Scholarly Writing – NUR600 Advanced Clinical Pharmacology Module 6 Assignment

Scholarly Writing

For this scholarly writing assignment, you will write a paper on the pharmacological management of the disease. The paper should include a review of the:

• Select a disease process that is of interest to you.
• Pathophysiology of the disease state.
• Review of the pharmacological agents used for treatment and important information related to advanced practice nurse.
• Each student will clearly write a title for this topic: For examples, “Pharmacological Effects of Anti-Hypertensive Medications in the Management of Hypertension”.

Submission Instructions:
The paper is to be clear and concise and students will lose points for improper grammar,
punctuation, and misspelling.
The paper should be formatted per the current APA and 5-7 pages in length, excluding the title, abstract and references page.
Incorporate a minimum of 5 current (published within the last five years) scholarly journal
articles within your work.
Complete and submit the assignment by 11:59 PM ET Sunday.
Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.

SAMPLE ANSWER

Medications for Treatment of Type Two Diabetes

Medications for Treatment of Type Two Diabetes

The Selected Disease Process

I have chosen type two diabetes as the disease to discuss in this assignment. It is a medical condition that arises from dysregulation of sugar metabolism within the body (Galicia-Garcia et al., 2020). Type 2 diabetes is characterized by two primary issues. The amount of insulin produced by the pancreas is insufficient to regulate the amount of sugar that enters cells. Furthermore, cells respond poorly to insulin and thus, absorb less sugar. The presence of the disease is demonstrated by many symptoms. Symptoms include exhaustion, increased appetite, thirst, hazy vision, recurrent infections, frequent urination, tingling or numbness in the hands and feet, slow-healing wounds, unintentional weight loss, and darker patches of skin, mainly around the neck and armpits (Galicia-Garcia et al., 2020).

In addition to these symptoms, diabetes poses serious health risks. One of the health problems is cardiovascular conditions. People with diabetes are at risk of suffering heart problems such as heart attack, stroke, angina, atherosclerosis (Wang et al., 2021). The disease can also lead to nerve damage. Diabetes prevents the body from properly regulating blood sugar and this can lead to too much sugar in the bloodstream (Wang et al., 2021). This phenomenon can lead to nerve damage and thus cause tingling or numbness in the feet. The disease can leave an individual completely paralyzed in the limbs if left untreated and poorly managed. It also has devastating effects on one’s healing process.

People with diabetes tend to have wounds that heal slowly. Diabetes can also lead to blurred vision and eventual permanent eye damage if not managed. Diabetes can also lead to an unstable mental state. Wang et al. (2021) noted that the disease is a risk factor for Alzheimer’s disease. Individuals with diabetes also risk developing severe COVID-19 symptoms. They are also more likely to die from the disease compared to people without diabetes. Other complications caused by the disease include hearing problems, skin problems, and respiratory problems (Wang et al., 2021). 

Pathophysiology of the Disease

There are some important missing links concerning type 2 diabetes biology that need further investigation. To understand the pathophysiology of type two diabetes, it is crucial to know the normal pathology associated with diabetes. A gland called Pancreas located behind the stomach and liver produces digestive enzymes and hormones like glucagon and insulin into blood circulation for glucose regulation purposes in healthy individuals (Valaiyapathi et al., 2020). Consequently, blood glucose levels become reduced since glucose allows this substance inside bodily cells for digestion (simple sugars taken from diet). Glucagon released by the pancreas stimulates the liver to let out glucose when blood sugar levels decrease too much (Banday et al., 2020). Following a meal, there is a rapid rise in blood glucose levels due absorption of amino acids and glucose directly into the bloodstream.

The beta cells release insulin into the bloodstream once blood sugar rises beyond a certain level. After about twenty minutes of eating, insulin reaches its peak value. It improves the absorption of glucose by body tissues such as liver muscles specifically (Banday et al., 2020). In this case, however, insulin plus other hormones determine whether to store or use energy from sugars. Under higher concentrations of insulin, synthesis stops while the presence of high blood glucose concentration causes the liver not to make any more until needed again at a later time point in the future (Banday et al., 2020).

However, with type two diabetes mellitus either enough production of this hormone does not happen or its signal is ignored by cells (Galicia-Garcia et al., 2020). Insulin resistance, the most common cause of type 2 diabetes generally starts there. As the body needs more insulin, the pancreas gradually loses its ability to produce it. Instead of going into cells, glucose remains in blood which can have devastating effects on an individual’s health such as kidney damage, nerve disorders, and heart diseases. The inability to regulate physiological glucose levels results from the reduced synthesis of insulin during β-cell malfunctioning (Valaiyapathi et al., 2020).

Conversely, the liver releases more glucose while less is absorbed by hepatic muscle and adipose tissue due to insulin resistance (Galicia-Garcia et al., 2020). However, β-cell dysfunction tends to be more severe than IR despite occurring early in pathophysiology and driving disease progression. However, both IR and β-cell failure lead to the exacerbation of hyperglycemia and the advancement of T2DM (Valaiyapathi et al., 2020). Kidney failure is not caused by trauma, non-traumatic lower-limb amputations; and adult blindness new cases are all symptoms of diabetes among adults in the USA.

Review of the Pharmacological Agents Used for Treatment Type Two Diabetes

Many medications can help to manage type 2 diabetes. Among the medications is metformin. It is the first-line drug used to treat type 2 diabetes. “It primarily functions by decreasing the liver’s synthesis of glucose and enhancing the body’s sensitivity to insulin, so facilitating better insulin use” (Lee et al., 2021, pg. 2775). Physiologically, Metformin cuts glucose synthesis in the liver whether directly or indirectly. Also, it increases the utilization of glucose, raises GLP-1, and modifies the microbiome within the gut (Lee et al., 2021). In some subgroups like younger age, more obese, or have a history of gestational diabetes metformin can be safe and beneficial in preventing or delaying type 2 diabetes among such high-risk individuals (Lee et al., 2021). Its effects are similar to lifestyle interventions (Lee et al., 2021). Some common symptoms of this medication include vomiting, nausea, loss of appetite, abdominal age, diarrhea, and a metallic taste in the mouth. 

The second medication is Glipizide; Glipizide belongs to the sulfonylurea class of drugs. The FDA has approved generic Glipizide for the treatment of type II diabetes in adults (Madsen et al., 2019). This causes the pancreas to release more insulin which instructs your body to store blood sugar. A partial obstruction of the potassium channels in the pancreatic islets’ beta cells is one of glipizide’s molecular processes (Madsen et al., 2019). The depolarization that follows this potassium channel blocking allows the voltage-gated calcium channels to open, which triggers the pancreatic beta cells to secrete insulin. This aids in lowering blood sugar and re-establishing how your body uses food as fuel. It is used in addition to exercise and diet.

For individuals who, despite diet, exercise, and medication compliance, do not have appropriate metabolic control in three months, it can be used in conjunction with the biguanide metformin to achieve the goal of HbA1c (Madsen et al., 2019). When metformin is contraindicated or there is intolerance, it may be used as monotherapy in a particular setting. Glipizide and other sulfonylureas are frequently prescribed by doctors due to their reduced cost, accessibility, and effectiveness in managing type 2 diabetes (Madsen et al., 209). By weight, second-generation sulfonylureas are thought to be more powerful than first-generation medicines. 

The third medication is Repaglinide. One medication used to treat type 2 diabetes is repaglinide. It and nateglinide are members of the meglitinide class of antihyperglycemic drugs. Meglitinides lower blood glucose levels by promoting the body’s natural synthesis of insulin (Li et al., 2021). Hemoglobin A1c levels are used to determine the current suggested beginning dose; those with a level of less than 8% (64 mmol/mol) are advised to begin with 0.5 mg pre-prandially, while those with a level above 8% should begin with 1 to 2 mg (Li et al., 2021). Repaglinide can be taken either alone (as an addition to exercise and diet management) or in conjunction with other antihyperglycemic medications. Sulfonylurea use is an exception, as it is contraindicated for dual meglitinide therapy.

Repaglinide appears to be a good therapeutic option for those with end-stage renal disease and chronic kidney disease, according to research. Since repaglinide is FDA class C during pregnancy, caution must be used when using it. It is advised to choose an alternative since there is no evidence to support its safe usage while breastfeeding (Li et al., 2021). Since repaglinide’s safety in children under the age of 18 has not been demonstrated, it is not advised. When missing meals, repaglinide should be avoided and taken just before meals.

Role of Advanced Practice Nurse

Advance Practice Nurses (APNs)s should ensure that they comprehensively asses a patient with type two diabetes before prescribing any medication. A comprehensive assessment will ensure that the needs of the patient are identified and proper diagnosis is made. Also, APNs should ensure that the medications they prescribe respond to the patient’s individual needs and response to other treatment modalities. How the patient responded to previous medications should also be considered when prescribing the drugs. The patient should be monitored closely to ensure that the treatment outcomes are achieved. Another significant factor here is education. APNs should also educate patients about what their prescribed drugs are called and how many milligrams they will need at one time along with encouraging them to follow all prescription instructions relating to these medicines so as for them to work effectively.

Conclusion

Diabetes stands as a severe metabolic chronic condition resulting from the inability of the organism to control sugar levels. Often, this disease happens when the human body cannot produce enough insulin properly any longer or use it correctly if available at all. There are multiple types of drugs used for the treatment of this disease. One of them is metformin. It is the first-line drug used to treat type 2 diabetes. It causes the pancreas to release more insulin, which instructs your body to store blood sugar. The third medication is Repaglinide. It lowers blood glucose levels by promoting the body’s natural synthesis of insulin. APNs must ensure that any drugs prescribed to treat this disease are effective enough as far as possible treatment is concerned.

References

Banday, M. Z., Sameer, A. S., & Nissar, S. (2020). Pathophysiology of diabetes: An overview. Avicenna Journal Of Medicine, 10(04), 174-188. https://www.thieme-connect.com/products/ejournals/html/10.4103/ajm.ajm_53_20#htmlfulltext

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International Journal Of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275

Lee, C. G., Heckman-Stoddard, B., Dabelea, D., Gadde, K. M., Ehrmann, D., Ford, L., & Temprosa, M. (2021). Effect of metformin and lifestyle interventions on mortality in the diabetes prevention program and diabetes prevention program outcomes study. Diabetes Care, 44(12), 2775-2782. https://doi.org/10.2337/dc21-1046

Li, J., Zhao, M., Liu, M., Tang, K., & Sun, G. (2021). Clinical effects of insulin glargine combined with repaglinide in the treatment of type 2 diabetes. American Journal Of Translational Research, 13(11), 13010–13016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8661186/

Madsen, K. S., Kähler, P., Kähler, L. K. A., Madsbad, S., Gnesin, F., Metzendorf, M. I., & Hemmingsen, B. (2019). Metformin and second‐or third‐generation sulphonylurea combination therapy for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002%2F14651858.CD012368.pub2

Valaiyapathi, B., Gower, B., & Ashraf, A. P. (2020). Pathophysiology of type 2 diabetes in children and adolescents. Current Diabetes Reviews, 16(3), 220–229. https://doi.org/10.2174/1573399814666180608074510

Wang, L., Li, X., Wang, Z., Bancks, M. P., Carnethon, M. R., Greenland, P., Feng, Y. Q., Wang, H., & Zhong, V. W. (2021). Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018. JAMA, 326(8), 1–13. Advance online publication. https://doi.org/10.1001/jama.2021.9883