CPE Schedule and Analysis: Alzheimer's Disease Insights

CPE Evidence Phase 1 Thursday, July 27, 2023 9:23 PM 1a. CPE schedule table of tasks and timelines developed for this experience Phase One Tasks Estimated Time Date Completed CPE Schedule Table 0.5hr 07/30 Feedback and Synthesis Improvement Plan 2hr 08/09 GOReact Video and 2 Responses 1.5 Hours 08/29 Phase Two Tasks Estimated Time Date Completed Feedback and Synthesis Improvement Plan 0.5hr 08/14 GOReact Video and 2 Responses 1hr 08/29 Phase Three Tasks Estimated Time Date Completed Feedback and Synthesis Improvement Plan 0.5hr 08/26 Feedback and Synthesis Improvement Treatment Plan 0.5hr 08/27 GOReact Video and 2 Responses 0.5hr 08/29 1b. Feedback and Synthesis Improvement Plan Original

"Alzheimer's is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life" (Alzheimer's Association, n.d). While the exact cause of Alzheimer's is still unknown, risk factors and predispositions are widely contributed to its diagnosis. There is no current medicine or procedure to cure Alzheimer, however, there is a course of medication to help slow the progression down. A family history of this disease is one of the biggest risk factors. Having parents or grandparents with this disease can pose a possible indicator for developing this disease. The other risk factors include diet, comorbidities like diabetes, smoking, lack of exercise, and cognitive inactivity (Li et al, 2023). Possible pathogenic mechanisms linked to aberrant protein palmitoylation mediated by ZDHHC21 mutations. (Li et al, 2023). "Protein palmitoylation is a widespread lipid modification in which one or more cysteine thiols on a substrate protein are modified to form a thioester with a palmitoyl group" (Guan & Fierke, 2011). Discovering this possible gene mutation link can lead to the prevention or management of early stages. Early stages of Alzheimer's start as memory deficits and forgetfulness. Memory loss progresses to disorientation, lack of judgment mood alterations, and eventually motor function loss. The only way to definitively diagnose is through autopsy. The drastic changes of Alzheimer's are associated with unhealthy changes in the brain like improperly shaped proteins outside brain cells, affecting communication between different brain cells. This physiological change affects nutrient absorption within the brain cells causing

insufficient energy production. Cholinesterase inhibitors and N-methyl-D-aspartate are used in moderate to severe cases to help slow the progression. (Li et al, 2023). References Alzheimer's Association (n.d). What is Alzheimer’s Disease? https://www.alz.org/alzheimersdementia/what-is-alzheimers Guan, X., & Fierke, C. A. (2011). Understanding Protein Palmitoylation: Biological Significance and Enzymology. Science China. Chemistry, 54(12), 1888–1897. https://doi.org/10.1007/s11426-011-4428-2. Li, W., Pang, Y., Wang, Y., Mei, F., Guo, M., Wei, Y., Li, X., Qin, W., Wang, W., Jia, L., & Jia, J. (2023). Aberrant palmitoylation caused by a ZDHHC21 mutation contributes to the pathophysiology of Alzheimer's disease. BMC Medicine, 21(1), 1–17. https://doi.org/10.1186/s12916-023-02930-7 Feedback Need to change • Rearrange information for more cohesive and streamlined information • Need smoother transitions between paragraphs Positive feedback • Credited sources • Topics from simple to complex • Clear explanation of what Alzheimer’s is.

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Revised after feedback "Alzheimer's is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life" (Alzheimer's Association, n.d). While the exact cause of Alzheimer's is still unknown, risk factors and predispositions are widely contributed to its diagnosis. There is no current medicine or procedure to cure Alzheimer, however, there is a course of medication to help slow the progression down. The development of Alzheimer's is influenced by a combination of genetic, lifestyle, and environmental factors. A family history of this disease is one of the biggest risk factors. Having parents or grandparents with this disease can pose a possible indicator for developing this disease. The other risk factors include diet, comorbidities like diabetes, smoking, lack of exercise, and cognitive inactivity (Li et al, 2023). Possible pathogenic mechanisms linked to aberrant protein palmitoylation mediated by ZDHHC21 mutations. (Li et al, 2023). "Protein palmitoylation is a widespread lipid modification in which one or more cysteine thiols on a substrate protein are modified to form a thioester with a palmitoyl group" (Guan & Fierke, 2011). While research is ongoing into the biological causes, the symptoms of Alzheimer's are more evident. Early stages of Alzheimer's start as memory deficits and forgetfulness. Memory loss progresses to disorientation, lack of judgment mood alterations, and eventually motor function loss. The only way to definitively diagnose is through autopsy. The drastic changes of Alzheimer's are associated with unhealthy changes in the brain like improperly shaped proteins outside brain cells, affecting communication between different

brain cells. This physiological change affects nutrient absorption within the brain cells causing insufficient energy production. Cholinesterase inhibitors and N-methyl-D-aspartate are used in moderate to severe cases to help slow the progression (Li et al, 2023). References Alzheimer's Association (n.d). What is Alzheimer’s Disease? https://www.alz.org/alzheimersdementia/what-is-alzheimers Guan, X., & Fierke, C. A. (2011). Understanding Protein Palmitoylation: Biological Significance and Enzymology. Science China. Chemistry, 54(12), 1888–1897. https://doi.org/10.1007/s11426-011-4428-2. Li, W., Pang, Y., Wang, Y., Mei, F., Guo, M., Wei, Y., Li, X., Qin, W., Wang, W., Jia, L., & Jia, J. (2023). Aberrant palmitoylation caused by a ZDHHC21 mutation contributes to the pathophysiology of Alzheimer's disease. BMC Medicine, 21(1), 1–17. https://doi.org/10.1186/s12916-023-02930-7

1c.

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Reflection I chose Alzheimer's as my topic, due to my lack of knowledge I had on this disease process. I wanted to choose something that I could expand my knowledge on and learn the basic pathophysiology. I learned a lot from this assignment, including broadening the basic information I already had on this specific topic. CPE Evidence Phase 2 Thursday, July 27, 2023 9:23 PM 2b. Original There are two different kinds of strokes: hemorrhagic and ischemic. “Stroke is the second leading cause of death and a major contributor to disability worldwide” (Kuriakose & Xiao, 2020). Ischemic strokes are the most common types of strokes. There are known risk factors associated with strokes, as well as common diagnostic methods, medications to manage and help prevent, and lifestyle changes that are necessary for stroke prevention.

A stroke can be defined as an interruption of blood flow to the brain. This can be caused by a blockage or leak in the artery. A blockage or leak cause a lack of oxygen to the brain, if it is a prolonged period it can lead to devastating or fatal outcomes. Some of the clinical manifestations can include trouble speaking, understanding speech, weakness, numbness, severe headache, and blurry or loss of vision (National Heart, Lung, and Blood Institute, 2023). The way to definitively diagnose a stroke can be done with an MRI. Other tests can include CT scans, blood tests, PET, and blood tests. After diagnosis, there is a scale used to evaluate neurological function. This scale is called the National Institutes of Health Stroke Scale, or NIHSS. This is done by asking the patient a series of questions and actions to perform to grade. Depending on the type of stroke that has been diagnosed, the course of treatment could be anything from emergency medication to surgery. In an ischemic stroke if identified early enough a drug called tPA is given to help dissolve blood clots. Angioplasty and stenting are another form of treating an ischemic stroke. In a hemorrhagic stroke most often a coil embolization is used to cut off the bleeding. In the prevention of having another stroke, appropriate lifestyle changes and medication regimen is necessary. Medication controlling blood pressure and cholesterol is the most common way to help prevent reoccurring strokes. Exercise and healthy eating are other important aspect to keep risk factors for stroke down (National Heart, Lung, and Blood Institute, 2023). References Kuriakose, D., & Xiao, Z. (2020). Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. International Journal of Molecular Sciences, 21(20), 7609. https://doi.org/10.3390/ijms21207609 National Heart, Lung, and Blood Institute. (2023). Stroke: What is a Stroke? https://www.nhlbi.nih.gov/health/stroke/symptoms

Feedback Need to change • Nothing Positive feedback • Well explained • Interesting • Smooth transitions 2c.

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Reflection I enjoyed doing this assignment due to the fact that I came from a neuro background so it was nostalgic being able to use some of the information I already had and freshen up on information I had forgotten about. I mentioned that this assignment was difficult in the fact that it had to be kept to one page.

CPE Evidence Phase 3 Thursday, July 27, 2023 9:23 PM 3b. Original Shadow Health’s Makayla Henderson was diagnosed with a urinary tract infection with antibiotic sensitivity. This patient came into the office complaining of burning sensation and frequent urination. This patient needed to be educated on care, medication, and follow up information on UTIs. “Urinary tract infections (UTIs) rank as the most common bacterial infections” (Faiza et al, 2023). Some of the common causes of a UTI are sexual activity, pregnancy, poor hygiene, etc. Symptoms associated with a UTI are pain or burning during urination, frequency, and blood in the urine. Our patient Makayla Henderson was experiencing most of these symptoms. The patient was educated on the importance of urinating before and after sexual activity. This patient has a UTI with antibiotic resistance so antibiotic compliance with that information is imperative. Makayla also expressed she was taking cranberry supplements as well as cutting down on her water intake. I educated on how water consumption should be increased to help flush the bacteria out. Cranberry supplements are not effective in treating UTIs. The medication that is best suited for this situation is Nitrofurantoin. The other medication prescribed to Makayla was Phenazopyridine to help with symptom relief. Makayla was educated on the medications prescribed to her including taking the full course of medication. “Taking the entire course of an antibacterial medication is important to ensure that the disease-causing bacteria are killed or unable to reproduce within the patient’s

body, allowing the infection to return” (White, 2022). I let the patient know that it is a common side effect for phenazopyridine to turn urine bright orange. Refrences Faiza Asghar, Sardar Muhammad, Aftab Ahmad Anjum, Tehreem Ali, Abdul Shaheed Asghar, Sobia Naureen, & Rabia Manzoor,. (2023). Multi-drug resistance pattern of bacterial isolates from urinary tract infection. Pakistan Journal of Pharmaceutical Sciences, 36(4), 1107–1112. White, B. (2022). Why finishing your antibiotics is crucial . Legacy Community Health. https://www.legacycommunityhealth.org/newsblog-why-finishing-your-antibiotics- iscrucial/#:~:text=%E2%80%9CTaking%20the%20entire%20course%20of,Director%20of %20Pharmacy%20Services%20%26%20Outreach. Feedback Need to change • Include the common types of bacteria • Why UTIs are more common for women • More medications commonly used Positive feedback • Interesting facts • Informational

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Revised Shadow Health’s Makayla Henderson was diagnosed with a urinary tract infection with antibiotic sensitivity. This patient came into the office complaining of burning sensation and frequent urination. This patient needed to be educated on care, medication, and follow up information on UTIs. “Urinary tract infections (UTIs) rank as the most common bacterial infections” (Faiza et al, 2023).The most common types of bacteria associated with UTI are Escherichia coli, Staph. aureus, and Klebsiella. Some of the common causes of a UTI are sexual activity, pregnancy, poor hygiene; like wiping incorrectly, etc. Symptoms associated with a UTI are pain or burning during urination, frequency, and blood in the urine. Our patient Makayla Henderson was experiencing most of these symptoms. The patient was educated on the importance of urinating before and after sexual activity. This patient has a UTI with antibiotic resistance so antibiotic compliance with that information is imperative. Makayla also expressed she was taking cranberry supplements as well as cutting down on her water intake. I educated on how water consumption should be increased to help flush the bacteria out. Cranberry supplements are not effective in treating UTIs. The medication that is best suited for this situation is Nitrofurantoin. Other medications commonly used to treat UTIs are sulfonamide, ciprofloxacin, and ampicillin. The other medication prescribed to Makayla was Phenazopyridine to help with symptom relief. Makayla was educated on the medications prescribed to her including taking the full course of medication. “Taking the entire course of an antibacterial medication is important to ensure that the disease-causing bacteria are killed or unable to reproduce within the patient’s

body, allowing the infection to return” (White, 2022). I let the patient know that it is a common side effect for phenazopyridine to turn urine bright orange. Refrences Faiza Asghar, Sardar Muhammad, Aftab Ahmad Anjum, Tehreem Ali, Abdul Shaheed Asghar, Sobia Naureen, & Rabia Manzoor,. (2023). Multi-drug resistance pattern of bacterial isolates from urinary tract infection. Pakistan Journal of Pharmaceutical Sciences, 36(4), 1107–1112. White, B. (2022). Why finishing your antibiotics is crucial . Legacy Community Health. https://www.legacycommunityhealth.org/newsblog-why-finishing-your-antibiotics- iscrucial/#:~:text=%E2%80%9CTaking%20the%20entire%20course%20of,Director%20of %20Pharmacy%20Services%20%26%20Outreach. 3c. Treatment Plan The treatment plan for a urinary tract infection includes as assessment with an advanced medical professional. This will determine the range of symptoms the patient is having. Conducting an assessment is also one of the ways to determine if the infection has possibly spread to the kidneys. There are multiple diagnostic tests that can be run to determine a UTI. One of the diagnostics is a leukocyte esterase dip test, it is 90% accurate in detecting white blood cells in urine. A urine culture & sensitive and urinalysis are also other diagnostics that can be run. A positive test requires medication to help clear the infection. An antibiotic is prescribed to help clear up the UTI. Some of the common antibiotics are Nitrofurantoin, Fosfomycin, ciprofloxacin, amoxicillin, and ampicillin. The symptoms of a UTI like burning and urgency can be quite unpleasant so a medication to treat the symptoms is also prescribed in conjunction with an antibiotic. Phenazopyridine is a urinary analgesic that helps relieves symptoms but is not treatment for the infection. Some of the common side effects associated with these antibiotics are dizziness, headache, diarrhea, and nausea. Phenazopyridine has side effects that consist of bright orange urine, rash, and nausea.

Feedback Need to add • What is the normal course of antibiotics? • Type of bacteria? Revised Treatment Plan The treatment plan for a urinary tract infection includes as assessment with an advanced medical professional. This will determine the range of symptoms the patient is having. Conducting an assessment is also one of the ways to determine if the infection has possibly spread to the kidneys. There are multiple diagnostic tests that can be run to determine a UTI. One of the diagnostics is a leukocyte esterase dip test, it is 90% accurate in detecting white blood cells in urine. A urine culture & sensitive and urinalysis are also other diagnostics that can be run. A positive test requires medication to help clear the infection. An antibiotic is prescribed to help clear up the UTI. Some of the common antibiotics are nitrofurantoin, fosfomycin, ciprofloxacin, amoxicillin, and ampicillin. The course of antibiotics range from 3 to 7 days. The symptoms of a UTI like burning and urgency can be quite unpleasant so a medication to treat the symptoms is also prescribed in conjunction with an antibiotic. Phenazopyridine is a urinary analgesic that helps relieves symptoms but is not treatment for the infection. Some of the common side effects associated with these antibiotics are dizziness, headache, diarrhea, and nausea. Phenazopyridine has side effects that consist of bright orange urine, rash, and nausea.

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3d.

Reflection This assignment was lengthy, the shadow health modules had a lot to them so it did take a lot of time. I hadn't used this program since nursing school so it's been a while since I have done something like this. I chose the UTI because I felt like it had an interesting caveat of have an antibiotic resistance so it made choosing the right medication more dynamic. As for as the treatment plan, I mentioned in my video reflection that I wish there was an example or format provided just so it was more uniformed. Other students had mentioned doing it differently so I hope the correct information was provided in mine.

PathoPharmo CPE

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