| Course | NR 568 Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner |
|---|---|
| Week | 2 |
| Paper type | Medication list review |
| Length | About 1,120 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Adult-Gerontology Primary Care NP (AGPCNP) |
| Updated | October 2026 |
Free sample paper for NR 568 Week 2
Medication List Review: Ten Prescriptions and Three Over-the-Counter Products for a 79-Year-Old With an Estimated Clearance of 33, Grouped by What Clears Them
Student Name
College of Nursing, Chamberlain University
NR 568: Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner
Instructor Name
Month Day, Year
Medication List Review: Ten Prescriptions and Three Over-the-Counter Products for a 79-Year-Old With an Estimated Clearance of 33, Grouped by What Clears Them
The Patient and the Purpose
The patient under review is 79, weighs 70 kg and has stage 3b chronic kidney disease. A creatinine of 1.8 mg/dL translates, with Cockcroft-Gault, into a clearance near 33 mL/min. The patient came to a 40-minute visit with two grocery bags of bottles, at the practice's request. The purpose of this review is to decide which entries are still doing work, which are doing harm and which nobody can explain.
Grouped by What Clears It
Table 1
Prescribed Medicines Grouped by Main Route of Elimination
| Cleared mainly by the kidney | Cleared mainly by the liver | Other |
|---|---|---|
| Metformin 1,000 mg twice daily | Citalopram 40 mg daily | Levothyroxine 100 mcg daily |
| Allopurinol 300 mg daily | Atorvastatin 40 mg daily | Calcium carbonate 1,250 mg with breakfast |
| Lisinopril 40 mg daily | Trazodone 100 mg at bedtime | |
| Chlorthalidone 25 mg daily | Doxazosin 4 mg at bedtime | |
| Tamsulosin 0.4 mg daily |
Grouped this way, the load on the kidney is plain. Four of ten prescriptions depend on a kidney that is working at about a third of normal. Metformin is the most urgent: once filtration sits in the 30s or low 40s, the kidney guideline advises against starting metformin and calls for cutting an existing dose to no more than roughly a gram a day, because of the risk of accumulation and lactic acidosis (Rossing et al., 2022). The patient takes twice that.
An Origin for Every Entry
Each entry was traced to its prescriber and reason. Metformin was started 11 years ago by the practice for diabetes; the A1c is 6.6%. Allopurinol was started by a rheumatologist four years ago for gout; the patient has had two flares this year. Lisinopril and chlorthalidone were started for hypertension. Citalopram was started six years ago after a bereavement. Atorvastatin was started after a stent nine years ago. Trazodone was started three years ago by an urgent care clinician for sleep. Doxazosin was started for blood pressure eight years ago by a cardiologist; tamsulosin was added two years ago by a urologist for prostate symptoms. Levothyroxine treats hypothyroidism. Calcium was started by the patient on a friend's advice.
A Stop Date, or an Explicit None
Every entry is given a stop date or a statement that it continues indefinitely, with a reason. Atorvastatin, lisinopril, levothyroxine and allopurinol: no stop date, for secondary prevention, kidney protection, thyroid replacement and gout control. Citalopram: no stop date, but a dose reduction this month. Metformin: no stop date, but a dose reduction now. Trazodone: review for removal within eight weeks. Doxazosin: review for removal within four weeks, because tamsulosin, another alpha blocker, was added for the prostate without anyone removing the first. Calcium: stop date set at the next visit after checking diet and bone health.
The Record Against the House
The chart lists ten medicines. The bags held thirteen. The three extras were diphenhydramine 25 mg tablets (a nighttime sleep aid taken two or three nights a week), meclizine 25 mg bought for dizziness, and naproxen 220 mg taken for knee pain on bad days. All three matter. Diphenhydramine and meclizine both block acetylcholine, and the geriatric prescribing criteria name both as drugs to keep away from older adults, since they cloud thinking, slow the bowel, hold back urine and unsteady the gait (American Geriatrics Society Beers Criteria Update Expert Panel, 2023). Naproxen, combined with lisinopril and chlorthalidone in a patient with a clearance of 33, is the combination most likely to cause acute kidney injury. The meclizine also suggests a symptom, dizziness, that may itself come from the stacked blood pressure medicines.
Duplications and Timing Problems
Two alpha blockers, doxazosin and tamsulosin, act on the same receptors; together they lower standing blood pressure more than either alone. Levothyroxine goes down at breakfast alongside calcium carbonate, which latches onto the hormone before it can be absorbed, so the current dose may be compensating for a timing problem. Trazodone at bedtime adds sedation and orthostatic hypotension to the doxazosin taken at the same time.
What the Patient Thinks Each Medicine Is For
The patient was asked to say, for each bottle, what it was for. The answers were right for metformin, lisinopril, atorvastatin and levothyroxine. The patient thought doxazosin and tamsulosin were the same prostate pill in two strengths, did not know why trazodone had been started, and called allopurinol the arthritis pill. Those answers are findings too: a patient who cannot name the purpose of a medicine is less likely to notice when it causes harm or stops being needed. The review records the misunderstandings and uses the next visit to explain the purpose of every entry that remains, in plain words, with a printed list the spouse can keep on the refrigerator.
Kidney Function Trend
Creatinine has risen from 1.5 to 1.8 mg/dL over two years. The kidney-cleared entries in Table 1 come back for review if filtration drops under 30, the point at which metformin should end altogether (Rossing et al., 2022). The trend is checked every three months, and each kidney-cleared entry carries a note of the threshold at which it changes.
What the Regimen Costs to Run
The regimen costs the patient about 90 dollars a month after insurance, most of it for tamsulosin and atorvastatin co-payments, plus about 25 dollars for the over-the-counter products. It requires doses at four different times of day. The spouse fills a weekly pill box on Sundays and reports that the levothyroxine timing is the hardest to keep.
Survivors Named, Not Implied
The entries that survive the review without change are atorvastatin 40 mg, lisinopril 40 mg, allopurinol (pending a separate dosing review), levothyroxine (with timing moved) and tamsulosin. Naming each one shows it was weighed and kept, not passed over.
Proposed Changes
In order of urgency: reduce metformin to 500 mg twice daily now; stop naproxen now and replace it with acetaminophen; reduce citalopram to 20 mg; move levothyroxine to waking, 30 to 60 minutes before breakfast, and calcium to the evening meal; plan the removal of doxazosin, diphenhydramine, meclizine and trazodone in sequence, as set out in the deprescribing plan later in the course. Deprescribing works best one step at a time, with the patient's goals discussed and each change monitored (Scott et al., 2015).
References
American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
Rossing, P., Caramori, M. L., Chan, J. C., Heerspink, H. J., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., Sadusky, T., Tandon, N., Tuttle, K. R., Wanner, C., Wilkens, K. G., Zoungas, S., & de Boer, I. H. (2022). KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney International, 102(5), S1-S127. https://doi.org/10.1016/j.kint.2022.06.008
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., Gnjidic, D., Del Mar, C. B., Roughead, E. E., Page, A., Jansen, J., & Martin, J. H. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827-834. https://doi.org/10.1001/jamainternmed.2015.0324
Reading the NR 568 Week 2 instructions
The medication list review usually supplies a long regimen and asks which entries are still needed, which are harmful and what should change. Expect the prompt to ask for interactions, dosing against kidney or liver function, inappropriate drugs and recommendations. Group entries by how they are eliminated so that the load on a failing organ shows. Trace each entry to the prescriber and the reason it was started. Give every entry either a stop date or a stated reason to continue. Compare the chart against what the patient actually takes at home, including over-the-counter products. Note the cost and the dosing schedule as findings. Name the entries that survive, and recommend changes in order of urgency.
How the NR 568 Week 2 example is put together
The sample estimates clearance, then places the ten prescriptions in a table by elimination route, which shows four kidney-cleared drugs and metformin at 2,000 mg a day against a guideline ceiling near 1,000 mg. Each entry's origin is traced, from an 11-year-old metformin start to trazodone added by urgent care. Stop dates are set or explicitly declined. The home bags reveal diphenhydramine, meclizine and naproxen, each with its risk. Duplicate alpha blockers and levothyroxine taken with calcium are flagged. The patient's own understanding of each drug, the monthly cost and the four dosing times are recorded. Survivors are named, and changes follow in order, starting with metformin and naproxen.
NR 568 Week 2 rubric: what full points look like
A list review is generally judged on whether it proposes changes, whether entries are organized so that problems become visible, whether each entry has an origin and an end point, whether home use is checked and whether surviving entries are named. A review that finds problems and recommends nothing earns the least, so this sample lists changes in order of urgency. Grouping by elimination route reveals the kidney load in a way an alphabetical list cannot. Origins and stop dates show the writer examined each entry's purpose. Checking the bags from home uncovers three products that change the risk picture, which instructors tend to value. Cost and schedule treated as findings show practical judgment. Naming survivors proves the whole list was reviewed. Citations support the dosing limits.
NR 568 Week 2 help from the desk
Nothing costs more here than a review that lists concerns and hands every decision back to someone else. Close behind is a long restatement of the regimen with one comment per row, which fills the page without ranking anything. Many reviews accept the chart as complete and never ask what the patient takes at home. Some miss the load on one organ because the list is alphabetical. Others leave survivors implied, so a reader cannot tell whether an entry was kept or overlooked. Group by elimination route, trace origins, set stop dates, check the house and name what stays. A review of a different patient's list can be prepared from the bottles and laboratory values you send.
Get a NR 568 Week 2 example written to your instructions
Send the Week 2 case with the medication list exactly as your classroom prints it, plus any review template it requires, and a custom example is written to that regimen and returned inside 24 to 48 hours, the first at no cost. Which entries you would actually question remains your own call.
More NR 568 papers and AGPCNP samples
- NR 568 Week 1: Citalopram Dose Discussion Post
- NR 568 Week 3: Drug Interaction Analysis
- NR 568 Week 4: Prescribing Case Analysis
- NR 568 Week 5: Deprescribing Plan
- NR 568 Week 6: Adverse Effect Write-up
- NR 568 Week 7: Polypharmacy Case Study
- NR 568 Week 8: Pharmacotherapy Synthesis
NR 568 Week 2 questions, answered
Does every drug need a stop date?
No, but every drug needs a decision about one. Some entries are meant to run indefinitely and writing that down is itself an answer. What a review cannot do is leave the question unasked, since an entry with no end and no statement that none was intended is precisely the row that survives ten years past its reason. Marking the indefinite ones on purpose also makes the short courses stand out.
What if the case gives no dates for when things were started?
Say so, and say what the missing dates would have changed. The review can still ask which entries look as though they were written for a short problem, name the record it would request, and flag the ones whose age it cannot establish. Inventing plausible dates is worse than admitting the gap, and instructors read a stated limitation as competence rather than as a hole in the paper.
How is an entry grouped when more than one route clears it?
Put it with the organ that is under pressure in this patient, and note the second route in the same row. The point of grouping this way is to show what a failing kidney or liver has been asked to handle in total, so an agent with mixed handling belongs beside the organ carrying the strain. A short note keeps the other route from disappearing from the analysis entirely.
Where can I find a free NR 568 Week 2 sample paper?
The thirteen-product review shown above, grouped by elimination route with every survivor named, is the full NR 568 Week 2 sample. Send your own patient's list for a review built on it.
Why group medications by elimination route in NR 568 Week 2?
Grouping by kidney, liver or other routes shows how much of the regimen depends on one struggling organ, which an alphabetical list hides.