| Course | NURS 6521 Advanced Pharmacology |
|---|---|
| Week | Week 7 |
| Paper type | Neurologic prescribing decision tree |
| Length | About 1,070 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NURS 6521 Week 7
A Three-Decision Prescribing Tree for Episodic Migraine in a 29-Year-Old Woman Planning Pregnancy
Student Name
College of Nursing, Walden University
NURS 6521: Advanced Pharmacology
Instructor Name
Month Day, Year
A Three-Decision Prescribing Tree for Episodic Migraine in a 29-Year-Old Woman Planning Pregnancy
Patient Summary
Ms. A.R. is invented for this assignment. She is a 29-year-old dental hygienist with migraine without aura since her teens. Over the past six months she has had six or seven attacks a month, each lasting most of a day, with throbbing unilateral pain, nausea, and sensitivity to light. Ibuprofen 400 mg helps with milder attacks but not with severe ones, and she has missed four workdays this quarter. She and her husband plan to try to conceive within the next year. She has no cardiovascular disease, no hypertension, and no asthma. Her examination is normal. The tree below has three decision points: acute treatment, prevention, and response to the first review.
The Decision Tree
Decision 1, acute treatment: options sumatriptan (selected), higher-dose NSAID alone, or an opioid combination. Decision 2, prevention: options propranolol (selected), topiramate, or valproate. Decision 3, at the 12-week review with attack frequency down from seven to four a month: options continue and reassess (selected), increase the propranolol dose, or add a second preventive. In the submitted diagram, the selected branch at each node is highlighted and the rejected branches are shaded but labeled, with a one-line reason printed beneath each.
Decision 1: Acute Treatment
Situation: moderate to severe attacks that an over-the-counter NSAID does not control. Choice: sumatriptan 50 mg orally at the onset of headache, repeated once after two hours if needed, with no more than two doses in 24 hours. She is taught to take it early in the attack, while pain is still mild, because triptans work best before central sensitization develops, and to keep a headache diary recording each attack, each dose, and the response, which will be the evidence used at every later decision point.
Rationale: triptans are agonists at serotonin 5-HT1B and 5-HT1D receptors. Activation of 5-HT1B receptors constricts dilated cranial blood vessels, and activation of 5-HT1D receptors on trigeminal nerve terminals inhibits release of calcitonin gene-related peptide and other neuropeptides that drive neurogenic inflammation and pain transmission. That dual action targets the mechanism of the attack, which is why triptans are first-line for moderate to severe migraine when simple analgesics fail (Ailani et al., 2021). She has no coronary, cerebrovascular, or uncontrolled hypertensive disease, the conditions in which the vasoconstrictive effect contraindicates the class.
Rejected alternatives: a higher NSAID dose alone was set aside because her severe attacks have not responded to ibuprofen, and raising the dose adds gastrointestinal risk without addressing the trigeminovascular mechanism. An opioid combination was rejected because opioids are less effective for migraine than triptans and carry a high risk of medication overuse headache and dependence, and guidance advises against their routine use (Ailani et al., 2021).
Expected outcome: freedom from pain or meaningful relief within two hours for most attacks, with fewer missed workdays.
Ethical consideration: because she may conceive while using sumatriptan, she is told what is known. A prospective cohort study of women exposed to triptans in pregnancy found no increase in major birth defects compared with women with migraine who did not use them (Spielmann et al., 2018). She is told that the data are reassuring but not complete, so she can decide whether to continue it once she is pregnant.
Decision 2: Prevention
Situation: six or seven attacks a month with lost workdays, which meets accepted thresholds for starting prevention, in a woman planning pregnancy. Choice: propranolol, starting at 40 mg of the extended-release form daily and increasing toward 80 to 160 mg as tolerated.
Rationale: propranolol has Level A evidence for migraine prevention (Silberstein et al., 2012). Its mechanism in migraine is not fully established; proposed actions include reduced central noradrenergic activity, stabilization of cortical excitability that may reduce cortical spreading depression, and effects on the thalamus. What makes it fit this patient is its safety profile in pregnancy relative to the alternatives. Beta blockers have long been used in pregnancy for hypertension, and although they are associated with lower birth weight, they are not major teratogens. She has no asthma, which would contraindicate a nonselective beta blocker.
Rejected alternatives: valproate was explicitly set aside because it is a major teratogen, causing neural tube defects and other malformations and reducing later cognitive development after exposure in pregnancy; guidance advises against its use for migraine prevention in women who may become pregnant (Ailani et al., 2021). Topiramate also has Level A evidence, but it is associated with an increased risk of oral clefts after first-trimester exposure and, at higher doses, reduces the effectiveness of hormonal contraception, both unwelcome in a woman planning conception on her own timeline (Rosenthal & Burchum, 2021).
Expected outcome: a reduction in attack frequency of at least 50 percent within two to three months, the usual threshold for a successful preventive trial.
Ethical consideration: the ethical issue here is reproductive autonomy. Rather than simply avoiding valproate and topiramate without comment, the plan explains why they were not chosen, so that if another clinician suggests them later she can recognize the risk and ask about it.
Decision 3: Response at 12 Weeks
Situation: after 12 weeks on propranolol 80 mg, her attacks have fallen from seven a month to four, a reduction of about 43 percent, with shorter and less severe attacks and one missed workday. She has mild fatigue but no dizziness, and her resting heart rate is 62. Choice: continue the current dose and reassess in eight weeks.
Rationale: preventive medicines often continue to improve for several months after a dose is reached, and her response is already close to the 50 percent threshold. Increasing the dose would add to her fatigue and lower her heart rate further, with uncertain added benefit.
Rejected alternatives: raising the propranolol dose was deferred rather than excluded, as the next step if improvement stalls. Adding a second preventive was rejected because combination prevention adds adverse effects and, with pregnancy planned, a second drug exposure without clear need.
Expected outcome: four or fewer attacks a month at the next review, ideally trending toward three, with sumatriptan used on no more than nine days a month to avoid medication overuse headache.
Ethical consideration: choosing not to change therapy requires honesty about expectations. She is told that prevention rarely eliminates migraine and that a partial response may be the realistic goal, so that the decision to continue is made together rather than presented as a delay.
References
Ailani, J., Burch, R. C., & Robbins, M. S. (2021). The American Headache Society consensus statement: Update on integrating new migraine treatments into clinical practice. Headache, 61(7), 1021-1039. https://doi.org/10.1111/head.14153
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
Silberstein, S. D., Holland, S., Freitag, F., Dodick, D. W., Argoff, C., & Ashman, E. (2012). Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology, 78(17), 1337-1345. https://doi.org/10.1212/WNL.0b013e3182535d20
Spielmann, K., Kayser, A., Beck, E., Meister, R., & Schaefer, C. (2018). Pregnancy outcome after anti-migraine triptan use: A prospective observational cohort study. Cephalalgia, 38(6), 1081-1092. https://doi.org/10.1177/0333102417724152
Reading the NURS 6521 Week 7 instructions
Week 7 of NURS 6521 asks you to build a decision tree for prescribing in a neurologic condition. Set out each decision point, list options, choose one with a rationale tied to the patient and plan the review. Each decision is usually graded separately, so a weak final decision cannot be rescued by a strong first one. Cite guidelines in APA 7. Another neurologic condition can be used if the prompt allows. Choosing not to change therapy at review can be correct when the goal is met. Doses can be included where the prompt asks. Name the pregnancy plan's effect on each choice. Draw the tree as a simple diagram or numbered outline, then explain each decision in its own short section.
How the NURS 6521 Week 7 example is put together
The tree itself is a single page: three decision points, each offering three options, with the selected branch highlighted and the others shaded but still labeled. Under it, the written rationale runs about four pages, one section per decision. Decision one chooses a triptan for acute attacks, explaining serotonin receptor agonism and cranial vasoconstriction, and rules out an opioid for its rebound and dependence risk. Decision two chooses a preventive class and explicitly sets aside an anticonvulsant known for teratogenic risk because the patient is planning a pregnancy. Decision three responds to a partial reduction in attack frequency, choosing to continue and reassess rather than add a second agent. Each section states the expected outcome of the chosen branch and the ethical consideration it raised for this patient.
Reading the NURS 6521 Week 7 rubric
Most rubrics for this tree assess each decision on its own row, so a weak third decision cannot be rescued by a strong first one. Rationale is the dominant criterion at each node, and it asks for mechanism tied to the patient, not a description of the drug. Rejected options earn points when they are explained, and trees that show only the chosen path forfeit that share entirely. Expected outcomes are often underdeveloped; one sentence per decision saying what success would look like is the minimum graders look for. Ethical considerations are scored separately in many sections and lose points when informed consent is repeated at every node without variation. The diagram's clarity carries a small presentation mark of its own.
NURS 6521 Week 7 help: mistakes that cost marks
Decision trees score poorly when one branch has thin reasoning. Give each decision equal care. A second weakness is ignoring pregnancy plans. Let them shape prevention. Writers also skip the review step. Define what success looks like at 12 weeks. Avoid valproate in a woman planning pregnancy. Explain why. Draw the tree clearly. A rationale noting that topiramate can reduce contraceptive effectiveness and carries birth defect risk shows patient-specific reasoning. Close with the condition that would change the plan. Give each branch the same structure: options, choice, rationale.
Get a NURS 6521 Week 7 example written to your instructions
Decision trees in this week are often built on a video case your instructor assigns, so send that case, the prompt, the rubric and any template for the diagram. Diagram and rationale come back complete in 24 to 48 hours, and the first custom one is free. The migraine patient here is illustrative, standing in for whoever your case presents.
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NURS 6521 Week 7 questions, answered
Can the tree be about a condition other than migraine?
Yes, and many sections assign a different one, including seizure disorders, Parkinson disease and chronic musculoskeletal pain. The example uses migraine because pregnancy planning creates a patient factor that affects every decision. Send the condition and case your section uses and the tree is rebuilt around it, keeping three decisions with visible rejected branches.
Why does the third decision choose not to change anything?
Because partial benefit is a real clinical situation and continuing therapy is a legitimate choice that still requires justification. A tree that adds or switches a drug at every node can read as reflexive. The example sets out the case for waiting, defines the outcome that would count as failure, and names the point at which the choice gets revisited; grading on this node concentrates there.
Does the tree state doses for the chosen agents?
No. The example names classes and agents and argues mechanism, but it omits amounts, titration and frequency throughout. If your template has a field for dosing, fill it from the current drug references named in your syllabus, checked against the patient in your case. A sample page cannot responsibly supply numbers for a patient it has never assessed.
Where can I find a free NURS 6521 Week 7 sample paper?
The migraine prescribing tree is reproduced here with the patient summary and three decisions on acute treatment, prevention and review.
Why propranolol for prevention in NURS 6521 Week 7?
It has more reassuring pregnancy data than topiramate or valproate, which matters because she plans to conceive within a year.