Grand Canyon University Dietary Supplements and Herbal Medications Discussion

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Part 1 The Beer's criteria contain a list of drugs that are potentially unsafe for use in older persons. Utilize the provided resource, "American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults" for assistance in completing this question. Select a drug on the "avoid" list that you have administered to an older patient or a drug that you know is prescribed for an older adult. Relate the outcome of using this drug to the pharmacokinetics (absorption, metabolism, distribution, and excretion) of drugs in an older client. In addition to the link, cite one other reference to support your post. Make sure that you select a different drug than your peers. Include the name of the drug in the subject line so that the drugs can be followed. Include your references in APA style. Part 2 Many people are using herbal medications and dietary supplements for the prevention and treatment of medical problems. Review two current research articles about two of these products. Based on the findings, what would be the implications for you as a nurse? What additional research needs to be done in this area? Cite the two references to support your answer. Make sure that you select different herbal medications and dietary supplements than your peers. Include the name of the herbal medication and dietary supplement in the subject line so that the medications can be followed. Include your references in APA style. Part 3 Create an 8-9 slide presentation with speaker notes of 100 -150, words about a selected disease process and drug class. The presentation should provide content specific information on the selected disease process and drug class for staff or learners in a clinical environment. Follow these steps: 1. Select a disease process and a drug class used to treat the disease process. 2. Describe pharmacokinetics and pharmacodynamics of the drug related to the pathophysiology of the disease process. 3. Describe the product, its intended use, side effects, adverse reactions, and safety issues. 4. Identify ethnic, cultural, and genetic differences in patients that may affect the safety or efficacy of medications. 5. How would you monitor the desired effect is achieved? Be sure to include three to five references. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content. While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are not required to submit this assignment to LopesWrite. Acyclovir Antiviral Indications Acyclovir is used to treat ● ● ● ● Shingles Chickenpox Genital Herpes Cold sore Acyclovir is available in the following dosage forms: ● ● ● ● ● Suspension Tablet Capsule Solution Powder for Solution Indications IV : ● Treatment of initial and prophylaxis of recurrent mucosal and cutaneous herpes simplex virus (HSV-1 and HSV-2) in immunocompromised patients. Treatment of severe initial episodes of herpes genitalis in immunocompetent patients. Treatment of herpes simplex encephalitis including neonatal herpes simplex virus. Treatment of varicella-zoster virus (VZV) infections in immunocompetent pts. Buccal ● Treatment of initial episodes and prophylaxis of recurrent herpes simplex (HSV-2 genital herpes). Treatment of chickenpox (varicella). Acute treatment of herpes zoster (shingles). Management of initial genital herpes. Topical ● Cream: Treatment of recurrent herpes labialis (cold sores). Ointment: Treatment of mucocutaneous HSV in immunocompromised patients. Mechanism of Action & Pharmacokinetics Mechanism of action ● Antiviral agent; synthetic purine nucleoside analogue with inhibitory activity against herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2) ● Synthetic Nucleoside analogue ● Interferes with the replication of Herpes virus Pharmacokinetics ● Poor absorption ● Widely distributed ● Cerebrospinal concentration are 50% of plasma ● Crosses placenta ● Enter breast milk ● Metabolizes in the liver ● Excreted by the kidney Contraindication/precaution Contraindication ● Hypersensitivity to acyclovir or valacyclovir ● Hypersensitivity to milk protein concentrate (buccal only) ● Avoid rapid infusion because of risk of renal damage ● Renal failure Precaution ● Use with caution in immunocompromised patients (potential risk of thrombotic/thrombocytopenic purpura [TTP]/hemolytic uremic syndrome [HUS]) ● Use with caution in patients with renal impairment ● Treatment should begin within 24 hours of appearance of rash ● Use with caution in patients receiving nephrotoxic drugs ● Maintain adequate hydration during PO or IV therapy ● Thrombocytopenic purpura/hemolytic uremic syndrome reported Adverse reaction/Adverse Effects Common side effects: ● ● ● ● ● ● ● ● Nausea Vomiting Diarrhea Loss of Appetite Stomach pain Headache Swelling in the hands and feet Mouth pain Serious side effects: ● ● ● ● Pain in lower back Urinating less than usual or not at all Easy bruising or bleeding Unusual weakness Drug-Drug Interactions Cidovir ● Combined with acyclovir may increase the risk of liver damage. ● Patients on acyclovir should wait at least seven days after the last dose before using Cidovir. Sirolimus ● Combined with acyclovir increases the risk of liver impairment. Tacrolimus ● Combined with acyclovir increases toxicity to the kidney. ● Patient may experience decrease in urine production and or impaired hearing. Tizanidine ● Acyclovir may increase the blood level & effect of Tizanidine. Nursing Consideration Assessment ● Before administering Acyclovir, make sure to evaluate the patient for the presence of ○ allergies ○ congestive heart failure ○ seizures ○ renal disorder and lactation. ● Question for history of allergies, specific to acyclovir. ● Assess herpes simplex lesions before treatment to compare baseline with treatment effect. Nursing intervention/evaluation When administering systemic Acyclovir: ● ensure that the patient is hydrated throughout the course of the therapy. ● Remember that this drug is nephrotoxic, which means it can have a negative effect on the kidneys. ● If administering Acyclovir topically, institute treatment as soon as the first infectious signs and symptoms appear. Additionally, don a finger cot when applying the medication. ● Monitor patient lab value for BUN and creatinine Administration of the Medication : Dosage Parenteral : ● 5–10 mg/kg infused IV over 1 hr, q 8 hr (15 mg/kg/day) for 7–10 days. Oral : ● ● ● ● ● ● Initial genital herpes: 200 mg q 4 hr (1,000 mg/day) for 10 days. Long-term suppressive therapy: 400 mg bid for up to 12 mo. Acute herpes zoster: 800 mg q 4 hr five times daily for 7–10 days. Chickenpox: 800 mg qid for 5 days. Patients can take this medication without food. Do not crush or break the capsules. Topical : Cream/Ointment: Administration of the Medication continued PEDIATRIC PATIENTS : IV : ● ● ● HSV infections < 12 yr: 10 mg/kg infused IV over 1 hr q 8 hr for 7 days. Shingles, HSV encephalitis: 20 mg/kg IV over 1 hr q 8 hr for 10 days. Neonatal HSV: 10 mg/kg infused over 1 hr q 8 hr for 10 days. Oral : ● ● ● ● < 2 yr: Safety not established. 2 yr and < 40 kg: 20 mg/kg per dose qid (80 mg/kg/day) for 5 days. 40 kg: Use adult dosage. 12 yr: Use adult dosage. Dietary restriction ● Food does not affect the absorption of this medication. ● Patients are able to follow their own diet, however they are still encouraged to eat healthy and increase their fluids while taking this medication Lifestyle Modification ● Patients who are taking Acyclovir should avoid having sex while the herpes sores are present. ● Even if the patient has no signs of a herpes infection, it is still possible to spread the virus to others during sex. ● Therefore, always use an effective barrier method (latex or polyurethane condoms/dental dams) during all sexual activity Patient Teaching ● Combining acyclovir and valacyclovir or famciclovir increase nephrotoxicity which can lead to renal failure ● Acyclovir will not cure herpes, but it can lessen the symptoms of the infection. It slows the growth and spread of the herpes virus so that the body can fight off the infection. ● The patient should keep the drug away from light and exposure ● Patients should maintain good hydration to decrease the toxic effects on the kidneys ● Due to the fact that antivirals can cause orthostatic hypotension, rise slowly after taking the med. ● Remember to keep this and all other medications out of reach of children ● Never share your medication with others ● Use this medication only for the indication prescribed ● Do not take extra medicine to make up the missed dose. Education of Medication: ● Patient Understands: -Diagnosis, brand/generic name, function: how to take medication, when to take medication and length of time the medication is taken. Possible side effects, activities permitted and refill protocol if necessary . ● Ensure Compliance/Treatment Plan: -Demonstrate and explain than have patient teach back - give program instructions to take home for referencing - make patient aware of community resources available for financial cost and support. - Time constraints: teach patient to take in morning with oral care or at meal time to avoid missing a dose. - teach patient about herbal remedies and OTC drug interactions ● Compliance of Pediatrics : - assess caregivers abilities and readiness/feelings - Role play - allow child to participate - group teaching helps with encouragement of diagnosis ● Evaluate Understanding: - Measure how well the patient can and will achieve desired outcomes. - Ask direct question, expecting taught response - Analyze patients comments and thoughts *Patients health beliefs have big influence on motivation* Reference Page Acyclovir (Rx). (2016, December 30). Retrieved November 29, 2017, from https://reference.medscape.com/drug/zovirax-acyclovir-342601 Acyclovir. (2015). Retrieved November 29, 2017, from https://davisplus.fadavis.com/3976/meddeck/pdf/acyclovir.pdf “Acyclovir.” RNpedia, 3 July 2017, www.rnpedia.com/nursing-notes/pharmacology-drug-studynotes/acyclovir Kizior, R., Hodgson, k. (2018). Nursing Drug Handbook. St. Louis, MO: Saunders “Acyclovir.” RNpedia, 3 July 2017, www.rnpedia.com/nursing-notes/pharmacology-drug-studynotes/acyclovir Taylor, C. (10/2014). Fundamentals of Nursing. [CoursePoint]. Retrieved from https://coursepoint.vitalsource.com/#/books/9781469898032/
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Explanation & Answer

Please view explanation and answer below.

Disease process
Hypertension
 Hypertension is an elevation of blood pressure above

140 mmHg systolic and 90 mmHg diastolic
 Primary hypertension accounts for 90-95% of all cases
 Primary hypertension has no specific etiology
 Risk factors include age, high BMI, genetic

predisposition, race and gender

Drug class
Angiotensin converting enzyme inhibitor (ACEI)
 ACEIs are among the drugs used for the treatment of

hypertension
 ACEIs are also used in heart failure and diabetic

nephropathy
 Example: Enalapril

Pharmacokinetics and Pharmokinetics of enalapril
Pharmacokinetics
 Oral bioavailability of 95%
 Food reduce
bioavaolability
 Distributed mainly to
peripheral tissues
 Does not cross blood brain
barrier (BBB)
 All prodrug compounds
transformed to active
metabolites by the liver
 Eliminated in urine

Pharmacodynamics
 Mode of action is
prevention of conversion
of angiotensin I to
angiotensin II
 Causes arterial
vasodilation
 Reduces aldosterone
secretion

Use and side effects of enalapril
Uses
 Treating mild to moderate

hypertension
 Treatment of heart failure
 Treating diabetic

nephropathy

Side effects
 Persistent dry cough...


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