NURS-6521 Module 2

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.

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

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

  • Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
    • Chapter 33, “Review of Hemodynamics” (pp. 285–289)
    • Chapter 37, “Diuretics” (pp. 290–296)
    • Chapter 38, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 297–307)
    • Chapter 39, “Calcium Channel Blockers” (pp. 308–312)
    • Chapter 40, “Vasodilators” (pp. 313–317)
    • Chapter 41, “Drugs for Hypertension” (pp. 316–324)
    • Chapter 42, “Drugs for Heart Failure” (pp. 325–336)
    • Chapter 43, “Antidysrhythmic Drugs” (pp. 337–348)
    • Chapter 44, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 349–363)
    • Chapter 45, “Drugs for Angina Pectoris” (pp. 364–371)
    • Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)

Cardiovascular Disorders

  • Meet Dr. Norbert Myslinski as he discusses ACE inhibitors, angiotensin inhibitors, beta-blockers, calcium channel blockers, and diuretics as different categories of hypertension drugs. What potential drugs might be best recommended for patients suffering from hypertension? (8m)

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
Case Study

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 0.88 mg 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+ 3.8, Cl 99, CO2 25,
BP: Supine = 177/82 Glucose 101, SCr 0.9, BUN 42
HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1
Plt 255
Cr: 1.6 UA: Clear
eGFR: 45 ml/min

PE:

  • HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes
  • 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

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.

Solution

Pharmacotherapy For Cardiovascular Disorders

Name

University

Course code

Course instructor

Date

 

Pharmacotherapy For Cardiovascular Disorders

This paper examines the case of an 89-year-old female resident of a long-term care facility with a history of hypertension, Alzheimer’s disease, hypothyroidism, osteoarthritis, and diabetes. It looks at how aging affects a patient’s pharmacokinetic and pharmacodynamic processes, as well as how changes in these processes might impact the patient’s recommended drug therapy. Finally, the paper provides recommendations on improving the patient’s drug therapy plan to ensure safe and effective medication therapy.

Case study

The case is of an 89-year-old female resident of a long-term care facility with a history of hypertension, Alzheimer’s disease, hypothyroidism, osteoarthritis, and diabetes. Over the last six months, her ambulation status has declined from independent to wheelchair level, and she complains of pain in her legs when walking more than short distances. Upon physical exam, her vitals are stable, and her skin is intact. She is alert and oriented to person only with an MMSE score of 18/30, stable over the last 12 months. There is also evidence of bruising and skin tear to her

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