Week 2 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

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.

By Day 2 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.

More Directions

• Explain how the factor (i.e. genetics, gender, ethnicity, age or behavior) 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. Would you discontinue any medications, change the dosage, and/or add medications to the patient’s regimen? DISCUSS EACH MEDICATION.

Case study assigned

LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.

 

PMH:

• HTN
• Alzheimer’s disease
• Hypothyroidism
• Osteoarthritis
• Diabetes

 

MEDICATIONS:

• Amlodipine 10 mg QD
• Donepezil 10 mg QHS
• Levothyroxine 88 mcg QAM
• Celecoxib 200 mg QD
• Furosemide 40 mg QAM
• Metformin 500mg, 1 BID
• Glyburide 5mg, 1 BID

 

ALLERGIES: NKA

 

SOCIAL HISTORY:

Widowed with 2 adult children living in town, retired photographer and owner of an art supply store

 

VITALS:                         LABS:

Weight: 129 lbs                   TSH 2.45, Free T4 0.98

Height: 64 inches                  Na 135, K+ 3.5, Cl 99, CO2 25

BP: Supine = 177/82              Glucose 101

HR: 78 bpm                       WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1, Plt 255

             BUN 42, Cr 1.6, UA Clear

             eGFR: 45 ml/min

PE:

• HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI
• CV: RRR
• Respiratory: Clear to auscultation bilaterally
• Abdomen: Soft, non-tender, no masses or guarding
• G/U: Skin intact, assisted with toileting and personal hygiene by staff
• Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
• Neuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months

 

PAIN ASSESSMENT:

Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severe

Solution

Pharmacotherapy for Cardiovascular Disorders

 

Student

Institution Affiliation

Professor

Date

 

 

Introduction

Chronic cardiovascular diseases, including hypertension and hyperlipidemia, require lifelong treatment plans. Since the planned treatment programs for hypertension and hyperlipidemia are meant for long-term usage, evaluating several criteria before prescribing medications to patients is important. Consider age, behavior, ethnicity, genetics, and gender as just a few examples. The purpose of this paper is to analyze the pharmacokinetic (PK) and pharmacodynamic(PD) processes in the case study concerning the influence of “age.” Changes in pharmacokinetics and pharmacodynamics will be evaluated, as will their effect on the patient’s treatment plan. Finally, a set of suggestions for improving the patient’s pharmaceutical therapy plan will be provided (presented case study.

Pharmacotherapy for Cardiovascular Disorders

Influence of Age

The patient’s age has various effects on the pharmacokinetics and pharmacodynamics of their medication. M, who is 89 years old, is considered an older person because of his age. Getting older causes a person’s body to undergo physiological and anatomical changes, which reduces their resilience to outside pressures (Salihovic et al, 2018). Additionally, as people get older, there is a greater interindividual variance in their physiological responses. The accumulation of cumulative molecular, cellular, and tissue-level effects is what is meant when discussing about aging as a collective word (Salihovic et al., 2018). However, aging itself is not the cause of these changes. While there is no single, all-encompassing definition of aging, many of its aspects are well understood. The loss of body organs is the most consistent loss throughout time (Salihovic et al., 2018).These are the smallest structures in the body that can carry out the specific physiological functions required by the organ in which they are found (e.g., nephrons, alveoli, or neurons) (Salihovic et al., 2018). Another feature of this condition is the breakdown of numerous regulatory systems that support the functional integration of cells and organs. Because of this, homeostasis cannot be

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