La Consolacion University Philippines

City of Malolos, Bulacan 3000

http://www.lcup.edu.ph

College of Allied Medical Sciences

Bachelor of Science in Nursing
SY 2019-2020

NCM 106-PHARMACOLOGY

FLORES, GLADYS V.

Scenario:
Patient Z is a 53-year-old male who was diagnosed with acute kidney failure and was scheduled
to undergo kidney transplant on December 15, 2019 after a thorough organ matching tests
done. Answer the following questions comprehensively and focus on the pharmacologic
process since this is not an MS class. The more comprehensive your answer is, the higher the
corresponding grade will be. However, giving a comprehensive answer does not necessarily
means giving long copy-paste answers.

1. The physician ordered Azathioprine to prevent renal transplant. What is the mechanism
of this drug of choice for the case of Mr. Z and what are nursing considerations it’s
accompanies? (8 points)
 Azathioprine is an immunosuppressant drug. It increases immune system function so that
the transplanted organ is not damage.
 To prevent bleeding, avoid all I.M injections when platelet count is below 100,000/mm3
 Monitor CBC and platelet count weekly for 1 month twice for two months, then monthly
unless more frequent monitoring is clinically indicated. Also monitor counts at dosage
changes. Notify prescriber if counts drop suddenly or become dangerously low. Drug may
need to be temporarily held.
 Watch for early signs of hepatoxicity and for increase alkaline phosphatase, bilirubin, AST
and ALT levels.
 Monitor patient for bacterial, viral, fungal, protozoal and opportunistic infections
including reactivation of latent infections such as TB.
 Therapeutic response usually occurs within 8 weeks. Patients not improved after 12
weeks can be considered refractory to treatment.
REFERENCE: Wolters Kluwer. (2020). Nursing 2020 drug handbook (Vol. 1). Philadelphia
 2. After more than a year of kidney transplant, Mr. Z contracted measles during its outbreak
in summer 2021. What is the type of this vaccine that should be given to patient Z when
he was a child and what is the vaccine’s mechanism in developing his immunity? (8
points)
 The vaccine that should be given to patient Z when he was a child is MMR vaccine
(Measles, Mumps, Rubella Vaccine).
 It contains live weakened forms of the measles, mumps and rubella viruses. It stimulates
our immune system to produce antibodies which is protein so that it will fight and kill the
viruses against measles, mumps and rubella viruses.
REFERENCE: Omudhome Ogbru, P. D. (2019, August 5). MMR Vaccine (Measles, Mumps & Rubella)
Safety & Side Effects. Retrieved from https://www.medicinenet.com/measles_mumps_rubella_vaccine-
injection/article.htm#what_is_measles_mumps_rubella_vaccine_and_how_does_it_work_mechanism_
of_action.

3. In relation to No. 2 question, can the nurse give Measles vaccine booster knowing that he
had a renal transplant? If yes, why? If no, why not? (8 points)
 An immunosuppressed transplant recipient must never receive an injection of a live virus.
Immunosuppressed patients could develop the disease that the vaccine is trying to
prevent and decrease complications following liver transplant
REFERENCE: Vaccinations Post-Liver Transplant: Children's Pittsburgh. (n.d.). Retrieved from
https://www.chp.edu/our-services/transplant/liver/recovery/life-after/vaccinations.

4. With the cost burden of Mr. Z’s surgery and medication, his wife cheated and
unfortunately infected with HIV infection. What medication would you expect that the
doctor will prescribe and discuss the mechanism of action and nursing intervention of
your chosen drug. (10 points)
 Medication: EFAVIRENZ
 Efavirenz is used along with other medications to treat human immunodeficiency virus
(HIV) infection. Efavirenz is in a class of medications called non-nucleoside reverse
transcriptase inhibitors (NNRTIs). It works by decreasing the amount of HIV in the blood.
Although efavirenz does not cure HIV, it may decrease your chance of developing
acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious
infections or cancer.
 Using drug with ritonavir may increase liver enzyme levels and adverse effects such as
dizziness, nausea and paresthesia.
  Monitor LFT values before and during treatment in all patients. Consider discontinuing
drug in patients with persistent elevations of serum transaminase levels greater than 5 x
ULN. Discontinue drug if elevation is accompanied by clinical signs or symptoms of
hepatitis or hepatic decompensation.
 Discontinue drug if patient develops severe rash associated with blistering,
desquamation, mucosal involvement or fever.
 Monitor patients for elevated triglyceride and cholesterol levels before therapy and
periodically during treatment.
REFERENCE: Wolters Kluwer. (2020). Nursing 2020 drug handbook (Vol. 1). Philadelphia

5. Mr. Z’s wife cheating came to his knowledge and he became overly depressed and
anxious. He consulted a psychiatrist and prescribed him benzodiazepines instead of
barbiturates. What is the rationale for this? What are the mechanisms of actions of those
drugs and their corresponding nursing interventions? (10 points)
 Because barbiturates have been abandoned as sedatives and tranquillizers due to their
high abuse and dependence potential and risk of side effects. There are several uses of
these agents and at present there are two major uses – as an agent that induces general
anesthesia and as an agent that may control seizures. While benzodiazepines have
qualities that can help to reduce anxiety and seizures, relax the muscles, and induce
sleep.
 BENZODIAZEPINES:
 Benzodiazepine receptor agonists (BZRAs) work through GABAA receptors to
promote sleep by inhibiting brainstem monoaminergic arousal pathways, through
facilitation of VLPO inhibitory GABAergic projections to arousal centers such as
the anterior hypothalamus TMN, the posterolateral hypothalamic hypocretin
neurons, and the brainstem arousal regions.
 Monitor vital signs. Observe respiratory patterns, especially during sleep, for
evidence of apnea or shallow breathing. (Benzodiazepines can reduce the
respiratory drive in susceptible clients.)
 Monitor neurological status, especially level of consciousness. (Confusion or lack
of response may indicate overmedication.)
 Monitor the client’s intake of stimulants, including caffeine (in beverages such as
coffee, tea, cola and other soft drinks, and OTC analgesics such as Excedrin), and
nicotine from tobacco products and nicotine patches. (These products can reduce
the drug’s effectiveness.)
 Monitor affect and emotional status. (Drug may increase risk of mental
depression, especially in clients with suicidal tendencies.)
  Avoid abrupt discontinuation of therapy. (Withdrawal symptoms, including
rebound anxiety and sleeplessness, are possible with abrupt discontinuation after
long-term use.)
 Assess prior methods of stress reduction. Reinforce previously used effective
methods and teach new coping skills. (This will assist client to use medications for
the shortest time possible and build self-confidence.)
REFERENCE: Benzodiazepines Drug Class: Side Effects, Types & Uses. (n.d.). Retrieved from
https://www.rxlist.com/benzodiazepines/drugs-condition.htm.

 BARBITURATES:
 The primary mechanism of action of barbiturates is inhibition of the central
nervous system. It causes central nervous system depression. This is brought
about by stimulating the inhibitory neurotransmitter system in the brain called
the [gamma]-aminobutyric acid (GABA) system.
 The GABA channel is a Chloride channel that has five cells at its gate. When
barbiturates bind to the GABA channel, they lead to prolonged opening of the
channel letting in Chloride ions into the cells in the brain. This leads to increased
negative charge and alters the voltage in the brain cells.
 Monitor patient responses, blood levels (as appropriate) if any interacting drugs
listed above are given with phenobarbital; suggest alternative means of
contraception to women using hormonal contraceptives.
 WARNING: Do not give intra-arterially; may produce arteriospasm, thrombosis,
gangrene.
 Administer IV doses slowly.
 Administer IM doses deep in a large muscle mass (gluteus maximus, vastus
lateralis) or other areas where there is little risk of encountering a nerve trunk or
major artery.
 WARNING: Monitor injection sites carefully for irritation, extravasation (IV use).
Solutions are alkaline and very irritating to the tissues.
 Monitor P, BP, respiration carefully during IV administration.
 Arrange for periodic lab tests of hematopoietic, renal, and hepatic systems during
long-term therapy.
 WARNING: Taper dosage gradually after repeated use, especially in patients with
epilepsy. When changing from one antiepileptic drug to another, taper dosage of
the drug being discontinued while increasing the dosage of the replacement drug.
REFERENCE: Mandal, A. (2019, April 18). Barbiturate Mechanism. Retrieved from https://www.news-
medical.net/health/Barbiturate-Mechanism.aspx.
 6. After knowing the different sedatives and hypnotics, the physician resorted to
miscellaneous agents. Give one example of miscellaneous drug and discuss its
mechanism of action and its corresponding nursing intervention. (6 points)
 ZOLPIDEM:
 Although drug interacts with one of three identified GABA-benzodiazepine
receptor complexes, it isn’t a benzodiazepine. It exhibits hypnotic activity and
minimal muscle relaxant and anticonvulsant properties.
 Use drug only for short-term management of insomnia, usually 7 to 10 days.
Reevaluate patient if insomnia persist.
 Use smallest effective dose in all patients.
 Take precautions to prevent hoarding by patients who are depressed, suicidal or
drug-dependent or who have a history of drug abuse.
REFERENCE: Wolters Kluwer. (2020). Nursing 2020 drug handbook (Vol. 2). Philadelphia