This document provides a nursing student's response to a case study on medications for a patient named Mr. MP. It includes details of the medications, their uses, dosages, side effects and special considerations. It also lists potential problems related to the medications, assessments to monitor for side effects, and healthcare providers to collaborate with including the physician, respiratory therapist, pharmacist, and physical therapist. The student identifies risks of bleeding, infection, and falls and interventions like careful injections, hand washing, and fall precautions. Assessments include respiratory, cardiovascular and musculoskeletal exams.

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NORTHERN ILLINOIS UNIVERSITY
Pharmacology Case Study 2
Nursing Student Response Sheet
Student Name: Michelle King
PART 1: MEDICATION INFORMATION (15 points)
MEDICATION
NAME
REASON FOR
USE by this
CLIENT
COMMON CLASS
(if none, indicate
MAJOR CLASS)
DOSAGE WITHIN
RANGE?
ADVERSE EFFECTS SPECIAL CONSIDERATIONS
(for this specific CLIENT)
Generic name:
ceftriaxone
Trade name:
Rocephin
Lower
respiratory tract
infection
(pneumonia)
Antibiotic (Third-
generation
cephalosporin)
Dosage:
1 g I.V. qday
Normal range:
1-2 g I.V. daily
Yes, within
normal range
Hematologic: leukopenia,
GI: pseudomembranous
colitis
Administration:
-Total daily dose should not
exceed 4 g
-Treat between 4 to 14 days.
-Before giving drug, ensure
patient is not allergic to
penicillins or cephalosporins.
-Follow IV administration
directions (i.e, drug
reconstitution, dilution).
Patient teaching:
-Instruct patient to report any
discomfort at the I.V. insertion
site.
Nursing Consideration:
-Monitor for any signs and
symptoms of superinfection.

2. 2
Generic name:
ciprofloxacin
Trade name:
Cipro
Respiratory tract
infection
Antibiotic
(fluoroquinolones)
Dosage:
500 mg, P.O.
daily
Normal range:
500 mg, P.O.
every 12 hours
No, not within
normal range
due to longer
dosing interval.
 Rationale:
“Start low
and go slow”
guidelines.
 Mr. MP is an
elderly
patient and
age-related
changes such
as longer
metabolism
and excretion
time is likely.
Adverse Effects:
Hematologic:
thrombocytopenia
Musculoskeletal: tendon
rupture
Skin: Stevens-Johnson
syndrome
Black Box Warning:
-Drug associated with increased
risk of tendinitis and tendon
rupture, especially in patients
older than age 60. (Mr. MP is
76)
-Instruct patient to notify
prescriber if he experiences pain
or inflammation.
Drug-Food interaction:
Caffeine
-Warn patient that caffeine’s
effects will increase when taken
with this drug.
-Monitor patient closely,
especially heart rate.
Administration:
-Before administering first dose,
obtain specimen for culture and
sensitivity tests.
-Administer drug with fluids to
reduce risk of urine crystals.

3. 3
Generic name:
fluticasone
propionate-
salmeterol
inhalation
powder
Trade name:
Advair diskus
Reasonfor use:
To reduce
exacerbations of
COPD in
patients with a
history of
exacerbations
Common class:
Corticosteroid
(long-acting
beta2-adrenergic
agonist)
Dosage:
250/50 – 2 puffs,
Bid
Normal Range:
1 inhalation of
250/50 only,
b.i.d., about 12
hours apart.
Yes, within
normal range,
however should
specify
instruction of 1
inhalation about
12 hours apart.
Adverse Effects:
Respiratory: lower
respiratory tract
infection, pneumonia
Cardiovascular:
palpitations
Other: viral or bacterial
infections
Nursing consideration:.
-If Mr. MP has taken this drug
longer than 6 months, he should
be evaluated to assess the
therapy’s risks or benefits.
Administration:
-Remind patient to do 1
inhalation of the Advair Diskus
250/50 b.i.d, and about 12 hours
apart.
Patient Teaching:
Instruct patient to report any
symptoms of palpitations, chest
pain, rapid heart rate, tremor or
nervousness
Albuterol
inhaler
Generic name:
albuterol sulfate
Trade name:
AccuNeb,
Proventil-HFA
Reasonfor use:
To prevent or
treat
bronchospasm in
patients with
reversible
obstructive
airway disease.
Common class:
Bronchodilator
Dosage:
2 puffs q2hrs prn
for wheezing
(call if needed >
twice in 8 hrs)
Normal Range:
1-2 inhalations
every 4 to 6
hours prn
Not within
normal range.
Mr. MP’s dosage
Adverse Effects:
CV: tachycardia,
hypertension
Metabolic: hypokalemia
Respiratory:
bronchospasm
Administration:
-Shake inhaler before using.
-Wait at least 2 minutes between
inhalations.
Patient Teaching:
-Teach patient and have patient
demonstrate back the correct use
of albuterol inhaler.
-Warn patient about risk for
paradoxical bronchospasm and
to stop drug immediately if it

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interval is
shorter compared
to the
recommended.
The rationale
might be due to
the severity or
duration of
having COPD.
In addition,
adjust-a-dose is
stated for elderly
patients to have
2 m.g. P.O. t.i.d
or q.i.d. as oral
tablets or syrup.
occurs.
Generic name:
omeprazole
Trade name:
Prilosec
Reasonfor use:
Symptomatic
gastroesophageal
reflux disease
(GERD)
Common class:
Proton pump
inhibitor (PPI)
Dosage:
20 mg capsule,
P.O. daily
Normal Range:
20 mg capsule ,
P.O. daily
Yes, within
range
Adverse Effects:
CNS: asthenia, dizziness
Respiratory: upper
respiratory tract infection
Nursing considerations:
-Chronic use of this drug may
cause low magnesium levels.
-Monitor patient for signs
and symptoms of
hypomagnesemia (i.e,
abnormal heart rate or
rhythm, muscle spasms)
-Teach patient how to
recognize these
manifestations and report
them to his health care
provider.

5. 5
Administration:
-Don’t crush tablets or capsules.
-Give drug at least 1 hour before
meals.
Generic name:
amlodipine and
valsartan
Trade name:
Exforge
Reasonfor use:
Hypertension
Common class:
Amlodipine –
Calcium channel
blockers
Valsartan –
Angiotensin II
receptor
antagonist
Dosage:
Amlodipine 10
mg/ valsartan
160 mg
1 tablet P.O.
every a.m.
Normal Range:
Amlodipine 5-10
mg / valsartan
160 – 320 mg
P.O. once daily
Yes, within
normal range
Adverse Effects:
Amlodipine
CNS: dizziness
CV: palpitations
Valsartan
Respiratory: upper
respiratory tract infection
Amlodipine
Nursing Considerations:
Alert: Monitor patient carefully.
Some patients have developed
increased frequency, duration or
severity of angina.
Patient teaching:
-Inform patient that S.L.
nitroglycerin can be taken as
needed when angina symptoms
are acute.
Valsartan
Nursing Considerations:
-Correct sodium and volume
depletions before starting drug.
-Monitor BUN and creatinine
levels due to their chance of
increasing with this drug.

6. 6
Generic name:
theophylline
Trade name:
Theo-24
Reasonfor use:
Chronic
bronchospasm
using extended-
release
preparations
Common class:
Bronchodilator
(Xanthine
derivatives)
Dosage:
300 mg P.O.
capsule, daily
Normal Range:
Maximum 400
mg P.O. daily in
divided doses
every 8 to 12
hours
Yes, within
normal range
Adverse Effects:
CV: sinus tachycardia,
arrhythmias
Respiratory: respiratory
arrest
Administration:
-Give drug around-the-clock,
using extended-release product
at bedtime.
Nursing Considerations:
-Dosages may need to be
increased in cigarette smokers
because drug is metabolized
faster.
-If Mr. MP decides to quit, tell
him to inform his prescriber.
Dosage reduction may be needed
to prevent toxicity.
Caution:
-Use cautiously in elderly
patients and those with COPD,
cardiac failure, hypertension
angina and impaired circulatory
function.
Generic name:
dabigatran
etexilate
mesylate
Trade name:
Pradaxa
Reasonfor use:
To reduce the
risk of stroke and
systemic
embolism in
patients with
non-valvular
atrial fibrillation.
Common class:
Anticoagulant
Dosage:
150 mg P.O.,
twice daily
Normal Range:
150 mg P.O.,
twice daily
Yes, within
normal range
Adverse Effects:
GI: hemorrhagic erosive
gastritis, gastric and GI
bleeding
Hematologic: life-
threatening bleeding
Patient Teaching:
-Instruct patient to report
bleeding when brushing teeth or
shaving; blood in vomit, urine or
stool; nosebleeds.
-Inform patient that regular
blood tests will be required to
monitor drug’s effects.
-Inform patient to tell all of his
health care providers he is taking

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this drug.
Generic name:
acetaminophen
Trade name:
Aspirin, Tylenol
Reasonfor use:
Mild pain
Common class:
Analgesic
Dosage:
325 mg, 1 to 2
tablets every 4
hours prn for
pain or fever
Normal Range:
325 to 650 mg
P.O., every 4-6
hours.
Yes, within
normal range
Adverse Effects:
CV: hypertension
Respiratory: abnormal
breath sounds
Patient Teaching:
-Inform patient that drinking
alcohol while taking
acetaminophen increases risk of
liver damage.
Alert:
-Many OTC and prescription
products have acetaminophen.
When determining the total daily
dose of acetaminophen, be alert
of this.
-Maximum daily dose is 4 g
daily.

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PART 2: CLIENT PROBLEMS, ASSESSMENTS, and COLLABORATION (14 points)
List 3 important problems/issues/concerns caused by Mr. MP’s medications and 1 intervention for each problem/issue/concern. Note: Identify 3
problems and 3 interventions total – not for each medication. Include the medication(s) that each problem is related to. List the 3 problems that
you (the RN) are most concerned about. No more than 1 intervention can involve teaching the client. (6 points)
1. Risk for bleeding related to medication’s adverse effects of bleeding complications
Nursing Intervention:
 For injections or venous punctures, the needle with the smallest gauge possible should be used to prevent bleeding.
o In addition, after needle is removed, apply gentle and prolonged pressure to the area that was punctured.
 Patient teaching:
o Inform patient to use caution in activities that may cause bleeding.
 Brushing teeth: patient should use soft bristles.
 Sneezing: avoid blowing nose forcefully
 Bowel movements: avoid straining
 Shaving: avoid using a straight-edge razor
RelatedMedications:
Dabigatran etexilate mesylate (Pradaxa):
Adverse effects: Hemorrhagic erosive gastritis, gastric and GI bleeding, and life-threatening bleeding.
Ciprofloxacin (Cipro)
Adverse effect: Thrombocytopenia

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2. Risk for infection related to medication’s adverse effects of upper and lower respiratory infections, and leukopenia.
Nursing Interventions:
o Encourage patient to cough and deep breathe.
o Wash hands before contact with patient and between procedures with patient.
 In addition, inform patient and visitors to wash hands as well.
RelatedMedications:
Fluticasone propionate salmeterol (Advair diskus)
Adverse effects: Lower respiratory tract infection and pneumonia
Omeprazole (Prilosec)
Adverse effect: Upper respiratory tract infection
Ceftriaxone (Rocephin)
Adverse effect: Leukopenia
Valsartan
Adverse effect: Upper respiratory tract infection

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3. Risk for falls related to medication’s adverse effects of tendon rupture, dizziness and asthenia.
Nursing Interventions:
Implement measures and educate patient to prevent falls.
 Keep patient’s bed in lowest position.
 Instruct patient to rise from positions (i.e, sitting or supine) slowly.
 Instruct patient to wear non-slip socks or shoes when ambulating.
RelatedMedications:
Ciprofloxacin (Cipro)
Adverse effect: Tendon rupture
Omeprazole (Prilosec)
Adverse effect: Asthenia and dizziness
Amlodipine (Exforge)
Adverse effect: Dizziness
Valsarta
Adverse effect: Dizziness, fatigue, orthostatic hypotension, syncope.

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List 3 important assessments you will perform to identify potential side effects/adverse effects from Mr. MP’s medications. Include the
medication(s) that is related to each assessment. (3 points)
1. Respiratory assessment.
-Assess breathing pattern (i.e., regular or irregular), breathing rate, and use of accessory muscles.
-Auscultate lung sounds.
-In addition, compare the new assessment findings to findings from patient’s history.
RelatedMedications:
Fluticasone propionate salmeterol (Advair diskus)
Adverse effects: Lower respiratory tract infection and pneumonia
Omeprazole (Prilosec)
Adverse effect: Upper respiratory tract infection
Acetaminophen
Adverse effect: Abnormal breath sounds.
Theophylline
Adverse effect: Respiratory arrest.
2. Cardiovascular assessment.
-Monitor patient’s blood pressure and heart rate.
-Palpate Mr. MP’s peripheral pulse sites (i.e., carotid, radial, apical, pedal pulses)
-Assess skin color and temperature.
RelatedMedications:
Acetaminophen

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Adverse effect: Hypertension
Dabigatran (Pradaxa)
Adverse effect: Gastric, GI bleeding, hemorrhagic erosive gastritis
Theophylline
Adverse effect: sinus tachycardia, arrhythmias
3. Musculoskeletal assessment.
-Assess patient’s gait and balance.
-Ask Mr. MP if he is experiencing any feelings of weakness when ambulating.
RelatedMedications:
Ciprofloxacin (Cipro)
Adverse effect: Tendon rupture
Omeprazole (Prilosec)
Adverse effect: Asthenia and dizziness
Amlodipine (Exforge)
Adverse effect: Dizziness
Valsartan
Adverse effect: Orthostatic hypotension, dizziness, syncope, arthralgia

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 Identify at least 5 of the healthcare providers that you will collaborate with in administering medications to Mr. MP. Describe in a
minimum of 150 words what that collaboration will involve. (5 points – in order to maximize points earned, be sure to describe rather
than to simply list the disciplines involved and be sure to focus on collaboration related to medications) Note: Only 1 of the 5
healthcare providers can be a physician, NP, or PA.
Physician –
It is important to have good collaboration with the physician regarding Mr. MP’s medications and whether he’s improving or not improving
(i.e., blood pressure, respiratory function).
In addition, if any new pertinent information arises. For example, if Mr. MP suddenly states he thinks he may have an allergic reaction to
penicillin. I would hold his order of Rocephin due to its contraindication for penicillin allergies. Then, I would notify his physician about
this newly found information, and he/she would determine what changes should be done regarding his Rocephin.
Respiratory therapist -
A collaboration with the respiratory therapist is crucial for Mr. MP’s care. If I found during my physical assessment of Mr. MP that his
respiratory function has been worsening (i.e, abnormal breath sounds or shortness of breath), I would report this to his respiratory therapist.
The deterioration of his respiratory function may be due to medications or the need for a higher dosage. Nevertheless, this is all vital
information to provide to his respiratory therapist because he/she can do further re-evaluation and make adjustments to Mr. MP’s drug
therapy and treatment.
Pharmacist –
If a situation arises where I am unsure of Mr. MP’s medications and their orders, I would contact the pharmacist. For instance, I was unsure
of his prescription of the albuterol inhaler. When I looked into the drug book, Mr. MP’s dosage interval was shorter than the recommended.
In addition, there was an adjust-a-dose statement for elderly patients to use the form of tablets or syrup. Therefore, I would contact the
pharmacist of this concern.

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Physical therapist –
The collaboration between the nurse and the physical therapist regarding medications can involve Mr. MP’s walking ability. I think this is an
issue to address because it was reported that Mr. MP fell twice the last month due to ‘loss of balance’. If it appears to the nurse that the
medications are putting him at risk for falling (i.e., experiencing dizziness, weakness), then, the nurse should communicate this with the
physical therapist. That way the physical therapist can be aware of it and overcome it when working with the patient and planning their
therapy.
Occupational therapist –
The collaboration with the occupational therapist may involve how Mr. MP can manage any adverse effects he’s experiencing from his
medications and still perform the activities of daily living. For instance, it was reported in his history that he fell twice in the past month. In
addition, some of his medications put him at risk for falling again in the future. The nurse can address this issue with the occupational
therapist, so he/she can plan therapy for Mr. MP to prevent this from happening again. In addition, the fact that Mr. MP does not reportedly
use a device to help him walk. The nurse can communicate this with the occupational therapist who may make suggestions to Mr. MP of the
appropriate devices he can use.

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PART 3: ADDITIONAL QUESTIONS (10 points)
Part 3: Additional Questions (10 points)
1. Mr. MP’s ceftriaxone (1 gram) is diluted in 50 mL of fluid. If it is to be infused over 30 minutes, what rate (in mL/hr) will be set on
the pump?
50mL x 60 mins
_____________
Hour x 30 mins
Answer: 100 mL/hr
2. Mr. MP has a prn prescription for acetaminophen. How many tablets can he receive in one day without exceeding the maximum
daily dosage for this drug?
Prescription: 325 mg (1-2 tablets every 4 hours prn)
Maximum daily dosage: 4,000 mg/day
4,000 mg / 325 mg = 12.3
Answer: Up to 12 tablets (3,900 mg total) Mr. MP can receive in one day without exceeding maximum daily dosage (4,000 mg)

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3. Mr. MP arrived from the ED without an infusion pump on his IV fluids (D5 .45NS with 20 mEq/L KCL).
If the tubing pictured above is available, how many drops/minute will be required to maintain the infusion at the ordered rate?
Round your answer to the nearest whole number.
Gtt/min = (15 gtt/mL) (50mL/hr) (hr/60 mins) =
Gtt/min = 750/60
= 12.5
Answer =13 gtt/min required to maintain the ordered infusion rate.
4. Mr. MP has medications that are controlled-release or sustained release preparations. Briefly describe the nursing implications for
the administration of any controlled-release or sustained release medications.
The nursing implications for controlled or sustained-release preparations are to not crush these tablets. The reason to not crush these
medications is because their therapeutic effect will be lost if these are crushed. The purpose of these medications is to be dissolved over a
period of time and maintain a constant drug concentration level within the patient.

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5. Mr. MP reports an allergy to morphine. What action(s) would you take if Mr. MP had a prescription for an opioid during this
hospitalization?
According to Fraser Health, if an allergy of morphine exists, there are other opioids available that will lower the chance of an allergic reaction
re-occurring compared to the morphine. For instance, these other opioids can be semi-synthetic (i.e, oxycodone) or synthetic (i.e., fentanyl or
methadone). However, caution should still be taken when administering these.
The action I would take though is to look up this specific type of opioid in my drug book. I would check to see if there are any
contraindications if patient is allergic to morphine.
If I am still hesitant though, I would contact the physician and let him know my concerns of administering this drug.
6. Review Mr. MP’s theophylline level. What is the most likely cause of this level? What action(s) might be indicated?
Mr. MP’s theophylline level and normal range:
o Mr. MP’s theophylline level is 0.7, which is considered low. The normal range of theophylline is 10-20 mcg/mL.
Causes:
o The causes for low theophylline level are obesity, a diet high in carbohydrate and protein, cigarette smoking, and increased age.
Most likely cause:
o The most likely cause for Mr. MP’s low theophylline level is his chronic habit of smoking. Smoking quickens the excretion of
theophylline.
o Mr. MP did report that he has smoked 1 ½ packs of cigarettes/day x 60 years and has never successfully quit.
Indicated actions:
o Educate Mr. MP the factors that contribute to low theophylline level (i.e, obesity, diet high in carbohydrate and protein). Especially
inform Mr. MP that smoking is a risk factor.
 Inform Mr. MP what foods are low in carbohydrate and protein.
o Due to Mr. MP’s history of smoking, it should be strongly recommended for him to make plans of quitting.

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 Inform him of helpful ways to quit and suggest local support groups available.
o Ensure he is taking his theophylline medications as prescribed, and understands his dosage, why he is taking it, and the adverse
effects.
7. Mr. MP is a long-time smoker. What intervention(s) would be appropriate for him during this hospitalization?
Appropriate interventions would be to use therapeutic communication and educate him about the risks he’s taking by not quitting, and provide
referrals for extra support.
Therapeutic Communication
o It’s important to use therapeutic communication in order to understand what has prevented him from successfully quitting in the past.
Then once these barriers are identified, collaborate solutions and make a plan to overcome these barriers.
o In addition, it is also important to provide support and encouragement for him to make plans of quitting.
 Questions should be asked to assess whether Mr. MP does have social support (i.e., friends and family) to help him quit.
Patient Teaching
o Not only informing him the risks of continuing to smoke, but also inform him the benefits (i.e, short-term and long-term) if he does.
o Provide him an informational handout on discharge to remind him the reasons to quit and how he can quit.
o Bring up the option of nicotine replacement therapy (i.e, nicotine gum, nicotine patch).
Referrals
o Provide Mr. MP with local support groups or programs specific to help those quit smoking.

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8. Nipride (50 mg in 250 mL of D5W) is prescribed at 3 mcg/kg/min for a client who weighs 82 kg. What is the infusion rate (in mL/hr)?
Round to the nearest whole number.
mL/hr = (250 mL) / (3 mcg / kg x min) (82 kg) (60 min/hr) (0.001 mg/mcg) (1/50mg)
= 73.8
Answer= 74 mL/hr
9. Epinephrine (10 mg/500 mL) is prescribed at 0.3 mcg/kg/min for a client who weighs 15.5 kg. What is the infusion rate (in mL/hr)?
Round to the nearest whole number.
mL/hr = (500mL/10mg) (0.3 mcg / kg x min) (15.5 kg) (60 min/hr) (0.001 mg/ mcg)
mL/hr = 13.95
Answer= 14 mL/hr
10. Norepinephrine (1 mg/250 mL) is prescribed at 3 mcg/min for a client who weighs 209 pounds. What is the infusion rate (in mL/hr)?
Round to the nearest whole number.
mL/hr = (250 mL/mg) (3 mcg/min) (60 min/hr) (0.001 mg/mcg)
Answer = 45 mL/hr

20. 20
PART 4: REFLECTION (5 points)
In 1 to 2 paragraphs (a minimum of 150 words), reflect on what you learned from this case study, as well as what you need to continue to work on.
In this second case study I feel like I learned how to do each section more efficiently than last time. I feel like the first case study it took me a while
to find everything I needed to find. This time it was a lot easier to find information and I had more confidence that it would be accurate. In the last
case study I had some points taken off for not answering what the question was asking directly. For example, in the part that asks about the
collaboration with other healthcare providers, I didn’t focus it on the patient’s medications. For this case study I made sure to not make the same
mistake and focused it on the patient’s medications.
Overall, I think I made an improvement compared to the first case study. I felt a little overwhelmed with the first case study, but I had more
confidence and used my time more wisely for this one. For the future I think I will need to continue to work on managing my time with the case
study. I did the majority of the case study after spring break, and it would have been better if I did it during spring break.

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LIST OF ALL REFERENCES USED
Cengage Learning. (2010). Nursing considerations for nursing process: Implementation of the administration of medications by different routes.
Retrieved from http://www.cengagesites.com/academic/assets/sites/5407/pdf/drug-admin/section5.pdf
Elsevier. (2012). Nursing diagnosis. Retrieved from http://www1.us.elsevierhealth.com
Fraser Health. (2006). Principles of opioid management. Retrieved from http://www.fraserhealth.ca/media/16FHSymptomGuidelinesOpioid.pdf
National Institutes of Health. (1993). Nurses: Help your patients stop smoking. Retrieved from
http://www.nhlbi.nih.gov/health/prof/lung/other/nurssmok.txt
University of Cincinnati. (2000). Prescription medication in the elderly. Retrieved from http://www.netwellness.org/healthtopics/aging/faq16.cfm
Vanderbilt University Medical Center (2014). Serum theophylline level. Retrieved from
http://www.mc.vanderbilt.edu/diglib/consumerhealth/labs/49/150431.htm