaneously, and orally in the treatment. The urologist explained that these routes of administration are employed due to the alpha-agonists’ ability to induce vasoconstriction in smooth muscle tissue, particularly within the corpora cavernosa via α-mediated mechanisms. Phenylephrine exhibits a high degree of specificity, resulting in little occurrence of cardiac adverse effects such as tachycardia, palpitations, and hypertension (Ridley, et.al. 2017).

 Reference:

Richards E, Lopez MJ, Maani CV. (2023). Phenylephrine.  In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534801/#

Ridgley, J., Raison, N., Sheikh, M. I., Dasgupta, P., Khan, M. S., & Ahmed, K. (2017). Ischaemic priapism: A clinical review. Turkish journal of urology, 43(1), 1–8. https://doi.org/10.5152/tud.2017.59458