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Homework #1
SOCY 3115
Spring 20
Read the Syllabus and FAQ on how to do your homework before
beginning the assignment!
To get consideration for full credit, you must:
· Follow directions;
· Show all work required to arrive at answer (statistical
calculations often require multiple steps, so you need to write
these down, not just skip to the final answer)
· Use appropriate statistical notation at all times (e.g. if you are
calculating a population mean, begin with the equation for
population mean)
· Use units in your answer, where appropriate (e.g. a mean time
would be “6.5 hours” rather than just “6.5”)
Understanding the Structure of Data
1. For the following rectangular dataset:
Id
Highest degree
Works full-time
Annual income cat
1
Did not grad HS
Yes
Low
2
HS dip
Yes
Low
3
HS dip
No
Med
4
BA
No
Low
5
BA
Yes
Med
6
MA
Yes
High
7
HS dip
Yes
Med
a. What is the unit-of-analysis of the dataset?
b. How many variables are in the dataset?
c. How many observations/cases are in the dataset?
d. For eachvariable that is not named “id”:
i. What is the variable name?
ii. What is the level-of-measurement?
iii. What are the values for the variable?
iv. If you had to make a guess, what do you think the “question”
was that was asked of the unit-of-analysis to get these data?
(for example, if we had a continuous variable called “num_pets”
the question might be “How many pets live in your
household?”)
2. For the following rectangular dataset:
Id
num_bdrms
num_bthrms
sqft
Ranch
1
4
3
3200
Yes
2
2
1.5
2800
Yes
3
2
1
1200
Yes
4
3
2
1500
No
5
2
2
1100
No
a. What is the unit-of-analysis of the dataset?
b. How many variables are in the dataset?
c. How many observations/cases are in the dataset?
d. For each variable that is not named “id”:
i. What is the variable name?
ii. What is the level-of-measurement? Before answering, be
sure to consult the slide called “Level of measurement –
language to use”. Use the formal language!
iii. What are the values for the variable?
iv. If you had to make a guess, what do you think the “question”
was that was asked of the unit-of-analysis to get these data?
(for example, if we had a continuous variable called “num_pets”
the question might be “How many pets live in your
household?”)
3. For each of the following questions (1) construct a dataset
with one variable and three observations (2) add data that could
have theoretically been collected (just make up the actual
responses to the question); and (3) indicate the level-of-
measurement of the variable. I’ve done two examples for you.
Example#1:
What is your current age? (individual is the unit-of-analysis)
idage
1 25
2 32
3 61
The age variable is continuous/interval ratio.
Example#2:
What is the size of this hospital based on number of beds?
(hospital is the unit-of-analysis)? Answers can be small (1-100
beds), medium (101-500 beds), large (501 beds to 1000 beds),
extra large (1001+ beds)
idhosp_size
1 med
2 med
3 extra large
The hospital size variable is categorical ordinal
Now you do it:
a. Should the Senate vote to remove Trump from office, yes or
no? (individual is the unit-of-analysis)
b. What was your total income for 2019? (individual is the
unit-of-analysis)
c. Which of the following income categories contains your total
income for 2019? Answers can be $0; $1-$49,999; $50,000-
$99,999; $100,000+ (individual is the unit-of-analysis)
d. Do you think we should abolish the Electoral College system
of electing president? Answers can be yes absolutely; yes
probably; not sure; probably not; absolutely not. (individual is
the unit-of-analysis)
4. For each of the following datasets: (a) identify the unit-of-
analysis and (b) indicate the level of measurement for each
variable.
Dataset 1
Country
Gini index of inequality
Population (millions)
Austria
France
US
UK
Russia
Mexico
26
31
41
34
41
47
8
66
316
66
143
122
Dataset 2
Credit Score
Race/ethnicity
PersonID
5
6
2
9
10
2
1
1
3
2
1
2
1
2
3
4
5
6
Dataset 3
Company
Mean age of workers
Percent of workers w/bach degree
Google
Hulu
Hooli
Garigo
Placebo
42
41
38
26
51
82
86
82
70
64
Dataset 4
Average temperature
State
Crime Rate (crimes/10,000 people)
60
52
56
53
56
51
New Mexico
New York
Wyoming
Indiana
Kansas
Colorado
35
46
66
35
40
34
5. For each of the following survey questions, identify the type
of variable/level-of-measurement that would be created from the
data collected.
a. What do you think is the ideal number of children to have?
b. Do you have any pets living in your household?
c. What is the highest level of education you have achieved up
to this point?
· Less than high school
· High school diploma or equivalence (e.g. GED)
· Some college
· Bachelor’s degree
· Graduate degree
d. Which of the following best describes your support for the
U.S. plan to construct a Death Star Galactic Superweapon?
· Strongly support
· Support
· No opinion
· Do not support
· Strong do not support
e. How many living cousins do you have?
f. In your opinion, does your use of marijuana impact your
ability to complete your school work?
· No
· Yes
g. How many minutes does it take for you to commute to
campus on a typical day?
h. On how many occasions in your adult life have you slept in
your car because you had nowhere else to sleep?
· 0
· 1-3
· 4 or more times
6. This bulleted items below is actual Denver homicide data!
· In 2015, there were 50 homicides in Denver.
· In 2016, there were 56 homicides in Denver.
a. From 2015 to 2016, the annual number of Denver homicides
increased by ________ homicides. Is this a relative or absolute
measure?
b. From 2015 to 2016, the annual number of Denver homicides
increased by ______ percent. Is this a relative or absolute
measure?
· In 2015, 35 of Denver’s 50 homicides were by gunshot.
· In 2016, 44 of Denver’s 56 homicides were by gunshot.
a. In 2015, _________ percent of Denver’s homicides were by
gunshot. Is this a relative or absolute measure?
b. In 2016, _________ percent of Denver’s homicides were by
gunshot. Is this a relative or absolute measure?
c. From 2015 to 2016, the percent of Denver’s homicides that
were gunshot homicides increased ________ percentage points.
Is this a relative or absolute measure?
d. From 2015 to 2016, the percent of Denver’s homicides that
were gunshot homicides increased __________ percent. Is this
a relative or absolute measure?
7. Assume we collected data on 20 students in this class. We
asked them these questions:
· Do you feel you are mostly republican, democrat, or
independent?
· What is your current age?
· I’d like to ask your opinion on the amount of spending in
different areas by the US government. For each type of
spending, indicate whether you think the US government is
spending too little, too much, or just right.
i. Spending on the military
ii. Spending on social programs
Id
military_spending
socialprog_spending
party_id
1
too little
too much
repub
2
too much
just right
dem
3
too little
too much
repub
4
just right
just right
indep
5
too little
too much
indep
6
just right
just right
dem
7
just right
too much
repub
8
just right
too little
dem
9
too little
too much
dem
10
just right
just right
indep
11
too much
too much
repub
12
too much
just right
dem
13
too much
just right
dem
14
just right
too little
dem
15
too little
too much
dem
16
just right
just right
indep
17
too much
too much
repub
18
too much
just right
dem
19
too much
just right
dem
20
just right
just right
indep
a. Using this data, create two separate frequency tables, one that
summarizes opinions on military spending and one that
summarizes opinions on social program spending. The tables
should include columns for frequency, percent, and cumulative
percent. Be sure each has a title at the top, labels at the bottom,
column headings. Be sure to include “total” row at the bottom
(see text for examples). Do this by hand, not by computer
software.
b. Using this data, create two bar graphs, one that summarizes
opinions on military spending and one that summarizes opinions
on social program spending. The graph should have a title at the
bottom and labels where appropriate. Do this by hand, not by
computer software.
DQ 1
Amiodarone is considered the most effective antiarrhythmic
drug available today for the treatment of atrial fibrillation and
ventricular arrhythmias (Srinivasan, Ahmad, Bhindi &
Allahwala, 2019). Amiodarone is a potassium channel blocker
and is able to prolong the cardiac action potential by slowing
conduction and refractory periods of the SA and AV nodes,
bundles of His, and Purkinje fibers (Srinivasan et al., 2019).
This blocking of the potassium channel and slowing down
conduction give Amiodarone its anti-arrhythmic properties and
show its effective use in atrial fibrillation and ventricular
tachycardia (Srinivasan et al., 2019).
With amiodarone’s anti-arrhythmic properties and its incredible
effectiveness, it has become the number one choice for rhythm
control in patients who experience atrial fibrillation and
ventricular tachycardia (Vamos & Hohnloser, 2016). When
compared to other anti-arrhythmic medications, amiodarone has
the greatest potential of maintaining sinus rhythm once the
patient converts (Vamos & Hohnloser, 2016). When a patient is
experiencing an arrhythmia, the first step would be to obtain an
EKG to confirm the type of rhythm, if it is atrial fibrillation or
ventricular tachycardia then amiodarone would be indicated
(Vamos & Hohnloser, 2016).
Monitoring of amiodarone consists of measuring the patient’s
heart rate to ensure that there are no signs of bradyarrhythmias
that are caused by overdosing of amiodarone (Srinivasan et al.,
2019). An ECG should be measured as well due to amiodarone
prolonging the QT interval and can interact with other drugs
causing the same issue, possibly leading to an R on T
phenomenon (Srinivasan et al., 2019).
As food interactions are concerned, patients need to avoid
drinking grapefruit juice as it inhibits CYP3A4 which is also
the enzyme responsible for metabolizing amiodarone leading to
elevated serum levels (Srinivasan et al., 2019). Absorption of
amiodarone is variable when following oral administration, and
IV administration leads to 100% bioavailability (Srinivasan et
al., 2019). Amiodarone has a half-life of 60-90 days when taken
chronically by the oral route due to the body storing amiodarone
in adipose tissue (Srinivasan et al., 2019).
References:
Srinivasan, M., Ahmad, L., Bhindi, R., & Allahwala, U. (2019).
Amiodarone in the aged. Australian Prescriber, 42(5), 158–162.
https://doi-org.lopes.idm.oclc.org/10.18773/austprescr.2019.051
Vamos, M., & Hohnloser, S. H. (2016). Amiodarone and
dronedarone: An update. Trends in Cardiovascular Medicine,
26(7), 597–602. https://doi-
org.lopes.idm.oclc.org/10.1016/j.tcm.2016.03.014
DQ-2
For this question, I selected Levophed or norepinephrine.
In the ICU setting, we receiving a lot of patients who have a
variety of emergency medical issues present. Most of the time
in the ICU I work it we see patients who are undergoing septic
shock. Other diseases that can induce symptomatic hypotension
are drug overdose, sepsis, hypovolemia, and hypovolemic
shock, and hypotension with the use of sedation for mechanical
ventilator management (Cheung et al., 2015). Levophed is used
as a first-line vasoconstrictor and is administered via IV for its
quick effect on the body (Cheung et al., 2015). Levophed is also
the first line choice due to its fewer adverse side effects when
compared to other vasoconstrictors like dopamine (Cheung et
al., 2015).
Levophed’s mechanism of action is that it stimulates alpha 1
and 2 adrenergic receptors causing blood vessel constriction
(Cheung et al., 2015). This constriction occurs systemically
(Cheung et al., 2015). The constriction of the vessels increases
blood pressure by decreasing the intra-vessel diameter (Cheung
et al., 2015). Levophed also acts on beta 1 adrenergic receptors
causing an increase in cardiac output and heart rate (Cheung et
al., 2015). The vasoconstriction also reduces blood supply
regardless of blood demand and causes increased heart and
decreased blood supply to the kidneys as well (Cheung et al.,
2015).
Levophed is indicated in patients who are experiencing
symptomatic hypotension from a variety of disease processes
(Duclos et al., 2019) (Cheung et al., 2015). The advantages of
Levophed are that it is fast-acting and provides a systemic
response and an overall increase in blood pressure (Duclos et
al., 2019). Some disadvantages of Levophed include the
increased cardiac oxygen demand not being met and could
trigger a cardiac arrhythmia (Duclos et al., 2019). Another
disadvantage comes from its potent vasoconstriction abilities
(Duclos et al., 2019). Levophed causes such potent
vasoconstriction that in the smaller vessels such as in the hands
and toes, blood supply becomes very limited and almost cut off
and the patient's skin will begin to mottle (Duclos et al., 2019).
This has coined the phrase “Levophed leaves them dead”
because their skin begins to show signs of mottling and
discoloration and they look like they have expired.
In the past, cultural and ethnic differences come into play when
the family is first seeing the use of the medication and some
side effects such as mottling. After careful explanation and
expressing that the patient needs this medication to keep their
blood pressure in good ranges to sustain life, most if not all
family agrees with the usage of Levophed.
References:
Cheung, W. K., Chau, L. S., Laurinda Mak, I. I., Wong, M. Y.,
Wong, S. L., & Yee Tiwari, A. F. (2015). Clinical management
for patients admitted to a critical care unit with severe sepsis or
septic shock. Intensive and Critical Care Nursing, 31(6), 359–
365. https://doi-
org.lopes.idm.oclc.org/10.1016/j.iccn.2015.04.005
Duclos, G., Baumstarck, K., Dünser, M., Zieleskiewicz, L., &
Leone, M. (2019). Effects of the discontinuation sequence of
norepinephrine and vasopressin on hypotension incidence in
patients with septic shock: A meta-analysis. Heart & Lung,
48(6), 560–565. https://doi-
org.lopes.idm.oclc.org/10.1016/j.hrtlng.2019.05.007
DQ-3
There are many drugs that affect the cardiovascular and renal
systems, but one class of medications that has an effect on both
systems is the angiotensin-converting enzyme inhibitors
(ACEIs). ACEIs reduce the production of angiotensin II and
aldosterone in the renin-angiotensin-aldosterone system
(RAAS), which not only aids in lowering blood pressure but
also helps with the adverse effects of diabetes on the kidneys
(Robinson, 2016, p. 295). They also improve oxygenation and
reduce cardiac remodeling after a heart attack or during heart
failure (Robinson, 2016, p. 295). One such drug within this
class of medications is Lisinopril. Lisinopril works by binding
with and inhibiting the action of ACE, which block the
conversion of angiotensin I to II, and reduces the secretion of
aldosterone from angiotensin II activity (Lisinopril, 2020, para
1). In doing so it prevents vasoconstriction and increases
sodium and water excretion from the kidneys, which both aid in
reducing blood pressure. In patients with proteinuria, from
diabetes related kidney disease, Lisinopril helps slow the
progression of the disease state. It aids in reducing efferent
arteriolar resistance in the glomeruli, reduces capillary pressure
inside the glomeruli, stops hypertrophy of the glomeruli, and
reduces the declining glomerular filtration rates (Robinson,
2016, p. 296). Contraindications for the use of Lisinopril
include angioedema, pregnancy, and renal artery stenosis
(Robinson, 2016, p. 297). Renal artery stenosis requires
increased vascular pressure, and when reduced it can further
damage renal arteries and reduce perfusion within the kidneys.
In patients with hyperkalemia the use of Lisinopril should be
withheld because this medication can worsen the electrolyte
imbalance. Lisinopril is contraindicated in pregnancy because
of the injury and death risk of the developing fetus from direct
actions on the RAAS (Lisinopril, 2020, para 63). Angioedema
can be life threatening due to airway constriction, and ACEIs
can cause this phenomenon because of the bradykinin activity of
inhibiting ACE (Robinson, 2016, p. 297). Drug interactions
with Lisinopril include other antihypertensives due to their
hypotensive effect, potassium supplements or potassium
sparring diuretics due to the risk of hyperkalemia, and
concurrent use of Lithium because of increased risk of Lithium
toxicity (Robinson, 2016, p. 303). Other interactions include
using Lisinopril with antidiabetic agents and with renal
impairment due to hypoglycemia, and use with nonsteroidal
anti-inflammatories due to the decreased efficiency of
Lisinopril for hypertension management (Lisinopril, 2020, para
130). Dosage recommendations included starting at a low dose
and also stopping diuretics for a few days to allow rehydration
and prevents drastic declines in blood pressure (Robinson,
2016, p. 304). Switching to thiazide diuretics is also
recommended if able due to the risk of hyperkalemia with other
diuretics in combination with ACEIs (Robinson, 2016, p. 304).
Increment increases within the first couple weeks, starting with
a low dose, until target blood pressure is achieved is
recommended. Monitoring includes blood pressure and pulse
before initiating therapy and with dose changes, weight
measurements, renal function labs, and potassium levels
(Robinson, 2016, p. 307). If kidney function is too high then
reducing the dose is recommended. Complete blood counts
should also be monitored due to the risk of neutropenia from
kidney disease, and if the neutrophil count is lower than
1,000/mm³ therapy should be stopped (Robinson, 2016, p. 308).
References
Lisinopril. (2020). Retrieved from the National Center for
Biotechnology Information website:
https://pubchem.ncbi.nlm.nih.gov/compound/Lisinopril
Robinson, M. V. (2016). Drugs affecting the cardiovascular and
renal systems. In T. M. Woo & M. V. Robinson (Eds.),
Pharmacotherapeutics for advanced practice nurse prescribers
(pp. 3-10). Philadelphia, PA: F. A. Davis Company.
Need help to reply three post.
DO NOT JUST REPEAT SAME INFORMATION, DO NOT
JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED
TO ADD NEW INFORMATION TO DISCUSSION.
1- Each reply should be at least 200 words.
2- One scholarly reference ( NO MAYO CLINIC/ AHA)
3- APA style needs to be followed.
4- Each response should have reference at the end
5- Reference should be within last 5 years

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Homework #1SOCY 3115Spring 20Read the Syllabus and FAQ on ho.docx

  • 1. Homework #1 SOCY 3115 Spring 20 Read the Syllabus and FAQ on how to do your homework before beginning the assignment! To get consideration for full credit, you must: · Follow directions; · Show all work required to arrive at answer (statistical calculations often require multiple steps, so you need to write these down, not just skip to the final answer) · Use appropriate statistical notation at all times (e.g. if you are calculating a population mean, begin with the equation for population mean) · Use units in your answer, where appropriate (e.g. a mean time would be “6.5 hours” rather than just “6.5”) Understanding the Structure of Data 1. For the following rectangular dataset: Id Highest degree Works full-time Annual income cat 1 Did not grad HS Yes Low 2 HS dip Yes Low 3
  • 2. HS dip No Med 4 BA No Low 5 BA Yes Med 6 MA Yes High 7 HS dip Yes Med a. What is the unit-of-analysis of the dataset? b. How many variables are in the dataset? c. How many observations/cases are in the dataset? d. For eachvariable that is not named “id”: i. What is the variable name? ii. What is the level-of-measurement? iii. What are the values for the variable?
  • 3. iv. If you had to make a guess, what do you think the “question” was that was asked of the unit-of-analysis to get these data? (for example, if we had a continuous variable called “num_pets” the question might be “How many pets live in your household?”) 2. For the following rectangular dataset: Id num_bdrms num_bthrms sqft Ranch 1 4 3 3200 Yes 2 2 1.5 2800 Yes 3 2 1 1200 Yes 4 3 2
  • 4. 1500 No 5 2 2 1100 No a. What is the unit-of-analysis of the dataset? b. How many variables are in the dataset? c. How many observations/cases are in the dataset? d. For each variable that is not named “id”: i. What is the variable name? ii. What is the level-of-measurement? Before answering, be sure to consult the slide called “Level of measurement – language to use”. Use the formal language! iii. What are the values for the variable? iv. If you had to make a guess, what do you think the “question” was that was asked of the unit-of-analysis to get these data? (for example, if we had a continuous variable called “num_pets”
  • 5. the question might be “How many pets live in your household?”) 3. For each of the following questions (1) construct a dataset with one variable and three observations (2) add data that could have theoretically been collected (just make up the actual responses to the question); and (3) indicate the level-of- measurement of the variable. I’ve done two examples for you. Example#1: What is your current age? (individual is the unit-of-analysis) idage 1 25 2 32 3 61 The age variable is continuous/interval ratio. Example#2: What is the size of this hospital based on number of beds? (hospital is the unit-of-analysis)? Answers can be small (1-100 beds), medium (101-500 beds), large (501 beds to 1000 beds), extra large (1001+ beds) idhosp_size 1 med 2 med 3 extra large The hospital size variable is categorical ordinal Now you do it: a. Should the Senate vote to remove Trump from office, yes or
  • 6. no? (individual is the unit-of-analysis) b. What was your total income for 2019? (individual is the unit-of-analysis) c. Which of the following income categories contains your total income for 2019? Answers can be $0; $1-$49,999; $50,000- $99,999; $100,000+ (individual is the unit-of-analysis) d. Do you think we should abolish the Electoral College system of electing president? Answers can be yes absolutely; yes probably; not sure; probably not; absolutely not. (individual is the unit-of-analysis) 4. For each of the following datasets: (a) identify the unit-of- analysis and (b) indicate the level of measurement for each variable. Dataset 1 Country Gini index of inequality Population (millions)
  • 8. 2 3 4 5 6 Dataset 3 Company Mean age of workers Percent of workers w/bach degree Google Hulu Hooli Garigo Placebo 42 41 38 26 51 82 86 82 70 64 Dataset 4 Average temperature State Crime Rate (crimes/10,000 people) 60 52 56 53 56 51
  • 9. New Mexico New York Wyoming Indiana Kansas Colorado 35 46 66 35 40 34 5. For each of the following survey questions, identify the type of variable/level-of-measurement that would be created from the data collected. a. What do you think is the ideal number of children to have? b. Do you have any pets living in your household? c. What is the highest level of education you have achieved up to this point? · Less than high school · High school diploma or equivalence (e.g. GED) · Some college · Bachelor’s degree · Graduate degree d. Which of the following best describes your support for the U.S. plan to construct a Death Star Galactic Superweapon?
  • 10. · Strongly support · Support · No opinion · Do not support · Strong do not support e. How many living cousins do you have? f. In your opinion, does your use of marijuana impact your ability to complete your school work? · No · Yes g. How many minutes does it take for you to commute to campus on a typical day? h. On how many occasions in your adult life have you slept in your car because you had nowhere else to sleep? · 0 · 1-3 · 4 or more times 6. This bulleted items below is actual Denver homicide data! · In 2015, there were 50 homicides in Denver. · In 2016, there were 56 homicides in Denver. a. From 2015 to 2016, the annual number of Denver homicides increased by ________ homicides. Is this a relative or absolute measure?
  • 11. b. From 2015 to 2016, the annual number of Denver homicides increased by ______ percent. Is this a relative or absolute measure? · In 2015, 35 of Denver’s 50 homicides were by gunshot. · In 2016, 44 of Denver’s 56 homicides were by gunshot. a. In 2015, _________ percent of Denver’s homicides were by gunshot. Is this a relative or absolute measure? b. In 2016, _________ percent of Denver’s homicides were by gunshot. Is this a relative or absolute measure? c. From 2015 to 2016, the percent of Denver’s homicides that were gunshot homicides increased ________ percentage points. Is this a relative or absolute measure? d. From 2015 to 2016, the percent of Denver’s homicides that were gunshot homicides increased __________ percent. Is this a relative or absolute measure?
  • 12. 7. Assume we collected data on 20 students in this class. We asked them these questions: · Do you feel you are mostly republican, democrat, or independent? · What is your current age? · I’d like to ask your opinion on the amount of spending in different areas by the US government. For each type of spending, indicate whether you think the US government is spending too little, too much, or just right. i. Spending on the military ii. Spending on social programs Id military_spending socialprog_spending party_id 1 too little too much repub 2 too much just right dem 3 too little too much repub 4 just right just right indep 5
  • 13. too little too much indep 6 just right just right dem 7 just right too much repub 8 just right too little dem 9 too little too much dem 10 just right just right indep 11 too much too much repub 12 too much just right dem 13 too much just right dem 14
  • 14. just right too little dem 15 too little too much dem 16 just right just right indep 17 too much too much repub 18 too much just right dem 19 too much just right dem 20 just right just right indep a. Using this data, create two separate frequency tables, one that summarizes opinions on military spending and one that summarizes opinions on social program spending. The tables should include columns for frequency, percent, and cumulative percent. Be sure each has a title at the top, labels at the bottom, column headings. Be sure to include “total” row at the bottom (see text for examples). Do this by hand, not by computer software.
  • 15. b. Using this data, create two bar graphs, one that summarizes opinions on military spending and one that summarizes opinions on social program spending. The graph should have a title at the bottom and labels where appropriate. Do this by hand, not by computer software. DQ 1 Amiodarone is considered the most effective antiarrhythmic drug available today for the treatment of atrial fibrillation and ventricular arrhythmias (Srinivasan, Ahmad, Bhindi & Allahwala, 2019). Amiodarone is a potassium channel blocker and is able to prolong the cardiac action potential by slowing conduction and refractory periods of the SA and AV nodes,
  • 16. bundles of His, and Purkinje fibers (Srinivasan et al., 2019). This blocking of the potassium channel and slowing down conduction give Amiodarone its anti-arrhythmic properties and show its effective use in atrial fibrillation and ventricular tachycardia (Srinivasan et al., 2019). With amiodarone’s anti-arrhythmic properties and its incredible effectiveness, it has become the number one choice for rhythm control in patients who experience atrial fibrillation and ventricular tachycardia (Vamos & Hohnloser, 2016). When compared to other anti-arrhythmic medications, amiodarone has the greatest potential of maintaining sinus rhythm once the patient converts (Vamos & Hohnloser, 2016). When a patient is experiencing an arrhythmia, the first step would be to obtain an EKG to confirm the type of rhythm, if it is atrial fibrillation or ventricular tachycardia then amiodarone would be indicated (Vamos & Hohnloser, 2016). Monitoring of amiodarone consists of measuring the patient’s heart rate to ensure that there are no signs of bradyarrhythmias that are caused by overdosing of amiodarone (Srinivasan et al., 2019). An ECG should be measured as well due to amiodarone prolonging the QT interval and can interact with other drugs causing the same issue, possibly leading to an R on T phenomenon (Srinivasan et al., 2019). As food interactions are concerned, patients need to avoid drinking grapefruit juice as it inhibits CYP3A4 which is also the enzyme responsible for metabolizing amiodarone leading to elevated serum levels (Srinivasan et al., 2019). Absorption of amiodarone is variable when following oral administration, and IV administration leads to 100% bioavailability (Srinivasan et al., 2019). Amiodarone has a half-life of 60-90 days when taken chronically by the oral route due to the body storing amiodarone in adipose tissue (Srinivasan et al., 2019). References: Srinivasan, M., Ahmad, L., Bhindi, R., & Allahwala, U. (2019). Amiodarone in the aged. Australian Prescriber, 42(5), 158–162.
  • 17. https://doi-org.lopes.idm.oclc.org/10.18773/austprescr.2019.051 Vamos, M., & Hohnloser, S. H. (2016). Amiodarone and dronedarone: An update. Trends in Cardiovascular Medicine, 26(7), 597–602. https://doi- org.lopes.idm.oclc.org/10.1016/j.tcm.2016.03.014 DQ-2 For this question, I selected Levophed or norepinephrine. In the ICU setting, we receiving a lot of patients who have a variety of emergency medical issues present. Most of the time in the ICU I work it we see patients who are undergoing septic shock. Other diseases that can induce symptomatic hypotension are drug overdose, sepsis, hypovolemia, and hypovolemic shock, and hypotension with the use of sedation for mechanical ventilator management (Cheung et al., 2015). Levophed is used as a first-line vasoconstrictor and is administered via IV for its quick effect on the body (Cheung et al., 2015). Levophed is also the first line choice due to its fewer adverse side effects when compared to other vasoconstrictors like dopamine (Cheung et al., 2015). Levophed’s mechanism of action is that it stimulates alpha 1 and 2 adrenergic receptors causing blood vessel constriction (Cheung et al., 2015). This constriction occurs systemically (Cheung et al., 2015). The constriction of the vessels increases blood pressure by decreasing the intra-vessel diameter (Cheung et al., 2015). Levophed also acts on beta 1 adrenergic receptors causing an increase in cardiac output and heart rate (Cheung et al., 2015). The vasoconstriction also reduces blood supply regardless of blood demand and causes increased heart and decreased blood supply to the kidneys as well (Cheung et al., 2015).
  • 18. Levophed is indicated in patients who are experiencing symptomatic hypotension from a variety of disease processes (Duclos et al., 2019) (Cheung et al., 2015). The advantages of Levophed are that it is fast-acting and provides a systemic response and an overall increase in blood pressure (Duclos et al., 2019). Some disadvantages of Levophed include the increased cardiac oxygen demand not being met and could trigger a cardiac arrhythmia (Duclos et al., 2019). Another disadvantage comes from its potent vasoconstriction abilities (Duclos et al., 2019). Levophed causes such potent vasoconstriction that in the smaller vessels such as in the hands and toes, blood supply becomes very limited and almost cut off and the patient's skin will begin to mottle (Duclos et al., 2019). This has coined the phrase “Levophed leaves them dead” because their skin begins to show signs of mottling and discoloration and they look like they have expired. In the past, cultural and ethnic differences come into play when the family is first seeing the use of the medication and some side effects such as mottling. After careful explanation and expressing that the patient needs this medication to keep their blood pressure in good ranges to sustain life, most if not all family agrees with the usage of Levophed. References: Cheung, W. K., Chau, L. S., Laurinda Mak, I. I., Wong, M. Y., Wong, S. L., & Yee Tiwari, A. F. (2015). Clinical management for patients admitted to a critical care unit with severe sepsis or septic shock. Intensive and Critical Care Nursing, 31(6), 359– 365. https://doi- org.lopes.idm.oclc.org/10.1016/j.iccn.2015.04.005 Duclos, G., Baumstarck, K., Dünser, M., Zieleskiewicz, L., & Leone, M. (2019). Effects of the discontinuation sequence of norepinephrine and vasopressin on hypotension incidence in patients with septic shock: A meta-analysis. Heart & Lung, 48(6), 560–565. https://doi- org.lopes.idm.oclc.org/10.1016/j.hrtlng.2019.05.007
  • 19. DQ-3 There are many drugs that affect the cardiovascular and renal systems, but one class of medications that has an effect on both systems is the angiotensin-converting enzyme inhibitors (ACEIs). ACEIs reduce the production of angiotensin II and aldosterone in the renin-angiotensin-aldosterone system (RAAS), which not only aids in lowering blood pressure but also helps with the adverse effects of diabetes on the kidneys (Robinson, 2016, p. 295). They also improve oxygenation and reduce cardiac remodeling after a heart attack or during heart failure (Robinson, 2016, p. 295). One such drug within this class of medications is Lisinopril. Lisinopril works by binding with and inhibiting the action of ACE, which block the conversion of angiotensin I to II, and reduces the secretion of aldosterone from angiotensin II activity (Lisinopril, 2020, para 1). In doing so it prevents vasoconstriction and increases sodium and water excretion from the kidneys, which both aid in reducing blood pressure. In patients with proteinuria, from diabetes related kidney disease, Lisinopril helps slow the progression of the disease state. It aids in reducing efferent arteriolar resistance in the glomeruli, reduces capillary pressure inside the glomeruli, stops hypertrophy of the glomeruli, and reduces the declining glomerular filtration rates (Robinson, 2016, p. 296). Contraindications for the use of Lisinopril include angioedema, pregnancy, and renal artery stenosis (Robinson, 2016, p. 297). Renal artery stenosis requires increased vascular pressure, and when reduced it can further damage renal arteries and reduce perfusion within the kidneys. In patients with hyperkalemia the use of Lisinopril should be withheld because this medication can worsen the electrolyte imbalance. Lisinopril is contraindicated in pregnancy because of the injury and death risk of the developing fetus from direct actions on the RAAS (Lisinopril, 2020, para 63). Angioedema
  • 20. can be life threatening due to airway constriction, and ACEIs can cause this phenomenon because of the bradykinin activity of inhibiting ACE (Robinson, 2016, p. 297). Drug interactions with Lisinopril include other antihypertensives due to their hypotensive effect, potassium supplements or potassium sparring diuretics due to the risk of hyperkalemia, and concurrent use of Lithium because of increased risk of Lithium toxicity (Robinson, 2016, p. 303). Other interactions include using Lisinopril with antidiabetic agents and with renal impairment due to hypoglycemia, and use with nonsteroidal anti-inflammatories due to the decreased efficiency of Lisinopril for hypertension management (Lisinopril, 2020, para 130). Dosage recommendations included starting at a low dose and also stopping diuretics for a few days to allow rehydration and prevents drastic declines in blood pressure (Robinson, 2016, p. 304). Switching to thiazide diuretics is also recommended if able due to the risk of hyperkalemia with other diuretics in combination with ACEIs (Robinson, 2016, p. 304). Increment increases within the first couple weeks, starting with a low dose, until target blood pressure is achieved is recommended. Monitoring includes blood pressure and pulse before initiating therapy and with dose changes, weight measurements, renal function labs, and potassium levels (Robinson, 2016, p. 307). If kidney function is too high then reducing the dose is recommended. Complete blood counts should also be monitored due to the risk of neutropenia from kidney disease, and if the neutrophil count is lower than 1,000/mm³ therapy should be stopped (Robinson, 2016, p. 308). References Lisinopril. (2020). Retrieved from the National Center for Biotechnology Information website: https://pubchem.ncbi.nlm.nih.gov/compound/Lisinopril Robinson, M. V. (2016). Drugs affecting the cardiovascular and renal systems. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers
  • 21. (pp. 3-10). Philadelphia, PA: F. A. Davis Company. Need help to reply three post. DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION. 1- Each reply should be at least 200 words. 2- One scholarly reference ( NO MAYO CLINIC/ AHA) 3- APA style needs to be followed. 4- Each response should have reference at the end 5- Reference should be within last 5 years