NURS 6512 Assignment Pharmacotherapy for Cardiovascular Disorders

Sample Answer for NURS 6512 Assignment Pharmacotherapy for Cardiovascular Disorders Included After Question

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 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.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
• Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

A Sample Answer For the Assignment: NURS 6512 Assignment Pharmacotherapy for Cardiovascular Disorders

Title: NURS 6512 Assignment Pharmacotherapy for Cardiovascular Disorders

Pharmacokinetics refers to the processes that the body subjects a drug to once it is introduced to the body. These processes include absorption, distribution, metabolism, and excretion. Pharmacodynamics, on the other hand, refers to the effects that drugs cause to the body, like the side effects of the drug. Both pharmacokinetics and pharmacodynamics are affected by factors such as the medical history of a patient, other medication that the patient is using, and patient characteristics, such as age and sex. From the given case study, pharmacokinetics and pharmacodynamics in Patient CB are affected by the medical history of the patient and the current drugs being taken NURS 6521 week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders.

Treatment for patients with cardiovascular disease is always a challenge due to many comorbidities involved. These require different drugs, which have different reactions and side effects. Moreover, these reactions are not usually uniform among all patients. Consequently, it is necessary to continually monitor the patient to avoid adverse drug reactions (Mangoni & Jarmuzewska, 2019). Patient CB has a history of stroke and is currently suffering from type 2 diabetes mellitus, hypertension, and hyperlipidemia. All these conditions play a significant role in pharmacokinetics and pharmacodynamics. Diabetes, for example, increases mycobacterial burden among some patients, which affects treatment (Alfarisi et al., 2018). Additionally, patients with diabetes mellitus have difficulties in excreting toxins from the kidney, which puts them at a heightened risk of developing diabetic nephropathy that can potentially complicate their treatment further.

The patient, however, is under a Glipizide 10 mg dosage, which helps to prevent kidney damage. Since patient CB is taking multiple medications and is suffering from diabetes, it is easy for toxins to accumulate in the body. Hypertension is another significant condition that affects pharmacokinetics and pharmacodynamics. Since patient CB is suffering from the condition, it is necessary to consider its effects and the significance of pharmacotherapy interventions (Oparil & Schmieder, 2015). For example, the patient is under Verapamil 180 mg CD daily dosage, which helps to lower blood pressure and prevent stroke (Mancia et al., 2014) NURS 6521 week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders. The drug, however, has adverse effects on the body of the patient. It slows down the heartbeat rate and may cause severe liver damage and other mild effects, including headaches, nausea, and vomiting. NURS 6521 week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders

In treating the patient, it is necessary to consider the aforementioned side effects of the drugs. The patient is also under a Hydralazine 25 mg dosage, which is used in the treatment of high blood pressure. This drug’s pharmacodynamics is counter to that of Verapamil 180 mg. This is because it increases the heartbeat of the patient, while Verapamil 180 mg lowers the pulse (Flynn, Bradford, & Harvey, 2016). Such counter-reactions may be fatal to the patient and, therefore, using such drugs concurrently is ill-advised. Hyperlipidemia is another condition that is affecting patient CB, and which plays a critical role in pharmacokinetics and pharmacodynamics. Hyperlipidemia means that the level of lipids (such as triglycerides and cholesterol) in the patient’s blood is very high. These lipids are deposited along blood vessels, restricting the flow of blood in the body.

The high levels of lipid in the blood predispose the patient to stroke or myocardial infarction, commonly known as a heart attack (Navar-Boggan et al., 2015). The patient is under a Simvastatin 80 mg dosage to control the condition. However, this drug has negative effects on patients with diabetes. NURS 6521 week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders. Therefore, administering Simvastatin 80 mg puts patient CB at risk because he is also suffering from type 2 diabetes mellitus. When prescribing drugs to patients with cardiovascular disease, the physician must pay close attention to all the variables involved to avoid adverse drug reactions. For Patient CB, his conditions complicate pharmacokinetic and pharmacodynamics due to comorbidities NURS 6521 week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders. NURS 6521 week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders

References

Alfarisi, O., Mave, V., Gaikwad, S., Sahasrabudhe, T., Ramachandran, G., Kumar, H., … & Raskar, S. (2018). Effect of diabetes mellitus on the pharmacokinetics and pharmacodynamics of tuberculosis treatment. Antimicrobial Agents and Chemotherapy, 62(11), 1-14.

Flynn, J. T., Bradford, M. C., & Harvey, E. M. (2016). Intravenous hydralazine in hospitalized children and adolescents with hypertension. The Journal of Pediatrics, 168, 88-92. NURS 6521 week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders

Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., … & Galderisi, M. (2014). 2013 ESH/ESC Practice guidelines for the management of arterial hypertension: ESH-ESC: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Pressure, 23(1), 3-16.

Mangoni, A. A., & Jarmuzewska, E. A. (2019). The influence of heart failure on the pharmacokinetics of cardiovascular and non‐cardiovascular drugs: A critical appraisal of the evidence. British Journal of Clinical Pharmacology, 85(1), 20-36.

Navar-Boggan, A. M., Peterson, E. D., D’Agostino Sr, R. B., Neely, B., Sniderman, A. D., & Pencina, M. J. (2015). Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease. Circulation, 131(5), 451-458.

Oparil, S., & Schmieder, R. E. (2015). New approaches in the treatment of hypertension. Circulation Research, 116(6), 1074-1095.

A Sample Answer 2 For the Assignment: NURS 6512 Assignment Pharmacotherapy for Cardiovascular Disorders

Title: NURS 6512 Assignment Pharmacotherapy for Cardiovascular Disorders

Introduction

The prevalence and impact of cardiovascular disorders in the U.S. are undeniable, especially in contributing to the nation’s morbidity and mortality rates. Effective pharmacotherapeutic strategies are paramount, and these must be tailored according to individual patient characteristics. The case of LM, an 89-year-old female with a vast array of health complications, serves as a vivid representation of the complexities involved. Central to this discussion is the role of age, a factor with significant implications on both pharmacokinetics (the journey of a drug through the body) and pharmacodynamics (the body’s response to the drug).

Age’s Impact on Pharmacokinetics and Pharmacodynamics

Age plays a pivotal role in determining how drugs interact with the body. Elderly individuals often undergo physiological changes that can drastically alter the absorption, distribution, metabolism, and excretion of drugs. For instance, delayed gastric emptying and reduced gastrointestinal blood flow can result in a slower absorption rate for many medications in older adults. Similarly, reduced muscle mass and decreased serum albumin can impact how drugs are distributed throughout the body. When it comes to metabolism, the decrease in hepatic blood flow and liver mass commonly seen in elderly patients can reduce the body’s ability to process drugs effectively. Finally, diminished renal function, evident in LM’s eGFR of 45 ml/min, can affect drug excretion, posing potential risks for toxicity (Nightingale et al., 2019).

Moreover, the body’s response to drugs, or pharmacodynamics, undergoes changes with age. Older adults might experience heightened sensitivity to certain medications, leading to unpredictable or altered responses, thus increasing the potential for adverse reactions (McKearney & Coleman, 2020).

Implications for LM’s Drug Therapy

Given LM’s age and observed health metrics, there is a pressing need for keen scrutiny of her medication regimen. Amlodipine, prescribed for her hypertension, may be contributing to her experience (Rafeq & Salzman, 2022). The diuretic, Furosemide, when combined with her diabetes medications, Metformin and Glyburide, poses a potential risk for significant shifts in her electrolyte levels, which could be exacerbating her risk for falls (Ali et al., 2019). Celecoxib, prescribed for osteoarthritis, has known potential to aggravate hypertension and further decline kidney function, especially in the elderly (White et al., 2000).

Recommendations for Drug Therapy Modification

In light of the pharmacokinetic and pharmacodynamic considerations induced by age and LM’s evident health complexities, it is essential to revisit and possibly modify her medication regimen.

A thorough reevaluation of her antihypertensive medications is a priority. Given her recorded supine blood pressure, an adjustment in the dosage or a switch from amlodipine to another antihypertensive class with fewer side effects related to edema might be beneficial.

Regular monitoring of LM’s glucose, potassium, and overall renal function can ensure the safety of her diabetes medications combined with the diuretic (Davies et al., 2022). Additionally, her pain management strategy needs to be readdressed. It might be more advantageous to explore non-drug interventions or consider switching from celecoxib to acetaminophen, a medication with a better safety profile for the elderly (Alorfi, 2023).

Conclusion

The case of LM underscores the importance of meticulous pharmacotherapeutic planning, especially in elderly patients with multiple health challenges. Age-induced changes in pharmacokinetics and pharmacodynamics necessitate a tailored approach, ensuring not just effective treatment but also the well-being and safety of the patient. Collaborative and informed medical decisions remain the linchpin in achieving optimal therapeutic outcomes.

References

Ali, S., Peterson, G. M., Bereznicki, L. R., & Salahudeen, M. S. (2020). Association between anticholinergic drug burden and mortality in older people: a systematic review. European Journal of Clinical Pharmacology, 76(3), 319–335. https://doi.org/10.1007/s00228-019-02795-x

Alorfi NM. (2023). Pharmacological Methods of Pain Management: Narrative Review of Medication Used. International Journal of General Medicine, ume 16, 3247–3256.

Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S. E., Del Prato, S., Mathieu, C., Mingrone, G., Rossing, P., Tankova, T., Tsapas, A., & Buse, J. B. (2022, November 1). Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 45(11), 2753.

McKearney, K., & Coleman, J. J. (2020). Prescribing medicines for elderly patients. Medicine, 48(7), 463–467. https://doi.org/10.1016/j.mpmed.2020.04.004

Nightingale, G., Schwartz, R., Kachur, E., Dixon, B. N., Cote, C., Barlow, A., Barlow, B., & Medina, P. (2019). Clinical pharmacology of oncology agents in older adults: A comprehensive review of how chronologic and functional age can influence treatment-related effects. Journal of Geriatric Oncology, 10(1), 4–30. https://doi.org/10.1016/j.jgo.2018.06.008

Rafeq, R., & Salzman, M. (2022). Use of Concentrated Insulin in the Management of Calcium Channel Blocker Overdose: A Case Report. Journal of Pharmacy Practice, 1. https://doi.org/10.1177/08971900221116189

White, W. B., Faich, G., Whelton, A., & Maurath, C. (2000). Comparison of the renal effects of celecoxib, rofecoxib, and naproxen in elderly subjects. Journal of Clinical Pharmacology, 40(12 Pt 2), 1246-1256.

A Sample Answer For the Assignment: NURS 6512 Assignment Pharmacotherapy for Cardiovascular Disorders

Title: NURS 6512 Assignment Pharmacotherapy for Cardiovascular Disorders

Cardiovascular System 

Cardiovascular System 

The patient is dealing with a major cardiovascular issue based on the case study. All the current medication prescribed to the patient needs to be reviewed for appropriate changes. Cardiovascular disease counts as a major cause of disability and leads to a cause of death globally. The statistic indicates that approximately a person dies within approximately 36 seconds in the United States due to cardiovascular disease (Benjamin et al., 2019). Therefore, cardiovascular disease is the major cause of health disparities and increases the cost of health care. It is vital to consider the patient’s lifestyle, history, and review to manage HH’s illness effectively. This paper addresses the factors that influence a patient’s pharmacokinetics and pharmacodynamics process and gives changes that impact the recommended drug therapy. 

Factor Influencing Pharmacokinetic and Pharmacodynamics Process in the Patient 

Based on the case study, the factor that I have selected is age, which can lead to drug toxicity and influence the pharmacokinetics of different medications. Age causes an increase in the altered metabolism and blood concentration of drugs (Giri et al., 2018). A decrease in renal function causes an alteration of drug pharmacokinetics such as glomerular filtration rate and reduces blood flow. Age-related changes that occur in a patient include physiological factors and temperature (Giri et al., 2018). The physiological factors cognition, ventricular aerial stiffness, endothelial function, and electric conduction (Rosenthal & Burchum, 2021). Most people are sensitive to antihypertensive medication due to sympathetic neuronal and baroreceptor response (Giri et al., 2018). 

Glipizide is used to cure an adult with type 2 diabetes mellitus. The drug effectively promotes insulin release from the beta cells since it reduces glucose output from the liver (Addul-Ghani et al., 2021). For patients with inadequate metabolic control, the combination of metformin and Glipizide helps reach the goal of HbA1c within three months (Addul-Ghani et al., 2021). Glipizide is effective since it has a short life and effect duration, thus lowering the risk of long-lasting hypoglycemia (Addul-Ghani et al., 2021). Patients taking Glipizide with thyroid hormone, estrogen-containing contraceptives, thiazide diuretics, nicotinic acid, and calcium channel blockers have a high potential for hyperglycemia (Rosenthal & Burchum, 2021). 

Metformin effectively improves glycemic control, which takes place without inducing hypoglycemia or causing obesity, thus considered a first-line pharmacologic treatment (Shurrab & Arafa, 2020). The drug inhibits gluconeogenesis by causing a block on the mitochondrial redox shuttle, thus acting in the liver (Shurrab & Arafa, 2020). Metformin is identified to cause gastrointestinal adverse effects such as nausea, diarrhea, and vomiting (Shurrab & Arafa, 2020). FDA labels warn against prescribing Metformin drug therapy for patients with acute heart failure when supplemented with hypoxemia and hypoperfusion. 

Hydrochlorothiazide (HCTZ) is used to treat hypertension since it is a thiazide-type diuretic (Rosenthal & Burchum, 2021). The drug inhibits the sodium chloride co-transparent system leading to the distal of the convoluted tubules (Rosenthal & Burchum, 2021). A lower level of blood pressure is achieved due to the diuretic action. However, studies have declined hydrochloride as an ACE inhibitor for reducing the risk of cardiovascular disease (Handelsman et al., 2020). The adverse effect caused by the use of hydrochlorothiazide is the development of hyperglycemia (Rosenthal & Burchum, 2021). The drug therapy effectively manages latent diabetes and causes an increase in triglycerides and cholesterol (Rosenthal & Burchum, 2021). The combination of HCTZ with calcium channel blockers and ACE inhibitors effectively reduces hypertension. 

Atenolol acts as a beta blocker that causes an effect on blood circulation and the heart. The drug helps treat hypertension and angina, effectively bind the beta-1 adrenergic receptors in the vascular smooth muscle (Habib et al., 2021). This affects the chronotropic actions of the endogenous catecholamine. The process leads to a decrease in myocardial contractility heart rate and lowers blood pressure. The drug therapy is limited for a patient with moderate severely impaired renal (Habib et al., 2021). The side effects of Atenolol use include causing weight gain and heart failure for some patients. 

Hydralazine drug causes direct relaxation of the arteriolar smooth muscle. This is considered an antihypertensive agent and phthalazine derivative (Sangshetti et al., 2019). A reverse antihypertensive effect is likely to be experienced due to vasodilation (Sangshetti et al., 2019). This is caused by hydralazine followed by a reflex sympathetic response. The drug therapy is effective when combined with isosorbide dinitrate in reducing hypertension. The side effects of using hydralazine cause a lupus-like syndrome in rare cases. However, the drug leads to discontinuation of the drug (Sangshetti et al., 2019). 

Simvastatin is used as an adjunct to diet thus used as an oral HMG-CoA reductase inhibitor. A patient using Simvastatin gain a reduction in dyslipidemia and a decline in cholesterol production (Di Bello et al., 2020). The cholesterol synthesis is catalyzed by converting HMC-CoA to mevalonate, completely inhibited by hepatic hydroxymethyl-glutaryl coenzyme A (HMG-CoA) reductase (Di Bello et al., 2020). The agent effectively reduces the lipoprotein level and lowers the plasma cholesterol. The side effect of using Simvastatin 80mg is that it has a higher risk of possible rhabdomyolysis and myopathy after 12 months of use (Di Bello et al., 2020). 

Verapamil is used to treat hypertension, atrial tachyarrhythmia, and angina pectoris and is classified in the class of calcium channel blockers. It helps block the cardiac muscle cells and influx of calcium ions into the vascular smooth muscle in the membrane depolarization (Savage et al., 2020). The action helps in decreasing the oxygen consumption and the cardiac work. The drug is also effective in causing a reduction in atrial–ventricular conduction. This helps in controlling the supraventricular tachyarrhythmia (Savage et al., 2020). The side effect of using verapamil include causing transient serum enzyme elevation to be mild to moderate and the liver injury from mild (Savage et al., 2020). 

Improving Drug Therapy Plan 

The patient can experience congestive heart failure (CHF) when there is a combination of verapamil, atenolol, and Hydrochlorothiazide (HCTZ) (Rosenthal & Burchum, 2021). For effective control of stroke, it is important to control blood pressure. It is important to avoid duplicitous therapy, which causes harm. Interaction between verapamil and Simvastatin leads to an increase in the blood level of Simvastatin (Di Bello et al., 2020). The act leads to kidney damage and rhabdomyolysis and causing liver damage. Atenolol can cause an increase in the duration of hypoglycemic symptoms along with Glipizide (Habib et al., 2021). 

Conclusion 

It is important to ensure that a patient is educated on the need to consider frequent blood glucose monitoring. This is a result of atenolol due to the symptom of hypoglycemia. The symptom of hypoglycemia include heart palpitations, rapid heartbeat, and tremor (Rosenthal & Burchum, 2021). 

References 

Abdul-Ghani, M., Puckett, C., Adams, J., Khattab, A., Baskoy, G., Cersosimo, E., … & DeFronzo, R. A. (2021). Durability of triple combination therapy versus stepwise addition therapy in patients with new-onset T2DM: 3-year follow-up of EDICT. Diabetes care, 44(2), 433-439. https://diabetesjournals.org/care/article-abstract/44/2/433/35501 

Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., … & American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(10), e56-e528. https://www.ahajournals.org/doi/abs/10.1161/cir.0000000000000659 

Di Bello, E., Zwergel, C., Mai, A., & Valente, S. (2020). The innovative potential of statins in cancer: new targets for new therapies. Frontiers in Chemistry, 8, 516. https://www.frontiersin.org/articles/10.3389/fchem.2020.00516/full 

Giri, B., Dey, S., Das, T., Sarkar, M., Banerjee, J., & Dash, S. K. (2018). Chronic hyperglycemia mediated physiological alteration and metabolic distortion leads to organ dysfunction, infection, cancer progression and other pathophysiological consequences: an update on glucose toxicity. Biomedicine & Pharmacotherapy, 107, 306-328. https://www.sciencedirect.com/science/article/pii/S0753332218322406 

Habib, S., Alam, M., Mustafa, M., & Verma, A. K(2021). Role of Beta-Blockers as an Effective Cardio protective Agents, an insight in to Tackling with Cardiovascular Diseases (CVDs) and Hypertension. https://www.researchgate.net/profile/Abhishek-Kumar-Verma-2/publication/354694288 

Handelsman, Y., Jellinger, P. S., Guerin, C. K., Bloomgarden, Z. T., Brinton, E. A., Budoff, M. J., … & Wyne, K. L. (2020). Consensus statement by the American association of clinical Endocrinologists and American College of Endocrinology on the management of dyslipidemia and prevention of cardiovascular disease algorithm–2020 executive summary. Endocrine Practice, 26(10), 1196-1224. https://www.sciencedirect.com/science/article/pii/S1530891X20482047 

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier. 

Sangshetti, J., Pathan, S. K., Patil, R., Ansari, S. A., Chhajed, S., Arote, R., & Shinde, D. B. (2019). Synthesis and biological activity of structurally diverse phthalazine derivatives: A systematic review. Bioorganic & Medicinal Chemistry, 27(18), 3979-3997. https://www.sciencedirect.com/science/article/pii/S0968089619310193 

Savage, R. D., Visentin, J. D., Bronskill, S. E., Wang, X., Gruneir, A., Giannakeas, V., … & McCarthy, L. M. (2020). Evaluation of a common prescribing cascade of calcium channel blockers and diuretics in older adults with hypertension. JAMA Internal Medicine, 180(5), 643-651. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2761272 

Shurrab, N. T., & Arafa, E. S. A. (2020). Metformin: A review of its therapeutic efficacy and adverse effects. Obesity Medicine, 17, 100186. https://www.sciencedirect.com/science/article/pii/S2451847620300063