NU 636 Unit 5 Sample Paper

Adding an SGLT2 Inhibitor for a 58-Year-Old Adult With Type 2 Diabetes, Prior Myocardial Infarction, and Albuminuric Kidney Disease

Author Name

Department of Nursing, Herzing University

NU 636: Advanced Pharmacology

Unit 5 Assignment

Instructor Name

March 16, 2026

What this page is doingThe title commits to a drug class, a patient, and a reason, which is the argument compressed into one line. Papers in this genre lose points when the title names a class and the paper then tours every member of it. Naming the comorbid conditions in the title also signals that the defense will rest on organ protection rather than on glucose lowering alone, so the reader knows which rubric row the paper is aiming at before the first page.

The Patient and the Therapeutic Problem

A 58-year-old woman is seen in a family practice clinic for follow-up of type 2 diabetes diagnosed nine years ago. Her hemoglobin A1C is 8.4 percent today, up from 7.6 percent six months ago, on metformin 1000 mg orally twice daily, which she reports taking consistently. She had a non-ST elevation myocardial infarction three years ago. Her history also includes hypertension, dyslipidemia, and stage 3a chronic kidney disease with an estimated glomerular filtration rate of 48 mL/min/1.73 m2 and a urine albumin to creatinine ratio of 240 mg/g confirmed on two occasions. Body mass index is 33.6, blood pressure is 138/82, and weight is up 6 pounds since the last visit. Current medications are metformin, losartan 100 mg daily, hydrochlorothiazide 25 mg daily, atorvastatin 40 mg daily, metoprolol succinate 50 mg daily, and aspirin 81 mg daily.

The therapeutic problem is not glycemic control alone. This patient carries three indications that pull in the same direction: glucose above her individualized target, established atherosclerotic cardiovascular disease, and albuminuric chronic kidney disease with a filtration rate that is falling. Any agent added here is therefore judged against three questions rather than one. Does it lower A1C by an amount that matters at 8.4 percent, does it reduce cardiovascular and kidney events independently of that glucose effect, and does it avoid adding hypoglycemia and weight gain to a patient who needs neither. Current guidance treats cardiovascular and kidney indications as reasons to select an agent regardless of whether A1C is already at target (American Diabetes Association Professional Practice Committee, 2025).

What this page is doingThe first sheet ends by converting the case into three explicit questions, and those questions become the structure of the defense that follows. Setting the criteria before naming the agent is what keeps the paper from reading as a justification written backwards from a favorite drug. Every number offered here is one the argument uses later: the A1C, the filtration rate, the albumin ratio, the body mass index, and the full medication list.

Drug Selection and Rationale

Empagliflozin 10 mg orally once daily in the morning is added to metformin, with the option to titrate to 25 mg daily if glycemic control remains short of target and the drug is tolerated (U.S. Food and Drug Administration, 2024). The agent inhibits sodium glucose cotransporter 2 in the proximal convoluted tubule, where roughly 90 percent of filtered glucose is normally reabsorbed. Blocking that transporter lowers the renal threshold for glucose and produces urinary glucose loss on the order of 60 to 80 g per day, which lowers plasma glucose by a route that requires neither insulin secretion nor insulin action. Because the mechanism is insulin independent, the drug carries little intrinsic hypoglycemia risk, and the calories lost in the urine produce modest weight reduction.

Expected effects at this dose are an A1C reduction of roughly 0.5 to 0.8 percentage points, a systolic blood pressure reduction of about 3 to 5 mm Hg from the accompanying natriuresis, and weight loss of about 2 to 3 kg over the first six months. The kidney effect is separate and matters more for this patient. Increased sodium delivery to the macula densa restores tubuloglomerular feedback, constricts the afferent arteriole, and lowers intraglomerular pressure, which reduces hyperfiltration and slows the loss of filtration over time (Kidney Disease: Improving Global Outcomes CKD Work Group, 2024). That same mechanism produces an early decline in measured filtration rate that is hemodynamic rather than injurious.

The outcome evidence supports the choice for this specific patient rather than for diabetes in general. In the EMPA-REG OUTCOME trial, 7,020 adults with type 2 diabetes and established cardiovascular disease were randomized to empagliflozin or placebo and followed for a median of 3.1 years, and the treated group had lower cardiovascular death and fewer hospitalizations for heart failure than the placebo group (Zinman et al., 2015). Kidney guidance now recommends this class for adults with type 2 diabetes and chronic kidney disease at an estimated filtration rate of 20 mL/min/1.73 m2 or above, which this patient meets at 48 (Kidney Disease: Improving Global Outcomes CKD Work Group, 2024). Her prior myocardial infarction and her albuminuria place her inside both recommendations at once.

The alternatives were weighed and set aside on stated grounds. A sulfonylurea such as glipizide would lower A1C by a comparable amount and cost less, but it works by driving insulin secretion, which adds hypoglycemia risk and weight gain to a patient who needs neither, and it carries no cardiovascular or kidney benefit (Davies et al., 2022). Basal insulin would be effective and brings the same two liabilities plus injection burden, and it addresses only one of her three problems. A glucagon-like peptide 1 receptor agonist is a defensible rival with strong cardiovascular and weight evidence, and it becomes the better option if albuminuria progresses despite this plan; it was not chosen first because kidney protection in albuminuric disease is the more pressing target and the oral route matches her stated preference.

What this page is doingThe rationale sheet does four jobs in order: dose and route, mechanism, expected effect sizes, then outcome evidence, followed by each alternative rejected on a named ground. Numbers do the persuading. A paper saying the drug improves outcomes earns less than one reporting the sample size, the comparator, and the follow-up. Conceding that a rival agent is defensible, then stating what would change the decision, reads as clinical judgment rather than as hedging.

Monitoring, Interactions, and Patient Teaching

Monitoring begins before the first dose. The baseline values already on file are serum creatinine and estimated filtration rate, electrolytes, urine albumin to creatinine ratio, A1C, blood pressure, and weight. A basic metabolic panel is repeated one month after starting. A decline in estimated filtration rate of up to 30 percent is anticipated at that check and is not by itself a reason to stop the drug, because it reflects the hemodynamic change described above and is followed by a flatter long term slope of decline (Kidney Disease: Improving Global Outcomes CKD Work Group, 2024). A1C is rechecked at three months and the albumin to creatinine ratio at three to six months. Orthostatic blood pressure and volume status are assessed at every visit.

Two interactions in her current list change the prescription rather than simply appearing in a table. Hydrochlorothiazide 25 mg daily and empagliflozin both promote sodium and water loss, and the pair raises the risk of hypotension, dizziness, and a prerenal fall in filtration; the diuretic is reduced to 12.5 mg daily at initiation, home blood pressure readings are reviewed, and the office reading is repeated in two to four days. Losartan acts on the efferent arteriole while empagliflozin acts on the afferent, so filtration pressure falls from both sides. That combination is intended and evidence supported, but it makes the one month laboratory check mandatory rather than optional. Hypoglycemia risk remains low because she takes neither insulin nor a sulfonylurea (U.S. Food and Drug Administration, 2024).

Teaching is written around what she will notice and what she must not ignore. She is told to expect more frequent urination, to take the dose in the morning to limit nighttime trips, and to keep fluid intake steady rather than restricting or forcing it. Genital yeast infection is the most common adverse effect, and daily hygiene with prompt reporting usually settles it without stopping therapy. She is taught to hold the drug during any illness with vomiting, poor intake, or prolonged fasting, and to stop it at least three days before scheduled surgery (U.S. Food and Drug Administration, 2024). She is taught the symptoms of ketoacidosis that can occur with near normal glucose, including nausea, abdominal pain, unusual fatigue, and labored breathing, and to seek urgent care for pain, swelling, or redness of the perineum with fever.

What this page is doingThe safety plan is written in a form a reader could act on: what is measured, when it is measured, and which result would or would not stop therapy. The expected filtration decline is named in advance, and that detail separates a plan from a copied monitoring list. The interaction paragraph changes a dose instead of only noting a risk, and the teaching is written in the words the patient would use.

References

American Diabetes Association Professional Practice Committee. (2025). Standards of care in diabetes-2025. Diabetes Care, 48(Suppl. 1). https://diabetesjournals.org/care/issue/48/Supplement_1

Centers for Disease Control and Prevention. (2024). National diabetes statistics report. U.S. Department of Health and Human Services. https://www.cdc.gov/diabetes/php/data-research/

Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S. E., Del Prato, S., Mathieu, C., Mingrone, G., Rossing, P., Tankova, T., Tsapas, A., & Buse, J. B. (2022). Management of hyperglycemia in type 2 diabetes, 2022: A consensus report by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 45(11), 2753-2786.

Kidney Disease: Improving Global Outcomes CKD Work Group. (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. https://kdigo.org/guidelines/ckd-evaluation-and-management/

U.S. Food and Drug Administration. (2024). Jardiance (empagliflozin) tablets: Highlights of prescribing information. https://www.accessdata.fda.gov/scripts/cder/daf/

Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., Mattheus, M., Devins, T., Johansen, O. E., Woerle, H. J., Broedl, U. C., & Inzucchi, S. E. (2015). Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. New England Journal of Medicine, 373(22), 2117-2128. https://doi.org/10.1056/NEJMoa1504720

How this NU 636 Unit 5 example is structured

This NU 636 Unit 5 example is arranged as a decision rather than as a survey of a drug class. The first sheet states the patient and the therapeutic problem, including the three indications any added agent has to answer. The second names one agent, gives its dose and mechanism, quantifies the effects expected, cites the outcome evidence, and argues the rejected alternatives down one at a time. The third turns the decision into a safety plan: what is measured and when, which interactions change the prescription, and what the patient is taught to watch for. Herzing University publishes no unit-by-unit deliverable name for Advanced Pharmacology; in many sections this unit asks for a drug therapy paper built on one patient, and your classroom instructions and rubric decide the exact form for graduate nurse practitioner work.

NU 636 Unit 5 questions, answered

What belongs in an NU 636 drug therapy paper besides the drug choice?

The choice is only the middle of it. A complete paper states the patient and the therapeutic problem first, then justifies one agent with dose, route, mechanism, expected effect sizes, and outcome evidence, then rejects the realistic alternatives on named grounds. It closes with a monitoring plan tied to specific timepoints, the interactions inside that patient's own medication list, and teaching in plain language.

Herzing does not publish a deliverable name for this unit, so what is the example based on?

The genre was inferred from the course and from where the unit sits in the term. Advanced Pharmacology courses commonly ask, once past the foundations, for a paper that applies drug therapy to one patient and defends the selection. Your classroom instructions and rubric decide the exact form, the number of sources, and whether a particular drug class is assigned.

Is it acceptable to admit another drug would also work?

Yes, and a specific concession usually raises the score. Naming the strongest rival, stating what would make it the better option, and then giving the reason it was not selected here demonstrates the reasoning behind the decision. What loses points is listing alternatives without deciding among them, or waving them away with a phrase such as less effective.

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NU 636 Unit 5: sample paper, in real form