1) Minimum 8 pages
Part 1: Minimum 2 pages
Part 2: Minimum 4 pages
Part 3: Minimum 1 page
All paragraphs must be narrative and cited in the text- each paragraphs
Bulleted responses are not accepted
Dont write in the first person
Dont copy and pase the questions.
Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph
3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)
********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)
4) Minimum 3 references not older than 5 years
5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next
Q 1. Nursing is XXXXX
Q 2. Health is XXXX
6) You must name the files according to the part you are answering:
Part 1: Pharmacology
You must add at least 2 pages to the file “Part 1 Template”. To do this, you must take into account the document “Part 1 Feedback” and meet each of the criteria in red and add them in “Part1 template”
Part 2: Physiology
Topic: Case Study
See Part 2 Case Study
1. What is the transmission and pathophysiology of TB?
2. What are the clinical manifestations?
3. After considering this scenario, what are the primary identified medical concerns for this patient?
4. What are the primary psychosocial concerns?
5. What are the implications of the treatment regimen, as far as likelihood of compliance and outcomes? Search the Internet to research rates of patient compliance in treatment of TB, as well as drug resistant TB.
6. Identify the role of the community clinic in assisting patients, particularly undocumented patients, in covering the cost of TB treatment. What resources exist for TB treatment in community health centers around the United States? Compare the cost for treatment between, subsidized as it would be for a community health center, and unsubsidized.
7. What are the implications of TB for critical care and advanced practice nurses?
Part 3: Primary Care
A 29-year-old single, sexually active woman reporting that she is in a monogamous relationship, has experienced five attacks of acute cystitis in the past year, all characterized by dysuria, increased frequency, and urgency. Each case was diagnosed on the basis of the clinical picture and a laboratory finding of bacteriuria. The urine bacterial counts in these cases ranged from 104 to 106 organisms/ml. Lab tests indicated that the third and fourth infections were caused by Escherichia coli, while the fifth infection was caused by an enterococcus and the second infection was caused by Proteus mirabilis. Each infection responded to short-term treatment with trimethoprim sulfamethoxazole. The recurrences occurred at intervals of 3 weeks to 3 months following completion of antibiotic therapy. For the past two days, the woman has once again been experiencing dysuria, increased frequency, and urgency, so she goes to see her nurse practitioner provider. Her vital signs are T = 37.6°C, P = 100, R = 18, and BP = 110/75 mm Hg. Physical examination reveals a mild tenderness to palpation in the suprapubic area, but no other abnormalities. A bimanual pelvic examination reveals a normal-sized uterus and adnexae with no apparent adnexal tenderness. No vaginal discharge is noted. The cervix appears normal.
1. What is the differential diagnosis for this set of symptoms? What is your preliminary diagnosis?
2. What tests should you order to confirm your preliminary diagnosis?
3. What are the possible causes of recurrent lower UTIs? Which of these is most likely in this case?
4. When would you collaborate with other professionals and refer your patient to a specialist and why?
5. Please support with up-to-date evidence-based standard of care guidelines.
Feedback Based on the Rubric
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🟥 Need improvement 🟩 Done well, maintain
🟩 Addressed the medication and its significance. 🟩 Provided evidence supporting the significance. 🟩 It is succinct and well written.
🟥 Improve: add an introduction to include the following: 🟥 Clearly state the medication that you have chosen and describe its uses. 🟥 Clearly state the purpose of researching the chosen medi cation. 🟥 Indicate the main points that you will cover in the paper. 🟩 Approached the expectations.
🟥 Improve : Add manufacturing company. 🟥 Improve : Expand the contraindications. 🟥 Improve: Integrate and appropriately cite in-text credible and current scientific evidence. 🟩 Included most of the required parts.
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🟥 Improve: include at least five credible references with scientific evidence (e.g., research studies on the medication published in peer-reviewed journals; information from websites are not sufficient) 🟩 Included some references. 🟩 Cited all references in the text.
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🟥 Improve: Proofread your paper to correct errors. 🟩 Formatted the references appropriately .
Overall Rough Draft
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Running Header: UBRELVY 1
Ubrevly is an oral non-narcotic medication used in treating migraine and lessen how frequent one develops migraines. The medication should be orally ingested according to the physician’s instructions and taken at the initial sign of a migraine. Its dosage differs in different people with different health conditions, medications, and other treatments. The drug acts by binding to CGRP receptors in plasma and elicits its activity. Before Ubrelvy is prescribed to a patient, the physician and the patient should be well-informed about the drug and its uses for effective and safe use. 200mg is the maximum dosage per day. There is no evidence that a person can take Ubrelvy for more than eight migraines in one month, and it does not have preventative treatments for migraines. This paper will examine the dosages, clinical studies, contraindications, drug interactions, clinical pharmacology, medication use, adverse reactions, overdosage and its implications, nonclinical toxicology, and patient counseling information Ubrelvy.
Keywords: Ubrelvy, migraine, patient, and treatment.
The purpose of this paper is to discuss the use of Ubrelvy as a migraine medication and how it works to relieve an individual from headache, pain, and other symptoms of migraine such as nausea and vomiting.
Ubrelvy is a non-narcotic and oral pain prescription medication used to treat acute migraine attacks including or excluding aura, in grownups. It is dissimilar from other migraine medications as it immediately blocks CGRP protein, which is involved in migraine attacks. Ubrogepant is the ingredient active in Ubrelvy that acts as a CGRP receptor antagonist (Hossain, 2020).
The benefits of Ubrelvy in managing each migraine Symptom
Ubrelvy relieves one pain, headache, nausea, light sensitivity, and vomiting immediately. After taking the medication, an individual feels no pain, headache, does not feel like vomiting, and nauseated. For those taking Ubrevly medication to treat migraine, the recommended oral dosage is 50 milligram or 100 milligrams with or with no food. If need be, a second dose can be ingested no less than 2 hours after the first dose (Singh, 2020). Two hundred milligrams is the maximum amount a person can ingest within 24 hours. Ubrelvy does not cause carcinogenesis, nor does it cause mutagenesis.
Pharmacokinetics of Ubrelvy
After ingestion of Ubrelvy, the active ingredient ubrogepant is absorbed into the bloodstream, and after one and a half hours, its plasma concentration peaks. However, when the drug is ingested with high-fat food, the high-fat meal delays the maximum plasma concentration of ubrogepant by 2 hours. Ubrogepant bind to CGRP protein in plasma and is distributed. After plasma distribution, ubrogepant undergoes metabolism, mainly by CYP3A4 into ubrogepant and two glucuronide conjugate metabolites eliminated primarily through fecal matter and minimally through urinary tract (Hossain, 2020).
Pharmacodynamics of Ubrevly
When an individual ingests more than twice the recommended dose of ubrevly, it does not protract QT’s interval to a clinically significant degree. However, they experience nausea, drowsiness, and dry mouth (Young, 2020).
Effects of Ubrevly on Lactation and administration
There is no evidence of the presence of ubrogepant in human breast milk, its effects on breastfeeding babies, or its effects on breast milk production (Hossain, 2020).
An estimated 12% of the global population, comprising 10% of children, experience migraines (Young, 2020). Among this percentage, 6% are American men, while 18% are women. In total, 4 million people experience chronic migraines daily and a total of 15 days of chronic migraines in a month. Several medications are available for treating migraines, and Ubrevly is one of them (Elliot & Chan, 2020). According to clinical studies, using 50mg or 100mg of Ubrevly is efficacious in treating migraine of moderate to severe pain, nausea, vomiting, and photophobia.
Dosage and Administration
Ubrevly dosage modification includes 50mg with moderate CYP3A4 inhibitors, weak CYP3A4 inhibitors, strong CYP3A4 inducers, 100mg with weak and moderate CYP3A4 inducers initial and second dosage, and 50mg with BCRP and P-gp only inhibitor based on drug interaction. Dosage modifications based on specific populace include severe hepatic impairment 50mg initial dosage and 50mg second dosage, and severe renal impairment 50mg initial and second dosage (Singh, 2020). The use of Ubrevly should be avoided in end-stage renal disease, while concurrent use to be avoided in strong CYP3A4 inducers.
Ubrevly’s use is contraindicated with concurrent administration with potent CYP3A4 inhibitors.
Concomitant administration of Ubrevly with ketoconazole, a potent CYP3A4 inhibitor, inhibits the action of Ubrogepant. Additionally, administering it with verapamil moderately inhibits its function. Conversely, concomitantly administering Ubrevly with rifampin strongly induces CYP3A4, highly reducing exposure of Ubrogepant (Hossain, 2020). There are no significant interactions between Ubrevly and contraceptives. When ingested together with BCRP and P-gp only inhibitors, the CYP3A4 is highly exposed to Ubrevly, increasing its efficacy.
Clinical Pharmacology and Mechanism of Action
Ubrevly does not have pharmacodynamics effects. It does not protract the QT interval to any medically significant extent. Ubrevly’s pharmacokinetics involves absorption, distribution, and elimination. After the ingestion of Ubrevly, Ubrogepant binds to CGRP receptors in plasma and is absorbed in plasma; however, high-fat foods reduces its plasma concentration after absorption (Hossain, 2020). After absorption, the Ubrogepant is distributed into the bloodstream; it is then metabolized to ubrogepant and two glucuronide conjugates by CYP3A4, which are eliminated mostly in feces while some in urine.
Medication use in Specific populations
There are no established effectiveness and safety of use of Ubrevly in pediatric care. There are no adverse effects of Ubrelvy in patients with hepatic impairment. On pregnant women, there is inadequate evidence of the effects of Ubrevly. There are inadequate medically pharmacokinetic disparities between the elderly and young persons (Elliot & Chan, 2020). There are no dose modifications for patients with mild or moderate renal impairment since the renal system plays an insignificant role in eliminating Ubrevly. For patients with severe renal impairment, dose modifications should be done, and its use avoided in patients with end-stage renal disease.
Adverse reactions and overdose implication
Causes nausea, dry mouth, and drowsiness are the effects of Ubrelvy overdose.
Ubrevly does not have any carcinogenic or mutagenic, or fertility impairment effects.
Patient counseling information
Patients should be told the drug’s use, advised on not using it concurrently with strong CYP3A4 inhibitors. They should tell their physicians about their health conditions and medications they take before prescribing them. Patients should also know the side effects, storage conditions, and active ingredients.
Ubrelvy is significantly useful in treating migraine due to its pain, headache, vomiting, and nausea relieving effect.
Elliott, W., & Chan, J. (2020). Ubrogepant Tablets (Ubrelvy). Internal Medicine
Hossain, M. A. (2020). New Drug Approvals Vol. 23 (1). Bangladesh Pharmaceutical
Journal, 23(1), 80-82.
Young, C. A. (2020). The first-in-class drug provides acute pain relief for migraine
Sufferers. Pharmacy Today, 26(3), 17.
Singh, A., Gupta, D., & Sahoo, A. K. (2020). Acute migraine: can the new drugs clinically
Outpace. SN Comprehensive Clinical Medicine, 2(8), 1132-1138.
Case Study TB
Maria is a 42-year-old single mother living in New York City with her three sons. She immigrated to New York from Peru two years ago. About six months after she arrived, she began developing night sweats and unexplained fevers. Most recently, she has developed a persistent, worsening cough. Her illegal status has made her hesitant to seek medical treatment, but a neighbor told her that the local community clinic would see her and would not check her residency status.
Screening at the clinic included a questionnaire that addressed some of the problems she was experiencing. The nurse explained to Maria that she might have TB. The physician treating Maria performed a complete physical exam and discussed her questionnaire responses with her, including her response that in Peru, she lived with her grandfather who she believes may have died from TB.
Physical exam findings showed abnormal lung sounds in Maria’s upper lobes bilaterally. The physician found cervical and axial lymphadenopathy. Maria was asked to leave sputum samples to be tested for mycobacterium tuberculosis. A PPD was placed with instructions for Maria to return in two days to have it read. When Maria returned two days later, the result showed a 10 mm raised, red reactive site. Maria was also screened for HIV at the time of initial exam because it is often found in patients with TB. In this case, she tested negative for HIV. Her sputum culture tested positive for M. tuberculosis.
The physician explained that given the findings on the chest x-ray and the clinical findings on exam, he believed that she had reactivation TB. The physician informed Maria that he planned to start her on a four-drug regimen of isoniazid, rifampin, pyrazinamide, and ethambutol (Myambutol) for two months. The physician then explained that a “continuation phase” would follow, which would consist of isoniazid and a rifamycin (rifampin, rifabutin [Mycobutin], or rifapentine [Priftin]) that is administered daily for four to seven months. He also informed her that he would start her treatment at the hospital, where she would stay for least two days because she was still considered contagious. Following the hospital stay, Maria would need to come to the clinic for observed medication administration and to assure compliance.
Two months passed and Maria continued about her day-to-day life including going to the clinic for her medication. She attempted to work full time and to take care of her three sons. She found that her night sweats had become a nightly occurrence, and her cough had become productive with blood along with intense coughing spells. Maria was compliant with the drug regimen but called the clinic because her symptoms were worsening. Maria was scheduled for a visit the very next day.
The follow up chest x-ray showed no improvement, and it was determined that Maria was exhibiting signs of multidrug-resistant TB. Because multidrug-resistant and extensively drug-resistant tuberculosis requires at least 18 to 24 months of therapy, depending on the patient’s response to treatment, the physician decided to extend her therapy to 18 months, beyond the 4 to 7 month time period he had projected. He also stopped the ethambutol and started moxifloxacin. Thoracic surgery for resection of lung lesions is often considered as adjunctive therapy, and this was discussed with Maria at the time of the exam.
Maria was devastated to learn about her multidrug resistant TB because she needed to work. Fortunately, the clinic was able to fund Maria’s drugs at a discounted rate. Nonetheless, the entire situation has put Maria under stress to the point that it is unclear how she will meet this challenge and adequately handle her health crisis.