Assignment: Pharmacotherapy for Cardiovascular Disorders

Posted: December 20th, 2022

Assignment: Pharmacotherapy for Cardiovascular Disorders

The administration of cardiovascular medication has a significant role in the treatment of cardiovascular illnesses. Pharmacotherapy is one of the therapeutic options that has been shown to be beneficial. One of these benefits is an improvement in the patients’ life quality, which comes from better symptom management. This paper seeks to discuss the case of BN, a 74-year-old African American male presenting with heart problems. The following will be covered in this paper: an explanation of the factors that influence the pharmacokinetics and pharmacodynamics processes of the patient BN; an examination of how these processes affect his medication treatment plan; an analysis of approaches in which his drug therapy plan may be improved.

How age might influence Pharmacokinetics and Pharmacodynamics

Age is one of the factors in BN that may have an effect on pharmacokinetic and pharmacodynamic processes. This is because he is a patient who is considered to be geriatric. As people become older, their stomachs produce less acid, which might make it more difficult for some medications to dissolve (Andres et al., 2019). It is possible that this patient’s solubility of the lisinopril medicine he takes will be impacted due to a decrease in the drug’s uptake and bioavailability. Aged people also have a decreased intestinal blood circulation, which further delays or reduces the amount of medication absorption that occurs Assignment: Pharmacotherapy for Cardiovascular Disorders

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Additionally, geriatric individuals may have approximately a third more fat than they had in their earlier years. As such, the center of the body, especially the areas surrounding the organs found within the abdomen, becomes increasingly surrounded by fatty tissue (Thürmann et al., 2020). This phenomenon has been found to lead to a rise in the diffusion of lipophilic medications like metoprolol.

The age of patient BN also has an impact on how drugs interact with the body due to alterations in the makeup of the body, metabolic activity, and organ function. There is a correlation between the patient’s age and the degree to which they respond favorably to certain medications. As people become older, they may experience a loss in their kidney function as well as a decrease in the number of nephrons that are still functioning (Thürmann et al., 2020). As such, it may become more difficult for patient BN to get drugs out of his body, which will raise the likelihood that he may experience drug poisoning. Assignment: Pharmacotherapy for Cardiovascular Disorders

How Changes in the Processes Might Impact the Patient’s Recommended Drug Therapy

The natural rise in PH that occurs with aging causes a slowdown in the clearing of the stomach, and diminished intestinal surface area can affect the pharmacokinetic properties of the many medications that BN is taking. For instance, Lisinopril may be absorbed both when taken orally and when it passes through the digestive system. Reduced stomach clearing may raise the amount of medicine absorbed through the digestive system; however, this may result in a reduction in bioavailability. Furthermore, a lower intestinal surface area can potentially result in a reduced space available for uptake. As people become older, their bodies naturally produce less total body water, which may cause a reduction in the uptake and diffusion of somewhat hydrophilic medications including digoxin (Drenth‐van Maanen et al., 2020). Moreover, the patient BN may experience a rise in the diffusion of lipophilic medications like metoprolol, which he uses for the treatment of high blood pressure. This rise is caused by the natural surge in the patient’s fat content that occurs with aging. There are additional metabolic changes that occur in the liver as a result of aging. Because of this, the pharmacokinetic mechanisms of diltiazem, digoxin, and lisinopril may be disrupted. It would thus be necessary to make adjustments to the patient’s medications, particularly those medications that are metabolized in the liver, in order to prevent buildup to hazardous concentrations. Assignment: Pharmacotherapy for Cardiovascular Disorders

How to improve the patient’s drug therapy

The medication regimen for this patient might potentially be improved by the use of a number of different approaches. According to Sotaskar (2020), prior to administering certain medications, a number of different tests need to be carried out beforehand. For example, it is necessary to evaluate the patient’s kidney efficiency in order to decide whether or not his dose of hydrochlorothiazide and lisinopril has to be adjusted. This is done so that the patient may achieve optimal blood pressure control. Before administering or making adjustments to any medications, it is also necessary to do an analysis of both the possible advantages and the adverse effects of such medications. By doing this, healthcare practitioners can guarantee that the patient is given only those medications that have the fewest potential side effects. Individuals with cardiovascular problems, diabetes, and the elderly are at increased risk for adverse effects from some medications, therefore medical professionals must take extra precautions (Rankin et al., 2018). Tofranil, Artane, Bentyl and are some examples of medications that should not be used in individuals who are 65 years of age or older. Most significantly, ensuring that patient BN attains a good level of health literacy is essential. As such, it would be important to educate him on the importance of taking his prescription medications as directed.

Conclusion

Conclusively, the age of the patient is one of the many considerations that should be examined prior to the selection of a certain pharmacological treatment for a patient. This is because, from this discussion, it is evident that a patient’s age as a factor may impact pharmacokinetic and pharmacodynamic processes. Assignment: Pharmacotherapy for Cardiovascular Disorders

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References

Andres, T. M., McGrane, T., McEvoy, M. D., & Allen, B. F. (2019). Geriatric pharmacology. Anesthesiology Clinics, 37(3), 475-492. https://doi.org/10.1016/j.anclin.2019.04.007

Drenth‐van Maanen, A. C., Wilting, I., & Jansen, P. A. (2020). Prescribing medicines to older people—How to consider the impact of ageing on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921-1930.

Rankin, A., Cadogan, C. A., Patterson, S. M., Kerse, N., Cardwell, C. R., Bradley, M. C., Ryan, C., & Hughes, C. (2018). Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews, 2018(9). https://doi.org/10.1002/14651858.cd008165.pub4

Satoskar, R. S., & Bhandarkar, S. D. (2020). Pharmacology and pharmacotherapeutics. Elsevier India.

Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anaesthesiology, 33(1), 109-113. https://doi.org/10.1097/aco.0000000000000814

Assignment: Pharmacotherapy for Cardiovascular Disorders

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

Photo Credit: Getty Images/Science Photo Library RF

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm Assignment: Pharmacotherapy for Cardiovascular Disorders

To Prepare

• Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
• Review the case study assigned by your Instructor for this Assignment.
• Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
• Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
• Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
• Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient. Assignment: Pharmacotherapy for Cardiovascular Disorders

By Day 7 of Week 2

Write a 2- to 3-page paper that addresses the following:

• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting. Assignment: Pharmacotherapy for Cardiovascular Disorders

Case study

Case Study 3

BN is a 74-year-old African American male who is seeing his PCP because he noticed when he woke up that his “heart was not beating right; it feels like it is going to slow.” He denies chest pain, SOB, N/V. He notes feeling dizzy earlier in the day. 6 weeks earlier his PCP started him on Diltiazem CD to further lower his BP to goal. His Metoprolol was lowered at that time as well from 75 mg to 50 mg BID. His PCP recommends he be admitted to the hospital.

Upon presentation to the hospital: Assignment: Pharmacotherapy for Cardiovascular Disorders

PMH:

• HTN x 7 years
• Type II DM
• CAD s/p angioplasty 2 years ago
• MI 3 years ago
• EF = 60%
• PVD s/p left femoral to posterior bypass
• Hx of A Fib x 4 years Assignment: Pharmacotherapy for Cardiovascular Disorders

Medications:

• Digoxin 0.25 mg QD
• KCl 40 mEq QD
• Vitamin C 500 mg QD
• Diltiazem CD 180 mg QD
• ASA EC 325 mg QD
• Vitamin E 400 IU QD
• Metoprolol 50 mg BID
• Warfarin 5 mg QD
• Ibuprofen 200 mg 2 tabs prn headache
• Lisinopril 20 mg QD
• Imdur 30 mg QD
• HCTZ 12.5 mg QD
• Humalog 8u with meals
• Lantus 26u QHS
• Ca++/Vit D 500mg/200 IU BID
• Famotidine 20 mg QHS
• Multivitamin QD

PE:

• BP 110/50
• Pulse 38 bpm
• Resp 14/min
• Rest of physical exam unremarkable

Labs:

• K+ 6.9
• Na+ 135
• Cr 1.9
• BUN 35
• Gluc 102
• Dig 2.78
• INR 2.3
• WBC 5,800/mm3
• Hct 35%

Rubric Detail

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Name: NURS_6521_Week2_Assignment_Rubric

	Excellent
Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.	23 (23%) – 25 (25%) The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. Assignment: Pharmacotherapy for Cardiovascular Disorders
Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. ORDER A PLAGIARISM-FREE PAPER HERE	27 (27%) – 30 (30%) The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy. Accurate, complete, and aligned examples are provided to support the response.
Explain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements. Assignment: Pharmacotherapy for Cardiovascular Disorders	27 (27%) – 30 (30%) The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan. The response includes an accurate and detailed explanation to support the recommended improvements.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.	5 (5%) – 5 (5%) Uses correct APA format with no errors

Name: NURS_6521_Week2_Assignment_Rubric

I have uploaded the directions, and rubric. The case study that must be used is included in the directions. Must have title page and reference page and also must have an introduction paragraph and a conclusion paragraph. Must be original writing because I have had too many close matches. Must have 5 references. Assignment: Pharmacotherapy for Cardiovascular Disorders