Pharmacology

 

Choose ONE of the following scenarios to discuss in paragraph form with no fewer than six sentences.

Scenario 1

S.S., a 26-year-old woman, takes diazepam to control grand mal seizures. S.S. and her husband are contemplating starting a family.

List the antiepileptic and an anticonvulsant medication prototype this week and then briefly explain how they work. Describe a situation in which each could be prescribed. (USLO 4.2, 4.3, 4.4)
Explain the general teaching points of antiepileptic and anticonvulsants. (USLO 4.3, 4.4. 4.8)
What is status epilepticus? (USLO 4.1)
As S.S is contemplating pregnancy, what would you say to her? How do anticonvulsants impact pregnancy? (USLO 4.6, 4.8)
Scenario 2

An 82-year old woman who resides in a nursing facility is admitted to the hospital with pneumonia. She has a history of agitation and is ordered the antipsychotic haloperidol.

How do antipsychotics work? What neurotransmitter is greatly affected by antipsychotics? (USLO 4.1, 4.3)
When you assist the patient up you notice muscle rigidity and shuffling gait. What is the patient experiencing? Explain the characteristics of this syndrome. How is it treated? (USLO 4.6, 4.8)
What are the major side effects and adverse effects seen with haloperidol? (USLO 4.5, 4.6)
What is included in education for a patient taking antipsychotics? (USLO 4.8)
Scenario 3

You are assigned to care for a patient prescribed fluoxetine. The patient’s son arrives and tells you that his mother already has a prescription for fluoxetine, but stopped taking the medication after 1 week because she did not feel any better.

What drug classification is fluoxetine? How does this classification work? (USLO 4.2, 4.3)
What side effects and adverse reactions will you monitor for? (USLO 4.5, 4,8)
What teaching needs to be included when giving this medication? (USLO 4.8)
How will you address the son’s concern over his mother’s compliance with the antidepressant? (USLO 4.3, 4.6, 4.8)
Briefly explain the mechanism of just one other serotonin-modulating drug prototype this week. (USLO 4.2, 4.3, 4.4)
Scenario 4

A 63-year-old woman returns with a 4-year history of advanced Parkinson’s disease. Currently, her medication is only effective for 4 hours, after which her tremors become more severe, handwriting “cramped”, and walking is worse. She denies involuntary movements with her medication (dyskinesias), falls, or “freezing” of gait. Her neuropsychiatric review demonstrates no history of depressed mood, anxiety, hallucinations, or significant cognitive impairment. She continues to work part-time, is driving, and has no sleep impairment or daytime somnolence from her medication. Presently she is taking levodopa-carbidopa 25/100 mg po tid.

Explain the mechanism of actions and adverse effects of levodopa-carbidopa. (USLO 4.3, 4.4)
Why is ‘carbidopa’ a critical part of levodopa-carbidopa? Include the term ‘peripheral’ in your answer and explain it. (USLO 4.1, 4.2, 4.4)
For a patient diagnosed with Parkinson’s disease, what other prototype medication from this week may be used? How is it different/similar to levodopa-carbidopa? (USLO 4.1, 4.2, 4.4)

Sample Solution

Status epilepticus is believed to take place when a seizure lasts too long or when seizures occur close together and the person doesn’t recover between seizures. Just like there are different types of seizures, there are also different types of status epilepticus.Over the last several decades, the length of seizure that is considered as status epilepticus has shortened. Years ago, a seizure needed to last longer than 20 minutes to be considered status epilepticus. In the last few years, it is now defined as any seizure greater than 5 minutes. This makes sense because most seizures do not last longer than 2 minutes. The longer a seizure lasts, the less likely it will stops on its own without medication.

hip of Lolita’s tragic story, and in using him as a character focaliser, Nabokov prevents the reader from perceiving any other account of the narrative, encouraging them to accept the monstrosity of Humbert’s recitation. The satirical tragic romance takes advantage of the prominence of themes of sexuality and psychology during the early 20th Century as a consequence of the influence of Freudianism on literature, as seen Joyce’s similarly scandalous Ulysses and Lawrence’s Lady Chatterley’s Lover. Nabokov’s ultimate unreliable narrator entices the reader through enhancing the façade of romance and mysticism surrounding his paedophilia, encouraging sympathy and a common identity among the readership, and deluding Humbert’s depiction of himself within his narrative. However, central to the plot is the repulsive sexual relationship between Humbert and teenager Lolita, and the reader is unable to avoid recognising the unreliability and contradiction within the narrative and cannot disguise the inevitable shame and sympathy felt towards Lolita’s pain and loss of childhood. Therefore, while it is indisputable that Nabokov encourages the reader to accept his monstrous narrator, this is only to emphasise the tragic ending and evoke a sense of self-hatred and humiliation.

It could be argued that the reader is encouraged to accept Nabokov’s monstrous male narrator through his use of elaborate language to enhance the veneer of romance and mysticism surrounding his paedophilia which prevents the reader from truly acknowledging the violent and manipulative nature of the relationship. The purity of his love is enhanced through his narrative, with the discussion of ‘nymphets’ at the beginning of the novel immediately romanticising his attraction to justify the relationship, which is furthered by Nabokov’s listing of adjectives, ‘the elusive, shifty, soul-shattering, insidious charm’, which have clear otherworldly and mystical connotations. Additionally, the adjective ‘shifty’ subtly implies the dishonest and deceitful nature of the narrator. The alliterative phrase ‘intangible island of entranced time’ highlights this magical and elusive nature of the monstrous male hero and positions the narrative in a place of ethereal and indefinable romanticism. The monstrous male protagonist also describes himself as the ‘Enchanted Hunter’ and ‘nympholept’ to attribute magical characteristics to himself which compliments the mysterious concept of the ‘nymphet’ and creates a justification for his actions, enabling the reader to accept Humbert as an otherworldly, unrelatable narrator. Surprisingly, the unreliable narrator himself admits to the ability to distract the reader with his language, ‘you can always count on a murderer for a fancy prose style’, suggesting that the intention in using such elaborate and eloquent language is, indeed, to engage the reader in the romance and mystery of the narrative. This suggestion is enhanced by Nabokov’s use of the French language throughout the novel, which both relates to the autobiographical elements of the novel as both Nabokov and his monstrous narrator were highly educated and academic Europeans and creates a romantically academic façade of Humbert’s character. Such references, ‘comme, vous le savez trop bien, ma gentille’, are commonly concerning Lolita, and the inability of the common reader to understand his foreign narration furthers the seductive and private natu

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