| Course | NR 568 Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner |
|---|---|
| Week | 7 |
| Paper type | Polypharmacy case study |
| Length | About 1,110 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 7
Polypharmacy Case Study: Counting the Totals for a 79-Year-Old on Twelve Products, Where Five Blood-Pressure Effects, Three Sedatives and Four Daily Dosing Times Add Up to One Unsafe Morning
Student Name
College of Nursing, Chamberlain University
NR 568: Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner
Instructor Name
Month Day, Year
Polypharmacy Case Study: Counting the Totals for a 79-Year-Old on Twelve Products, Where Five Blood-Pressure Effects, Three Sedatives and Four Daily Dosing Times Add Up to One Unsafe Morning
Counted, Not Listed
This 79-year-old with stage 3b kidney disease started the term taking twelve products: ten prescriptions and two over-the-counter medicines taken regularly. Reviewed one row at a time, almost every entry looked defensible. Counted together along the axes they share, the regimen explains the patient's main problems: dizziness on standing, two near falls, poor sleep and a monthly cost that strained the household budget.
The Axes That Stack
Table 1
Effects That Stack Across the Regimen
| Axis | Contributing entries | Total effect |
|---|---|---|
| Lowering standing blood pressure | Lisinopril, chlorthalidone, doxazosin, tamsulosin, trazodone | Orthostatic drop of 28 mm Hg systolic |
| Sedation | Trazodone, diphenhydramine, meclizine | Morning grogginess, near falls |
| Anticholinergic burden | Diphenhydramine, meclizine | Constipation, urinary hesitancy, confusion risk |
| QT prolongation | Citalopram 40 mg, trazodone | Corrected QT 468 ms |
| Kidney load | Metformin, allopurinol, lisinopril, chlorthalidone, plus naproxen | Doses exceeding what a clearance of 33 supports |
No single row explains the orthostatic drop. Each blood-pressure-lowering drug lowers standing pressure a little; five together produce a patient who cannot stand up safely. The same is true of sedation: trazodone alone at bedtime might be tolerable, but with diphenhydramine on some nights and meclizine during the day, the patient was never fully alert. The Beers Criteria warn specifically about combinations of three or more central nervous system active drugs and about anticholinergic burden in older adults (American Geriatrics Society Beers Criteria Update Expert Panel, 2023).
The Schedule as a Finding
The regimen required doses at four times a day: on waking (levothyroxine, which should be taken on an empty stomach), with breakfast (metformin, lisinopril, chlorthalidone, citalopram, allopurinol, tamsulosin, calcium), with the evening meal (metformin) and at bedtime (doxazosin, trazodone, atorvastatin). In practice, levothyroxine was taken with breakfast and calcium, reducing its absorption; tamsulosin, which is meant to be taken 30 minutes after the same meal each day, was taken at varying times. The spouse spent about 40 minutes every Sunday filling the pill box. A schedule that a household cannot keep is itself a cause of poor outcomes.
The Budget as a Finding
The monthly cost was about 90 dollars in co-payments plus about 25 dollars for over-the-counter products, on a fixed pension. The patient admitted skipping atorvastatin some weeks to stretch the supply, which meant that the drug with the strongest evidence for preventing another heart attack was the one being rationed.
What a Removal Buys
Each removal is linked to the total it reduces.
Doxazosin removed: standing blood pressure drop expected to fall by roughly half; one fewer bedtime tablet; one co-payment saved.
Meclizine and diphenhydramine removed: anticholinergic burden reduced to zero; daytime sedation reduced; about 25 dollars a month saved.
Citalopram reduced to 20 mg: QT prolongation reduced, with the depression monitored.
Naproxen removed: the most dangerous kidney combination eliminated.
Metformin reduced: kidney-appropriate dosing restored, one fewer evening dose if switched to once-daily extended release.
Trazodone tapered: sedation, orthostasis and QT stacking all reduced, if sleep allows.
When It Buys Nothing Visible
Some removals buy nothing the patient will feel, and the study says so. Moving calcium to the evening will not change how the patient feels this month, but it should improve levothyroxine absorption, visible only in a thyroid test six weeks later. Reducing metformin will not change glucose noticeably, since the A1c is 6.6%, but it reduces the risk of a rare and serious complication. Reducing citalopram may produce no felt change at all. These are still worth doing, and the patient is told in advance that some benefits are measured in blood tests, not in how the day feels.
What Stays and Why It Was Not Cut
Cutting for a smaller count would be its own error. Atorvastatin stays despite the budget pressure because the patient has a coronary stent; the solution was to make it affordable by removing over-the-counter spending and checking for a lower-cost generic, not to stop it. Lisinopril stays because it protects the kidney in diabetes. Allopurinol stays and rises because the gout is not controlled. Citalopram stays at a lower dose because depression is in remission. Each of these entries passed the same test as those removed: it treats a current problem at a safe dose without harmful stacking.
How the Totals Were Measured
The orthostatic drop was measured lying, then standing at one and three minutes. Sedation was rated from the spouse's description of mornings. Anticholinergic burden was counted using the Beers list of strongly anticholinergic drugs. Kidney load was checked entry by entry against current dosing guidance for a clearance of 33 mL/min. Measuring the totals the same way at each visit lets the practice see, visit after visit, whether the planned changes have actually worked.
The Regimen as It Would Stand
After the planned changes, the regimen would be eight prescriptions: lisinopril 40 mg, amlodipine 2.5 mg (replacing chlorthalidone after the sodium event), citalopram 20 mg, atorvastatin 40 mg, allopurinol 400 mg with colchicine 0.3 mg prophylaxis for six months, levothyroxine 100 mcg on waking, metformin extended-release 1,000 mg with the evening meal and tamsulosin 0.4 mg after the evening meal. Dosing times fall from four to two, plus levothyroxine on waking. Monthly cost falls by about 40 dollars. The blood-pressure-lowering axis falls from five contributors to three, the sedation axis from three to none, and the anticholinergic axis to none. Fewer medicines is not the goal in itself; definitions of polypharmacy based purely on counts miss whether each entry is appropriate (Masnoon et al., 2017). Deprescribing guidance frames the same point as reviewing each entry against the patient's goals (Reeve et al., 2014). What matters is that every remaining entry has a reason and that the totals no longer stack against the patient.
Monitoring the Totals
Orthostatic blood pressure at each visit, a fall and sleep log, the PHQ-9, sodium and potassium, kidney function every three months and urate every four weeks during titration, then every six months.
The household's own measure is included too: the spouse times the Sunday pill box filling, which fell from 40 minutes to about 15 after the first three removals, a practical sign that the regimen is now easier for the whole household to live with each week.
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
Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17, Article 230. https://doi.org/10.1186/s12877-017-0621-2
Reeve, E., Shakib, S., Hendrix, I., Roberts, M. S., & Wiese, M. D. (2014). Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. British Journal of Clinical Pharmacology, 78(4), 738-747. https://doi.org/10.1111/bcp.12386
The Chamberlain NR 568 Week 7 instructions
The polypharmacy case study usually asks you to evaluate a complex regimen as a whole and recommend changes that improve safety and function. Expect the prompt to ask about cumulative effects, adherence, cost and the patient's priorities. Count effects across the list, such as blood pressure lowering, sedation, anticholinergic burden or QT prolongation, instead of judging each drug alone. Treat the dosing schedule and the cost as findings. For each proposed removal, say which total it reduces. Be honest about removals whose benefit will not be felt. Explain why entries that stay were kept. Write the regimen as it would stand afterward, and describe how you will measure whether the totals improved.
Inside the NR 568 Week 7 example
The sample opens by noting that a row-by-row review found every entry defensible. A table then counts five axes: lowering standing pressure, sedation, anticholinergic burden, QT prolongation and kidney load, each with its contributing drugs and total effect. The schedule section shows doses at four times a day, levothyroxine taken with calcium and a 40-minute weekly pill box task. The budget section reveals rationed atorvastatin. Each removal is linked to its total, and several are described as producing no visible change. A section explains why atorvastatin, lisinopril, allopurinol and citalopram stay. The regimen as it would stand lists eight prescriptions and two dosing times, followed by how each total was measured.
NR 568 Week 7 rubric: what full points look like
Polypharmacy case studies tend to be graded on whether the writer finds cumulative effects that single rows miss, whether schedule and cost are treated as clinical, whether removals are linked to benefits and whether the resulting regimen is shown in full. Concluding that a regimen is appropriate because each entry looks reasonable loses the most, so this sample counts totals along shared axes. The opposite error, cutting for a smaller count, is avoided by explaining what stays and why. Treating rationed atorvastatin as a finding shows awareness of real-world adherence. Admitting that some removals produce no felt change shows honesty. Writing the full regimen afterward, with the totals it changes, completes the argument. Geriatric prescribing criteria and polypharmacy research support it.
Common NR 568 Week 7 mistakes, and how to avoid them
Most points disappear when a case study examines each drug separately, finds nothing wrong with any single entry and declares the regimen appropriate. Nearly as costly is cutting drugs simply to reach a lower count, without saying what each removal buys. Many studies ignore the dosing schedule and cost, even though a household that cannot keep the schedule will not get the intended benefit. Some promise improvements the patient will never notice. Others never write out the regimen as it would stand. Count effects across the list, treat schedule and budget as findings, link each removal to a benefit and show the final regimen. A case study for your own patient can be drafted from the full list and the patient's routine.
Get a NR 568 Week 7 example written to your instructions
Send the Week 7 case with the full regimen and any required elements your section publishes, and a custom example is written to that patient and returned inside 24 to 48 hours, the first at no cost. One line worth stating plainly: we produce coursework only, and hour tallies, clinical logs and the evaluation a preceptor completes sit outside anything this desk drafts.
More NR 568 papers and AGPCNP samples
- NR 568 Week 1: Citalopram Dose Discussion Post
- NR 568 Week 2: Medication List Review
- NR 568 Week 3: Clarithromycin Interaction Analysis
- NR 568 Week 4: Allopurinol in CKD Case Analysis
- NR 568 Week 5: Deprescribing Plan
- NR 568 Week 6: Hyponatremia Adverse Effect Write-Up
- NR 568 Week 8: Pharmacotherapy Synthesis
NR 568 Week 7 questions, answered
How many entries should be put forward for removal?
As many as the reasoning supports, and the count itself is not what gets graded. Two removals argued through to a specific expected change beat six proposed because the list looked long. Where the honest answer is one, say why the others stay and what would have to happen for them to be reconsidered. Cutting for the sake of a lower number tends to lose the entries doing real work.
How is a total for a shared effect actually shown?
By naming the contributing entries beside it. A sentence reporting that the sedating load is high proves nothing on its own, while the same claim with four drugs listed underneath can be checked by anybody reading. Where a published tool assigns scores, use it as the arithmetic and still name the entries, because the marks sit in the reader following the addition rather than in the tool being cited.
Does the study have to add anything, or only remove?
Adding is allowed and occasionally required, since a regimen can be missing a therapy the patient ought to be receiving. What matters is that an addition passes the same counting test as everything else: which shared effect it joins, what it does to the daily schedule, and what it costs in money and in handling. A paper that removes carefully and then adds without that check has broken its own method.
Where can I find a free NR 568 Week 7 sample paper?
The twelve-product case study above, which counts effects across the list and shows the regimen as it would stand, is the complete NR 568 Week 7 sample. Your own patient's list can be studied the same way.
What does counting totals mean in the NR 568 Week 7 case study?
Adding up shared effects across drugs, such as five agents that each lower standing blood pressure a little, which together explain a problem no single drug explains.