NR 545 Week 5 Drug Therapy Write-Up Example

Course	NR 545 Pharmacology, Physical Assessment, and Pathophysiology Nurse Practitioner graduate placement
Week	5
Paper type	Drug therapy write-up
Length	About 1,280 words, 2 pages
Format	APA 7 student paper
School	Chamberlain University
Program	MSN, nurse practitioner core
Updated	September 2026

Free sample paper for NR 545 Week 5

Drug Therapy Write-Up: Adding Dapagliflozin 10 mg Once Daily for a 64-Year-Old Patient With Heart Failure, Reduced Ejection Fraction, Type 2 Diabetes and an eGFR of 50, and Why Two Other Reasonable Agents Wait

Student Name

College of Nursing, Chamberlain University

NR 545: Pharmacology, Physical Assessment, and Pathophysiology

Instructor Name

Month Day, Year

What this page is doingThe title names the agent, dose and schedule for a specific person and signals that rejected alternatives will be argued, which is how a drug therapy write-up defends a decision rather than describes a drug. Student APA 7 title page.

Where the Patient Stands

The 64-year-old patient from earlier weeks returns one week after the diagnosis, with an ejection fraction of 30% on echocardiography. At the first visit, furosemide 40 mg by mouth once daily was started, amlodipine was stopped and the lisinopril and the metformin carried on at their usual doses. Today the patient reports sleeping on one pillow with no nocturnal waking. Weight is 88.8 kg, down 2.6 kg. Blood pressure is 128/78 mmHg, heart rate 84. Jugular venous pressure is about 8 cm of water; crackles are present only at the right base; ankle edema is 1+. Laboratory results: creatinine 1.35 mg/dL, eGFR 50 mL/min/1.73 m², potassium 4.4 mmol/L, sodium 137 mmol/L. HbA1c at diagnosis was 7.4%. Coronary evaluation is scheduled.

This write-up defends the next step: adding dapagliflozin.

The Therapeutic Goal

The long-term goal is to reduce the patient's risk of hospitalization for heart failure and cardiovascular death. That goal cannot be observed in one patient, so the write-up sets three measurable short-term goals that the monitoring section will check: weight reaching an estimated dry weight of about 86 kg with no orthopnea within four weeks, no symptomatic hypotension or volume depletion, and an eGFR that does not fall by more than about 30% from today's value, a threshold beyond which the cause should be investigated.

Why This Agent, in This Patient

Dapagliflozin blocks the sodium-glucose cotransporter 2 protein lining the proximal tubule, which reabsorbs most filtered glucose and a share of filtered sodium. Blocking it causes glucose and sodium to be excreted in the urine. In this patient, three effects follow from that one point of action, and each connects to something already found.

First, heart failure outcomes. In a trial of patients with reduced ejection fraction, dapagliflozin 10 mg daily added to standard therapy lowered the rate of a composite of worsening heart failure and cardiovascular death, and the effect did not depend on whether patients had diabetes (McMurray et al., 2019). The mechanism of that benefit is still debated, as the Week 2 write-up noted, but the evidence for benefit is strong, and current guidelines recommend a sodium-glucose cotransporter 2 inhibitor for patients with symptomatic reduced ejection fraction regardless of diabetes status (Heidenreich et al., 2022).

Second, congestion. The modest natriuresis adds to the effect of furosemide on the fluid overload the examination found, which is still present at the right base and ankles.

Third, the kidneys and glucose. This patient has type 2 diabetes and an eGFR of 50, which may reflect diabetic kidney disease. Among trial participants with chronic kidney disease, whether or not they had diabetes, dapagliflozin reduced the risk of a sustained decline in kidney function, kidney failure or death (Heerspink et al., 2020). The glucose-lowering effect is modest at this eGFR, and because the drug acts independently of insulin, it rarely causes hypoglycemia with metformin.

No other single agent addresses all three of this patient's problems.

Dose, Route and Adjustments

Dapagliflozin 10 mg by mouth once daily in the morning, continued indefinitely. The 10 mg dose is the dose studied in heart failure and no titration is needed. No reduction is required at an eGFR of 50; the heart failure indication allows the drug to be started at much lower kidney function.

Furosemide: continue 40 mg once daily for now, with a planned review in one week. Dapagliflozin adds natriuresis, so the combined effect may overshoot as the patient nears dry weight. The patient will weigh each morning and call if weight falls below 86 kg or if lightheadedness on standing develops, at which point the furosemide dose will be reduced.

Metformin: continue 1,000 mg twice daily. At an eGFR of 50, no change is needed. If eGFR falls below 45, the metformin dose will be reviewed, and it must be stopped below 30.

Lisinopril: continue 20 mg daily. It is not changed today, for the reason given below.

Alternatives Actually Rejected

Switching lisinopril to sacubitril/valsartan today. Sacubitril/valsartan is preferred over an ACE inhibitor in patients with reduced ejection fraction who can tolerate it, and a switch is planned. It is not made today for a reason taken from this case. The switch requires a 36-hour gap after the last lisinopril dose to reduce the risk of angioedema, and it typically lowers blood pressure and can raise creatinine at first. The patient is one week into diuresis, with creatinine and blood pressure still settling. Changing two agents that both affect kidney hemodynamics at the same visit would make any rise in creatinine impossible to attribute. The switch is planned for the next visit, once weight and creatinine are stable.

Adding spironolactone today. A mineralocorticoid receptor antagonist is also recommended, and spironolactone reduced mortality in severe heart failure (Pitt et al., 1999). It is deferred because this patient combines an ACE inhibitor, diabetes and reduced kidney function, all of which raise the risk of hyperkalemia. After that trial was published, hospitalizations for hyperkalemia rose substantially in older adults prescribed spironolactone with ACE inhibitors in routine practice (Juurlink et al., 2004). It will be added once kidney function is stable, with potassium checked within a week of starting.

A beta-blocker today. An evidence-based beta-blocker will be started, but the patient still has residual congestion, and beta-blockers are best begun when the patient is close to dry weight. Carvedilol at a low dose is planned once edema has resolved.

Pioglitazone for glucose. Thiazolidinediones cause fluid retention and are avoided in heart failure. It is rejected outright.

Monitoring

The monitoring schedule checks each goal and the known risks.

Daily at home: morning weight after voiding, before breakfast. Phone the clinic if the reading is up by over a kilogram from yesterday, up by two kilograms on last week, or under 86 kg.

One to two weeks: blood pressure seated and standing, weight, jugular venous pressure and lung examination; basic metabolic panel for creatinine, eGFR, potassium and sodium. A small early fall in eGFR is expected with dapagliflozin and on its own does not justify stopping the drug. A fall greater than about 30% prompts a look for volume depletion.

Each visit: ask about genital itching or discharge and urinary symptoms, since yeast infections of the genital area are the side effect seen most often.

What would mean the choice was wrong: symptomatic hypotension or volume depletion that does not resolve after reducing furosemide, recurrent genital infections despite hygiene measures or an unexplained, sustained eGFR decline.

Patient Education

The education is written in the words the patient would use. "This new pill helps your heart and your kidneys. It makes you pass some sugar and salt in your urine, so you may go to the bathroom a little more at first. Keep weighing yourself every morning. Keep the private area clean and dry, and tell us if it itches or burns. If you are ill and not eating or drinking, or have vomiting or diarrhea, or are going to have surgery, stop this pill and call us, because it can rarely cause a serious acid problem in the blood when you are not eating. Start it again when you are eating normally."

References

Heerspink, H. J. L., Stefánsson, B. V., Correa-Rotter, R., Chertow, G. M., Greene, T., Hou, F.-F., Mann, J. F. E., McMurray, J. J. V., Lindberg, M., Rossing, P., Sjöström, C. D., Toto, R. D., Langkilde, A.-M., & Wheeler, D. C. (2020). Dapagliflozin in patients with chronic kidney disease. New England Journal of Medicine, 383(15), 1436-1446. https://doi.org/10.1056/NEJMoa2024816

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., . . . Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. https://doi.org/10.1161/CIR.0000000000001063

Juurlink, D. N., Mamdani, M. M., Lee, D. S., Kopp, A., Austin, P. C., Laupacis, A., & Redelmeier, D. A. (2004). Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. New England Journal of Medicine, 351(6), 543-551. https://doi.org/10.1056/NEJMoa040135

McMurray, J. J. V., Solomon, S. D., Inzucchi, S. E., Køber, L., Kosiborod, M. N., Martinez, F. A., Ponikowski, P., Sabatine, M. S., Anand, I. S., Bělohlávek, J., Böhm, M., Chiang, C.-E., Chopra, V. K., de Boer, R. A., Desai, A. S., Diez, M., Drozdz, J., Dukát, A., Ge, J., . . . Langkilde, A.-M. (2019). Dapagliflozin in patients with heart failure and reduced ejection fraction. New England Journal of Medicine, 381(21), 1995-2008. https://doi.org/10.1056/NEJMoa1911303

Pitt, B., Zannad, F., Remme, W. J., Cody, R., Castaigne, A., Perez, A., Palensky, J., & Wittes, J. (1999). The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New England Journal of Medicine, 341(10), 709-717. https://doi.org/10.1056/NEJM199909023411001

NR 545 Week 5 instructions, in plain terms

The fifth week focuses on selecting and defending drug therapy for a specific patient. Instructions usually ask for the therapeutic goal, the chosen agent with dose, route and frequency, the rationale based on pharmacology and patient factors, alternatives considered, monitoring and patient education. State goals that could be measured later. Explain how the drug's mechanism connects to this patient's findings. Give every number a reason, including any adjustment for kidney or liver function, age or other drugs. Discuss real alternatives and reject each on a ground taken from the case. Build monitoring as a schedule with named parameters and the result that would mean the choice was wrong. Write education in words a patient would use. Current guidelines and trials, cited in APA 7, anchor the rationale.

Inside the NR 545 Week 5 example

The write-up opens with the patient's status one week after diagnosis: improving congestion, weight down 2.6 kg, stable laboratory values. It sets three short-term goals. The rationale explains how blocking the sodium-glucose cotransporter in the proximal tubule serves heart failure, residual congestion and diabetic kidney disease, citing two trials and the heart failure guideline. The dose section fixes dapagliflozin at 10 mg and explains the plans for furosemide, metformin and lisinopril. The alternatives section defers the sacubitril/valsartan switch to avoid confounding kidney effects, defers spironolactone because of hyperkalemia risk, delays the beta-blocker until dry weight and rejects pioglitazone. Monitoring covers daily weights, laboratory checks and infection questions. Education uses plain language, including sick-day advice.

NR 545 Week 5 rubric: what full points look like

Drug therapy write-ups are commonly weighed on appropriateness of the agent for the patient, accuracy of dosing and adjustments, a rationale grounded in mechanism and evidence, genuine consideration of alternatives, a practical monitoring plan and clear patient education. Tying the choice to this patient's findings, rather than to the diagnosis alone, is what instructors look for first. Doses with units, frequency and duration, each with a reason, show precision. Rejecting alternatives on grounds from the case demonstrates judgment. A monitoring schedule that names the result signaling failure shows safe prescribing. Education in plain words shows the writer can communicate with patients. Current trials and guidelines, correctly cited in APA 7, support each decision and complete a strong submission.

NR 545 Week 5 help: mistakes that cost points

A frequent problem is describing the drug class at length and never explaining why it suits this patient. Anchor every point to the case. Another weakness is doses without reasons, or adjustments described as general caution rather than tied to kidney function or interactions. Some students list alternatives without rejecting them, or reject them on preference. Give a case-based reason for each. Monitoring is often thin; name the tests, the timing and the values that would prompt action. Avoid medical jargon in the education section and include what to do when ill. Check dosing against current references, since an error there undermines the whole paper. Make sure the drug you choose fits with what the patient already takes, and say how other doses will change.

Get a NR 545 Week 5 example written to your instructions

Send the Week 5 instructions, the rubric and the patient details you were given, and a custom drug therapy example is written to them and returned inside 24 to 48 hours. The first is free. Where your section requires a particular formulary, reference style or table, say so and it is followed.

More NR 545 papers and MSN samples

NR 545 Week 5 questions, answered

Is this a pharmacology paper?

Not on its own. NR 565 is where pharmacology is examined in its own right and NR 507 is where mechanisms are. This week is marked on the connection: an agent chosen because of what the physiology predicted and what the examination found, with monitoring that goes back to check both. A strong pharmacology essay with no patient inside it answers the wrong course.

Can I choose a drug that is not first line?

Yes, if the case gives a reason and the write-up says what that reason is. A defended second-line choice built on an allergy, an interaction or an organ function problem shows more than a first-line choice with no argument behind it. What costs points is departing from usual practice without acknowledging that is what you are doing.

How specific does monitoring need to be?

Specific enough that somebody else could act on it. Naming the parameter, the interval, and the value or finding that would trigger a change is what earns this section its points. Monitoring written as continued observation of the patient's response describes an intention rather than a plan, and graders read it as unfinished work.

Where can I find a free NR 545 Week 5 sample paper?

The dapagliflozin drug therapy write-up is posted above as the NR 545 Week 5 sample, open on this page. If your patient needs a different agent, give us the case and a write-up defending that choice can be drafted.

How many alternatives should the NR 545 Week 5 write-up reject?

At least one, argued properly from the case, and usually two to four. The sample defers sacubitril/valsartan, spironolactone and a beta-blocker and rejects pioglitazone, each for a reason drawn from the patient.