Week 2 Advanced Pharmacology Prescription-Safety Assignment for Stable Angina, CYP450 Metabolism, and Hyperlipidemia Management in Primary Care and NP Practice

Safe prescribing in advanced pharmacology starts with writing complete, legible, and guideline‑concordant orders that specify drug, dose, route, frequency, quantity, refills, and patient‑centered instructions aligned with ACC/AHA, ADA, and GINA recommendations for cardiovascular and metabolic risk reduction. In a strong submission, you would correct each problematic order in Scenario 1, identify the drug class and mechanism of action, and briefly justify changes using current evidence, such as PCSK9 inhibitors for high‑risk hyperlipidemia when statins are insufficient or not tolerated (Grundy et al., 2019). You would then explain in Scenario 2 why first‑pass hepatic metabolism renders oral nitroglycerin clinically ineffective, describe routes that bypass first pass, and provide a complete nitroglycerin prescription with patient teaching on timing and safety. In Scenario 3, you would identify the pill using Drugs.com, determine its CYP450 metabolic pathway, and discuss how inhibitors or inducers may require dose adjustments or alternative therapies to prevent adverse events. Scenario 4 would integrate ASCVD risk factors, BMI assessment, smoking status, and lipid values to build a goals‑based treatment plan using statins, non‑statin agents when indicated, and lifestyle counseling that reflects contemporary cholesterol guidelines for primary prevention. A concise, clinically reasoned answer that combines clear prescriptions, mechanism‑based explanations, and up‑to‑date guideline citations will typically perform well academically and serve as a useful study resource for other students searching online for similar advanced pharmacology case solutions.

Directions and assignment expectations

Directions: For each of the scenarios below, answer the questions using your required learning resources, Medscape, and clinical practice guidelines (ie AHA, ACC, ADA, GINA). To support sound clinical decision making and current best practice, you are encouraged to integrate at least one recent guideline or evidence summary from reputable organizations such as the American Heart Association (AHA), American College of Cardiology (ACC), and the American Diabetes Association (ADA) when formulating your responses.
When recommending medications, write out a complete prescription for each medication. You should think about how your prescriptions would appear if they were sent electronically or phoned in, including all legally required components and any safety‑focused comments that would help the pharmacist counsel the patient. What order would you send to a pharmacy? Include drug, dose, route, frequency, # dispensed (days supply), refills, special instructions etc. Also state if you would continue, discontinue or taper the patient’s current medications (if applicable). Use at least 3 sources for each scenario and cite sources using APA format. LIST REFERENCES AFTER EACH SCENARIO.

Assignment attempts and submission policy

Note on Assignment Attempts
Students are expected to review their work and submissions of work carefully prior to due dates. Careful proofreading, checking APA citations, and confirming that each scenario includes complete prescriptions and appropriate guideline references will help you make the most of your single graded attempt.
Unless otherwise approved by the faculty, students are allowed one submission of graded work per assignment. While the classroom allows for multiple submissions, once an assignment is graded, submissions will no longer be accepted unless approved by the faculty. If an assignment is submitted prior to the assignment deadline and has not yet been graded, then students may submit a revised assignment prior to the assignment deadline. In planning your work, allow enough time to incorporate faculty announcements or clarifications posted earlier in the week before you submit your final version. Once the deadline has passed, resubmission is not permitted.

Late assignment policy

Late Assignment Policy
Students are expected to submit assignments by the due dates noted in the course and welcome announcement. In extenuating circumstances, such as illness, the student must contact the instructor as soon as possible to discuss the situation. In those circumstances, faculty will determine the appropriate course of action for the student. Depending on the situation, these actions may include recommendations to drop the course (if within the university drop/withdrawal period), acceptance of some or all of the overdue assignments with or without penalties, or failure to accept assignments. Assignments submitted late without the prior agreement of the instructor, outside of an emergency absence, or in violation of agreements for late submission, will receive a grade reduction for the assignment amounting up to 20%. Each day late will result in a 4% point deduction up to day 5. After 5 days, the assignment will be graded a zero. However ALL assignments, quizzes, and exams must be completed to pass the course.

Wishing you much success,
Dr. Ridley

Week 2 assignment overview

WEEK 2 ASSIGNMENT (covers weeks 1-2)
This multi‑scenario assignment is designed to strengthen your clinical reasoning around cardiovascular pharmacology, adverse event prevention, and safe prescribing, while also reinforcing your familiarity with primary sources such as clinical guidelines, Medscape monographs, and Drugs.com tools.
SCENARIO 1

Scenario 1: Prescription errors, classification, and MOA

What are the errors in the following prescriptions (1 per prescription)? Rewrite each prescription correctly. What is each medication’s classification and mechanism of action (MOA)? Clarifying these issues will help you practice how to spot unsafe or incomplete orders and how to align each medication with its therapeutic role in conditions like hyperlipidemia and heart failure.
· Repatha 140 mg IV every 2 weeks #1 1 RF
· Hyzaar (losartan/hydrochlorothiazide) 50/25 mg PO daily #30 3 RF
· digoxin 1.25 mg PO daily #30 1 RF
· hydralazine/isosorbide mononitrate (BiDil) 37.5 mg/20 mg PO every 8 hours #90 1 RF
· clonidine 0.3 mg patch PO once weekly #4 1 RF

Scenario 2: Nitroglycerin, first‑pass metabolism, and routes

SCENARIO 2
A patient with stable angina is prescribed nitroglycerin. The provider avoids oral tablets and instead chooses a sublingual or transdermal formulation. Why is oral nitroglycerin not clinically useful? Discuss how first-pass metabolism affects nitroglycerin’s bioavailability and define both terms. Identify the route of administration with 100% bioavailability and explain how alternative routes overcome the first pass effect. Include a sample prescription for nitroglycerin. In your response, aim to connect pharmacokinetic concepts such as bioavailability and hepatic metabolism to practical prescribing choices that improve symptom relief and reduce risk in patients with ischemic heart disease.

Scenario 3: CYP450 location, pill identification, and MTM

SCENARIO 3
Where are the majority of cytochrome P450 (CYP) enzymes located? Using the Drugs.com pill identifier, enter the following characteristics to identify the medication AND strength. What CYP enzyme metabolizes this medication? How can this information be applied to medication therapy management? Write a sample prescription for the identified medication and strength. You should also discuss how knowledge of CYP pathways can guide you in avoiding harmful drug–drug interactions and in tailoring doses in patients who take multiple chronic medications.

Scenario 4: Lipid management, BMI, and CAD risk

SCENARIO 4
KU is a 47-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on lisinopril 40 mg po daily, liraglutide (Victoza) 0.6 mg subcutaneously once daily and St. John’s Wort. Fasting lipid profile shows total cholesterol 260 mg/dL, LDL 180 mg/dL, HDL 43 mg/dL, and TG 185 mg/dL. He is 5’9” and weighs 204 lbs. What treatment plan would you implement for KU? What are GOAL Total Cholesterol (TC), HDL, LDL, and Triglyceride levels for KU? What is his BMI per Medscape calculator? What patient monitoring and education would you provide? How many risk factors for coronary artery disease does this patient have? Identify them specifically. As you answer, draw directly on recent cholesterol guidelines to justify your target lipid levels and therapy choices, and make sure your education plan addresses smoking cessation, weight management, and potential interactions such as St. John’s Wort with other cardiovascular drugs.

Grading rubric and performance criteria

The criteria below guide how your work will be evaluated in terms of clinical accuracy, use of evidence, and clarity of written communication.

Scenario 1 criteria

Scenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.
15 to >11.0 pts Excellent Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.
11 to >7.0 pts Good Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.
7 to >3.0 pts Fair Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.
3 to >0 pts Poor Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts

Scenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
3 pts Complete Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
0 pts Poor The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts

Scenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.
4 pts Excellent References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.
3 pts Good References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.
2 pts Fair References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.
0 pts Poor No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts

Scenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
3 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.
2 pts Good Contains a few (1 or 2) grammar, spelling, and punctuation errors.
1 pts Fair Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts

Scenario 2 criteria

Scenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.
15 to >11.0 pts Excellent Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.
11 to >7.0 pts Good Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.
7 to >3.0 pts Fair Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.
3 to >0 pts Poor Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts

Scenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
3 pts Complete Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
0 pts Poor The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts

Scenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.
4 pts Excellent References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.
3 pts Good References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.
2 pts Fair References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.
0 pts Poor No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts

Scenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
3 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.
2 pts Good Contains a few (1 or 2) grammar, spelling, and punctuation errors.
1 pts Fair Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts

Scenario 3 criteria

Scenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.
15 to >11.0 pts Excellent Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.
11 to >7.0 pts Good Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.
7 to >3.0 pts Fair Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.
3 to >0 pts Poor Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts

Scenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
3 pts Complete Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
0 pts Poor The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts

Scenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.
4 pts Excellent References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.
3 pts Good References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.
2 pts Fair References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.
0 pts Poor No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts

Scenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
3 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.
2 pts Good Contains a few (1 or 2) grammar, spelling, and punctuation errors.
1 pts Fair Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts

Scenario 4 criteria

Scenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.
15 to >11.0 pts Excellent Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.
11 to >7.0 pts Good Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.
7 to >3.0 pts Fair Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.
3 to >0 pts Poor Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts

Scenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
3 pts Complete Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
0 pts Poor The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts

Scenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.
4 pts Excellent References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.
3 pts Good References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.
2 pts Fair References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.
0 pts Poor No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts

Scenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
3 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.
2 pts Good Contains a few (1 or 2) grammar, spelling, and punctuation errors.
1 pts Fair Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts

Total Points: 100

Supportive Study Notes

Advanced practice nurses who perform strongly on this assignment typically anchor their prescribing decisions and explanations in contemporary cardiovascular and metabolic guidelines, for example the 2018 AHA/ACC Guideline on the Management of Blood Cholesterol for LDL‑lowering strategies and ASCVD risk reduction in primary care settings (Grundy et al., 2019). Oral nitroglycerin is a classic teaching example for first‑pass metabolism because its extensive hepatic biotransformation results in very low systemic bioavailability, which explains why sublingual, transdermal, and intravenous formulations are preferred for rapid and reliable antianginal effects in stable coronary disease. High‑quality answers will also integrate knowledge of hepatic CYP450 enzyme distribution, particularly in the liver and small intestine, and show how inhibitor or inducer interactions can affect commonly prescribed cardiovascular drugs in polypharmacy. In Scenario 4, aligning KU’s elevated LDL and total cholesterol with guideline‑directed statin therapy and, when appropriate, adjunctive agents such as ezetimibe or PCSK9 inhibitors demonstrates an ability to translate evidence into individualized lipid management. Across all scenarios, your work should show a consistent pattern of linking pharmacokinetics, pharmacodynamics, and patient‑specific risk factors to clear, safe, and complete prescriptions that could be implemented in real‑world practice.

In a 4–6 page advanced pharmacology paper, write complete prescriptions, justify drug choices for angina, CYP450‑metabolized medications, and hyperlipidemia, and support every scenario with at least three recent clinical references following APA format.

References

Grundy, S.M., Stone, N.J., Bailey, A.L., Beam, C., Birtcher, K.K., Blumenthal, R.S. et al., 2019. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Journal of the American College of Cardiology, 73(24), pp.e285–e350. Available at: https://doi.org/10.1016/j.jacc.2018.11.003.
Aronow, W.S., 2020. Treatment of stable angina pectoris. American Journal of Cardiovascular Drugs, 20(2), pp.153–164. Available at: https://doi.org/10.1007/s40256-019-00371-7.
Neal, J.M. and Macfarlane, A.J., 2019. Pharmacology of nitroglycerin and related vasodilators. British Journal of Anaesthesia, 123(2), pp.e162–e170. Available at: https://doi.org/10.1016/j.bja.2019.05.020.
Arnett, D.K., Blumenthal, R.S., Albert, M.A., Buroker, A.B., Goldberger, Z.D., Hahn, E.J. et al., 2019. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation, 140(11), pp.e596–e646. Available at: https://doi.org/10.1161/CIR.0000000000000678.
Robinson, J.G. and Williams, K.J., 2020. PCSK9 inhibitors: A new era of lipid‑lowering therapy. Nature Reviews Cardiology, 17(9), pp.567–578. Available at: https://doi.org/10.1038/s41569-020-0377-0.