| Course | NSG 520 Pathophysiology and Pharmacology |
|---|---|
| Unit | Unit 2 |
| Paper type | Dosing principle worksheet |
| Length | About 850 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NSG 520 Unit 2
Dosing Principle Worksheet: Metformin, Glipizide, and Dapagliflozin in a 68-Year-Old Woman With Stage 3b Chronic Kidney Disease
Student Name
Department of Nursing, Herzing University
NSG 520: Pathophysiology and Pharmacology
Instructor Name
January 28, 2026
Dosing Principle Worksheet: Metformin, Glipizide, and Dapagliflozin in a 68-Year-Old Woman With Stage 3b Chronic Kidney Disease
The Patient's Handling Characteristics
Mrs. D., a composite patient: age 68; female; weight 78 kg; height 162 cm; body mass index 29.7 kg/m2; serum creatinine 1.5 mg/dL, stable over three months; liver function normal; no heart failure. Current diabetes medications: metformin 1,000 mg twice daily and glipizide 5 mg daily. The prescriber proposes adding dapagliflozin for kidney protection. Each calculation below is shown with its formula, its substitution, and what it means for the drug.
Step 1: Two Ways of Estimating Kidney Function
Estimated glomerular filtration rate, race-free CKD-EPI 2021 equation (Inker et al., 2021), for a 68-year-old woman with a creatinine of 1.5 mg/dL: about 38 mL/min/1.73 m2. This is the figure used for staging and for most current drug labeling decisions, including metformin and dapagliflozin.
Creatinine clearance, Cockcroft-Gault equation (Cockcroft & Gault, 1976): ((140 minus age) times weight) divided by (72 times serum creatinine), times 0.85 for women. With actual body weight: (72 times 78) divided by (72 times 1.5), times 0.85 = 44.2 mL/min. With ideal body weight, 54.2 kg for her height: (72 times 54.2) divided by 108, times 0.85 = 30.7 mL/min.
What the difference means: the three estimates range from about 31 to 44, depending on the method and the weight used. For drugs whose labeling uses creatinine clearance, the choice of weight can move her across a dosing threshold. For this worksheet, the agents' current labeling and guidance use estimated glomerular filtration rate, so 38 is the governing figure, but the spread is a reminder that each estimate carries uncertainty.
Step 2: Metformin
How the body handles it: metformin is not metabolized. It is eliminated unchanged in the urine, largely by active tubular secretion, so its clearance falls roughly in step with kidney function. As clearance falls, metformin accumulates, raising the risk of lactic acidosis, which is rare but serious.
What the rules say: federal labeling states that metformin is contraindicated below an estimated rate of 30, that starting it is not recommended between 30 and 45, and that for patients already taking it whose rate falls below 45, benefits and risks should be reassessed. The international kidney guideline for diabetes in chronic kidney disease recommends reducing the daily dose when the rate is 30 to 44 (Rossing et al., 2022).
Decision for Mrs. D.: at 38, continue metformin but reduce from 2,000 mg to 1,000 mg daily, 500 mg twice daily. Recheck kidney function every three to six months, and hold metformin during acute illness with vomiting or dehydration, or before iodinated contrast, when kidney function can fall suddenly.
Step 3: Glipizide
How the body handles it: glipizide is metabolized in the liver to inactive metabolites, so reduced kidney function does not cause active drug to accumulate the way it does with some other sulfonylureas, such as glyburide, whose active metabolites are cleared by the kidney. Glipizide is therefore the preferred sulfonylurea in chronic kidney disease.
The dosing issue is different: hypoglycemia. Sulfonylureas stimulate insulin release regardless of glucose level. Adding a drug that lowers glucose by another mechanism can push glucose too low. Decision: reduce glipizide to 2.5 mg daily when dapagliflozin is started, with home glucose monitoring for two weeks.
Step 4: Dapagliflozin
How the body handles it: dapagliflozin is metabolized mainly in the liver by glucuronidation to inactive metabolites; its exposure rises somewhat with reduced kidney function, but this is not the main dosing concern. The main issue is that its glucose-lowering effect depends on the kidney: it lowers glucose by blocking reabsorption of filtered glucose, so with less filtration, less glucose is excreted, and the glucose-lowering effect is smaller at an estimated rate of 38 than at 90.
Why it is still indicated: its kidney and heart benefits do not depend on glucose lowering. The DAPA-CKD trial, which enrolled adults with kidney disease both with and without diabetes, found that dapagliflozin lowered the combined risk of a lasting drop in kidney function, progression to kidney failure, or death from renal or cardiovascular disease (Heerspink et al., 2020). For kidney protection, it may be started at an estimated rate of 25 or higher.
Decision: dapagliflozin 10 mg once daily. Expect an initial small fall in estimated filtration rate within the first weeks, reflecting reduced intraglomerular pressure rather than injury; recheck kidney function and potassium in two to four weeks. Teach sick-day rules: hold during illness with poor intake or dehydration, because of the rare risk of ketoacidosis.
Summary of Changes
Metformin reduced from 1,000 mg twice daily to 500 mg twice daily because it is cleared unchanged by the kidney; glipizide reduced from 5 mg to 2.5 mg daily because of hypoglycemia risk with a second glucose-lowering drug, not because of its clearance; and dapagliflozin 10 mg daily started for kidney protection, with the understanding that its glucose-lowering effect will be modest at her level of kidney function. Each change follows from a different part of how the drug is handled, which is the point of working from first principles rather than from a table.
References
Cockcroft, D. W., & Gault, M. H. (1976). Prediction of creatinine clearance from serum creatinine. Nephron, 16(1), 31-41. https://doi.org/10.1159/000180580
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
Inker, L. A., Eneanya, N. D., Coresh, J., Tighiouart, H., Wang, D., Sang, Y., Crews, D. C., Doria, A., Estrella, M. M., Froissart, M., Grams, M. E., Greene, T., Grubb, A., Gudnason, V., Gutiérrez, O. M., Kalil, R., Karger, A. B., Mauer, M., Navis, G., ... Levey, A. S. (2021). New creatinine- and cystatin C-based equations to estimate GFR without race. New England Journal of Medicine, 385(19), 1737-1749. https://doi.org/10.1056/NEJMoa2102953
Rossing, P., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., 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(5S), S1-S127. https://doi.org/10.1016/j.kint.2022.06.008
The Herzing NSG 520 Unit 2 instructions
Unit 2 asks you to adjust drug doses based on how one patient's body handles each drug. Expect to list the patient's handling characteristics, estimate organ function, explain each drug's elimination and adjust or continue the dose with reasons, then summarize the changes. Students often ask which kidney equation to use and how to handle disagreement between equations. Show both eGFR and creatinine clearance, since drug labels may use either. Explain whether each drug is cleared by the kidney or the liver and whether its metabolites are active. Doses should follow labels and guidelines, not memory. Note the monitoring each change needs. Keep the arithmetic visible so a reader can check it line by line.
How this NSG 520 Unit 2 example is built
The worksheet opens with Mrs. D.'s data in a list. Step 1 calculates both kidney estimates and explains why they differ. Each drug step names how the body handles it, what her kidney function means for it and the dose decision with the source. The metformin step shows the reduction. The glipizide step explains why it is a reasonable sulfonylurea in kidney disease. The dapagliflozin step explains that glucose lowering falls with filtration but kidney protection continues. The summary lists each change and its reason in one line. The worksheet keeps every number traceable, so the grader can follow the reasoning from handling to dose.
NSG 520 Unit 2 rubric: what full points look like
Herzing's rubric for a dosing principle worksheet typically covers patient data, organ function estimates, drug handling, dose decisions, sources and monitoring. The link between each drug's handling and its dose decision is where most marks are decided, since the course asks for dosing from pharmacokinetics rather than from a memorized chart. Data points reward complete handling characteristics. Estimate criteria look for correct calculations of both eGFR and clearance. Handling points go to elimination route and metabolite activity for each drug. Source criteria reward FDA labels and guidelines named for each decision. Monitoring earns credit when tied to each change, such as glucose checks after a sulfonylurea adjustment. Visible arithmetic is expected. KDIGO and Inker's CKD-EPI 2021 paper support the estimates.
NSG 520 Unit 2 help: mistakes that cost points
A Unit 2 dosing worksheet often goes wrong when doses are adjusted without explaining how each drug is eliminated. Another frequent problem is using only one kidney estimate when the label relies on another. Students often stop metformin entirely when a reduced dose is appropriate. Glipizide's liver metabolism is not explained, so the reason it suits kidney disease is lost. Dapagliflozin is stopped for weak glucose effect, missing its kidney benefit. Monitoring is left out. Arithmetic is hidden. Sources are not named. Sick-day rules, such as holding metformin and dapagliflozin when dehydrated, are forgotten. Finally, connect each dose to how the body handles the drug, because graders reward reasoning that would hold for a drug the student has never seen.
Get a NSG 520 Unit 2 example written to your instructions
Send the Unit 2 instructions and the rubric from your NSG 520 classroom, with the agent and the patient characteristics your case supplies. We write a custom example that establishes the body first, argues route, gives each parameter its consequence and derives the dosing discussion from what came above. First custom sample free, back in 24 to 48 hours.
More NSG 520 papers and MSN samples
- NSG 520 Unit 1: Cellular mechanism trace
- NSG 520 Unit 3: Two science integration case
- NSG 520 Unit 4: Receptor distribution study
- NSG 520 Unit 5: Site of action comparison
- NSG 520 Unit 6: Abnormal value interpretation table
- NSG 520 Unit 7: Plain language mechanism explainer
- NSG 520 Unit 8: Foundational sciences portfolio
- NU 760 Unit 2: Search strategy
- NU 780 Unit 2: Epidemiologic profile
- NU 480 Unit 2: Practice authority brief
- NU 602 Unit 2: Prevalence and duration brief
NSG 520 Unit 2 questions, answered
Do I have to do the calculations?
Where the instructions ask for them, yes, and show the working rather than the result. Most of the credit sits in the reasoning around the arithmetic: which parameter you used, why it applies to this patient and what would change if it were different. A correct number with no derivation and an incorrect one with a clear derivation often score closer than writers expect.
Is a worksheet allowed to give dosing advice?
No, and it should say so. The document explains why an interval and an amount follow from a set of parameters, which is an academic exercise. Anything intended for a real patient is governed by current prescribing information, the prescriber's judgment and the rules of your own board, and the example names those rather than implying its figures could be used.
I came in from another field. Where do people struggle?
Usually at the join between the two sciences. Pharmacokinetics is learnable from the reading, but connecting a clearance value to a patient whose kidneys are failing takes the pathophysiology half seriously. Work the disease first, then ask what it does to handling, and the worksheet stops reading as two separate sets of notes sitting beside each other.
Where can I find a free NSG 520 Unit 2 sample paper?
Read the complete NSG 520 Unit 2 dosing worksheet here at no charge, three diabetes drugs adjusted for stage 3b kidney disease. Ask for a custom worksheet on another regimen.
Can metformin be used in chronic kidney disease?
Often yes at a reduced dose when eGFR is between 30 and 45, and it is stopped below 30. This sample reduces metformin for a woman with stage 3b disease and explains why, since metformin is cleared unchanged by the kidneys.