For one composite 86-year-old man, NU553's Unit 10 deprescribing plan reduces insulin first, stops a statin next and tapers a proton pump inhibitor last, ordering the changes by risk. Searches like "nu 553 unit 10 assignment example", "nu553 unit 10 sample" and "nu553 unit 10 example" land here.
Eleven Medicines, Three Changes: A Deprescribing Plan for an 86-Year-Old With Heart Failure and Diabetes
[Student Name]
Purdue University Global
NU553: Advanced Pharmacology and Pharmacotherapeutics
Unit 10 Deprescribing Plan
[Instructor Name]
[Date]
The patient is a composite; amounts are bracketed composite values and the plan is not dosing guidance.
1. The Patient and the Question
Mr. [W.], 86, ran a grain elevator for forty years. He lives alone in a small town, and his daughter drives in twice a week. His heart failure is the reduced-ejection-fraction kind, not caused by coronary disease, with symptoms on moderate exertion; type 2 diabetes for twenty years; benign prostatic enlargement; and knee arthritis. His kidney function is moderately reduced, with an eGFR of [42]. His A1C is [6.1] percent, and his meter shows two readings below 70 mg/dL in the past eight weeks, one at 3 a.m.
His daughter asked, "Which of these does he still need?" Deprescribing is the planned, supervised process of stopping or reducing medicines whose harms now outweigh their benefits, and it proceeds one agent at a time with monitoring (Scott et al., 2015).
2. The Medication Table
1. Sacubitril-valsartan. Indication: heart failure. Benefit: fewer admissions and deaths. Harm: low pressure, potassium. Verdict: continue.
2. Carvedilol. Indication: heart failure. Benefit: survival. Harm: fatigue, slow pulse. Verdict: continue.
3. Spironolactone. Indication: heart failure. Benefit: survival. Harm: potassium. Verdict: continue with checks.
4. Empagliflozin. Indication: heart failure and diabetes. Benefit: fewer heart failure admissions. Harm: genital infection, volume loss. Verdict: continue.
5. Furosemide. Indication: congestion. Benefit: symptom control. Harm: volume depletion. Verdict: continue at lowest effective amount.
6. Metformin [composite], within the limit for his kidney function. Indication: diabetes. Benefit: glucose control without hypoglycemia. Harm: gastrointestinal effects. Verdict: continue.
7. Insulin glargine [composite] units nightly. Indication: diabetes. Benefit: glucose control. Harm: hypoglycemia, two episodes in eight weeks. Verdict: REDUCE.
8. Atorvastatin. Indication: primary prevention. Benefit: small, over years. Harm: muscle aches, pill burden. Verdict: STOP.
9. Pantoprazole. Indication: esophagitis six years ago, healed. Benefit: none now. Harm: long-term risks, pill burden. Verdict: TAPER.
10. Tamsulosin. Indication: urinary symptoms. Benefit: urine flow. Harm: dizziness on standing. Verdict: continue, review at each visit.
11. Acetaminophen as needed. Indication: knee pain. Benefit: pain relief. Harm: minimal at his use. Verdict: continue.
3. The Plan in Sequence
The plan is sequenced by the harm each agent is causing now, not by how easy it is to stop. Changes are spaced so that any new symptom points back to a single step.
Step 1, week 0: reduce insulin glargine. Hypoglycemia in a man living alone is the most immediate danger; a 3 a.m. low with no one in the house can cause a fall, an arrhythmia or worse. His A1C of 6.1 percent reflects a target set for a younger man. Current diabetes standards call for less stringent glycemic goals in older adults with complex or intermediate health, for example an A1C below 8.0 percent, and make avoiding hypoglycemia a priority (American Diabetes Association Professional Practice Committee, 2025). The dose is reduced by [composite] percent, with home glucose checks before breakfast and at bedtime, a written target range of [100 to 200] mg/dL, and instructions to call for any reading below 90 or above 300.
Step 2, week 4: stop atorvastatin. He takes it for primary prevention. The benefit of a statin in preventing a first cardiovascular event accrues over years, and with advanced heart failure at 86 his time horizon is limited. In a randomized trial of adults with advanced, life-limiting illness, stopping statins did not significantly increase deaths within 60 days and was associated with better quality of life (Kutner et al., 2015). A statin can stop without tapering. The plan says this plainly, and it records that Mr. [W.] and his daughter agreed after hearing that the drug was unlikely to add to his years and that stopping removed one daily tablet and the muscle aches he blamed on it.
Step 3, week 8: taper pantoprazole. It was started six years ago for esophagitis that healed long ago, and he has no ongoing indication, such as Barrett esophagus or a history of bleeding ulcers. Stopping a proton pump inhibitor abruptly can cause rebound acid secretion and heartburn that is easily mistaken for the original disease. Following an evidence-based deprescribing guideline, the dose is halved for [four] weeks, then stopped, with an antacid or an as-needed H2 blocker available for occasional symptoms (Farrell et al., 2017).
4. Why the Other Eight Stay
Sacubitril-valsartan, carvedilol and spironolactone reduce deaths and admissions in heart failure with reduced ejection fraction. Empagliflozin reduces heart failure admissions and serves his diabetes without causing hypoglycemia on its own. Furosemide controls congestion and is kept at the lowest effective amount. Metformin controls glucose without hypoglycemia and is within the limit for his kidney function. Tamsulosin relieves urinary symptoms he values, though it is reviewed for dizziness. Acetaminophen is his safest analgesic, and NSAIDs are avoided in heart failure (American Geriatrics Society Beers Criteria Update Expert Panel, 2023).
5. The Grid of Checks
1. Weeks 1 to 4: glucose log reviewed by phone weekly; call for any low.
2. Week 4: visit. Glucose log, weight, blood pressure; confirm the insulin change is holding before stopping the statin.
3. Week 8: phone check on muscle aches and any new symptoms; begin the pantoprazole taper.
4. Week 12: visit. Glucose log, heartburn symptoms, potassium and kidney function, weight.
5. Month 6: A1C, aiming for below 8.0 percent without lows.
6. What Would Reverse Any Step
1. Insulin: fasting glucose repeatedly above [250] mg/dL or symptoms of high glucose would prompt a partial return of the dose.
2. Atorvastatin: a new diagnosis that changes his prognosis, or a strong preference to resume, would reopen the question.
3. Pantoprazole: heartburn that persists beyond the rebound period, difficulty swallowing, weight loss or bleeding would prompt evaluation and possible restart.
References
American Diabetes Association Professional Practice Committee. (2025). Standards of care in diabetes 2025. Diabetes Care, 48(Suppl. 1), S1-S352. https://diabetesjournals.org/care
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
Farrell, B., Pottie, K., Thompson, W., Boghossian, T., Pizzola, L., Rashid, F. J., Rojas-Fernandez, C., Walsh, K., Welch, V., & Moayyedi, P. (2017). Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Canadian Family Physician, 63(5), 354-364.
Kutner, J. S., Blatchford, P. J., Taylor, D. H., Ritchie, C. S., Bull, J. H., Fairclough, D. L., Hanson, L. C., LeBlanc, T. W., Samsa, G. P., Wolf, S., Aziz, N. M., Currow, D. C., Ferrell, B., Wagner-Johnston, N., Zafar, S. Y., Cleary, J. F., Dev, S., Goode, P. S., Kamal, A. H., ... Abernethy, A. P. (2015). Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: A randomized clinical trial. JAMA Internal Medicine, 175(5), 691-700. https://doi.org/10.1001/jamainternmed.2015.0289
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., Gnjidic, D., Del Mar, C. B., Roughead, E. E., Page, A., Jansen, J., & Martin, J. H. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827-834. https://doi.org/10.1001/jamainternmed.2015.0324
How this NU553 Unit 10 example is structured
The plan is sequenced by the harm each agent is causing now, not by how easy it is to stop. Hypoglycemia in a man living alone is the most immediate danger, so insulin changes first, with home glucose checks and a relaxed target written down. The statin follows because it can stop without tapering and its benefit depends on years he may not have; the plan says this plainly and records that the daughter and patient agreed after hearing it. The proton pump inhibitor comes last because its taper takes weeks and rebound heartburn could be mistaken for the original disease. Changes are spaced so that any new symptom points back to a single step. A continuing section explains why the other eight agents stay, each in a sentence, and the plan closes with what would reverse any step.
Get an NU553 Unit 10 example written to your instructions
Only four things are needed from an NU553 Unit 10 deprescribing case: the medication list, the history, any goals the patient or family have voiced, and the rubric. Expect the first plan free, within 24-48h: each change justified with dated evidence, sequenced by current harm, given its own method and monitoring, and set beside a reasoned list of what stays. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU553 Unit 10 questions, answered
How many medications should a deprescribing plan change?
As many as the evidence supports, but usually not all at once. Most cases reward choosing the few agents with the clearest harm and sequencing them, rather than attempting a complete overhaul in one visit. The sample changes three of eleven and explains why the rest continue, which shows judgment in both directions.
Which criteria should a deprescribing plan cite?
It depends on the drug. The AGS Beers Criteria and STOPP/START flag potentially inappropriate medications broadly, while drug-specific deprescribing guidelines, such as the 2017 proton pump inhibitor guideline, describe how to stop. The sample uses the drug-specific sources because the plan's question is method as much as whether, and each citation carries its year.
What if the patient does not want to stop a medicine?
Then the plan records that preference and respects it, with the reasoning the patient heard. Deprescribing is a shared decision, and a plan that overrides a clear refusal fails on ethics however sound the pharmacology. The sample notes the daughter's question and the patient's agreement, and it describes how the conversation about the statin was framed.