Supplemental Materials - Instructor Notes for Extra Credit Exercises
- Page ID
- 98947
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)Medication Adherence Case Study #1
AW is a 50-year-old with heart failure (HFrEF Stage C NYHA Class II) who is taking metoprolol, furosemide, and lisinopril. AW continues to work as a court reporter and cannot leave the proceedings once the court is in session. Create a medication plan for the frequency and timing of medications around AW’s work schedule while optimizing the pharmacotherapy. Please consider that during the incident hospitalization for heart failure, AW had an episode of hypotension. Also, AW has carpal tunnel syndrome and has a long commute to work (no available restroom). AW has been skipping the furosemide and taking metoprolol and lisinopril together on the way to work; sometimes arriving at the courthouse feeling lightheaded as AW goes through the metal detector.
Assigned Student Task #1.1:
1.1. Suggest a schedule for AW to take their medications that will allow AW to take all
medications daily, safely arrive at work, and minimize hypotensive episodes. Write a brief
description of the pharmacokinetics of the various drugs you considered when creating the
medication schedule.
Notes for Instructor:
-Encourage students to refer to the most recent guidelines for heart failure.
-Consider switching AW to a sodium-glucose co-transporter 2 inhibitor (SGLT2i), such as dapagliflozin or empagliflozin. These drugs have a mild diuretic effect and may allow AW to stop the furosemide (loop diuretic).
Assigned Student Task #1.2:.
1.2. Design a pillbox! AW requested a pillbox that would be small enough to fit in a pocket without any metal. You can
be creative with the features you would like to include that may help adherence.
Notes for Instructor:
-This assignment can be enhanced using a 3D printer. Students can compete for the best design. Search for free software to print a pillbox, such as https://cults3d.com/en/tags/pillbox?.
Medication Adherence Case Study #2
CZ is a 30-year-old with heart failure post-COVID infection (HFrEF Stage C NYHA Class II), is taking metoprolol, furosemide, and sacubitril/valsartan (Entresto). CZ has returned to work and bikes about three blocks to the office. Previously, on the weekends, CZ rode about 10 miles on a bike trail and wants to try resuming longer bike rides gradually. Create a medication plan for the frequency and timing of medications to optimize the pharmacotherapy and limit skipped or missed doses. CZ has been missing the furosemide and taking metoprolol and Entresto together at work.
Assigned Student Task #1.1:
1. Suggest a schedule for CZ to take their medications that will allow AW to take all medications
daily, safely bike to work, minimize hypotensive episodes, and resume biking. Write a brief
description of the pharmacokinetics of the various drugs CZ is taking, which will help you to
create the medication schedule.
Notes for Instructor:
You can easily change this assignment to a pediatric case with a child with a chronic problem, such as congenital heart disease.
Assigned Student Task #1.2:
2. Design a pillbox! CZ requested a pillbox that would be small enough to fit into biking clothes.
You can be creative with the features you would like to include that may help with adherence. Also, a
bioengineering student is available for consultation.
Notes for Instructor:
Pairing a nursing student with a bioengineering student may allow for greater creativity. Together, the students may be able to create and print a pillbox that a patient can use. Be aware of the type of resin that may be required.