Sample Answer for NURS 6521 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 6521 Pharmacotherapy for Cardiovascular Disorders
Title: NURS 6521 Pharmacotherapy for Cardiovascular Disorders
The disease processes in the case study have a significant impact on pharmacokinetic and pharmacodynamics processes in the patient. Firstly, ischemic heart attack, hyperlipidemia, and hypertension alter the absorption kinetics of drugs. The alteration occurs due to modification of the splanchnic blood flow. There is also the indirect alteration of the gastrointestinal peristalsis as well as secretions, which might slow down the rate of drug absorption. The above pathological states also alter the binding sites of the drugs in the plasma proteins. The consequence of the modification in protein binding sites for the drug includes a change in the total volume of drug distribution in the body. There is also the evidence that the above disease processes modify the local blood flow to the tissues (Karaman, 2015). As a result, it is anticipated that drug entry into the body tissues will be affected; hence, the pharmacokinetics processes of the prescribed drugs.
Diabetes and the above cardiac conditions also increase the risk of other complications such as nephropathy, which can affect pharmacokinetic processes of the prescribed drugs. For instance, there will be reduced clearance for drugs eliminated via the renal system with the above pathological processes, hence, increased risk of drug accumulation and its associated toxicities. The above pharmacokinetic changes also influence the pharmacodynamics processes in the patient. For instance, decreased renal clearance of drug metabolites increases the risk of drug-induced renal toxicity. There is also impaired drug metabolism in the liver, which increases the risk of cardiac arrhythmias and liver damage (Karaman, 2015). Therefore, there is a correlation between the pathological changes, pharmacokinetics, and pharmacodynamics changes in the patient.
The changes in the above processes might influence the patient’s drug recommended therapy in a number of ways. One of the ways in
which it will influence it is through increasing the need for the adoption of alternative therapies that are safer for the patient. The focus of management is placed on ensuring that the therapy is tolerable by the patient and is associated with few adverse health effects. An example of this case is the prescription of drugs that are eliminated through other routes in patients with decreased renal clearance. The effect of a drug is largely dependent on the dosage of its administration. However, in the above disease states, there is a need for the re-visiting of the drug dosages to achieve optimum health effect. Therefore, rather than optimizing use of drugs in the prescribed regime, the focus shifts to minimizing the adverse outcomes with the selected plan (Rosenbaum, 2016). This includes the administration of drugs in low dosage to minimize the toxicities associated with them on the patient.
One of the strategies that will be utilized to improve the drug therapy of the patient is eliminating barriers to adherence in drug use. It is important that factors contributing to non-adherence such as lack of awareness and adverse events be addressed to improve the drug therapy in a patient. For instance, the concerns of the patient related to side and adverse effects of the drugs should be addressed to enable informed decision-making. Drug therapy can also be improved by focusing on aspects that include simplifying the characteristics of the regimen, imparting knowledge, modifying the beliefs of the patient, adopting open communication, eliminating bias, and evaluating adherence (Malangu, 2018). Therefore, the use of these interventions will improve drug therapy by empowering patients to take responsibility for their health.
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References
Karaman, R. (2015). Commonly Used Drugs-Uses, Side Effects, Bioavailability and Approaches to Improve It, [ebook] New York.
Malangu, N. (Ed.). (2018). Pharmacokinetics and Adverse Effects of Drugs: Mechanisms and Risks Factors. BoD–Books on Demand.
Rosenbaum, S. E. (Ed.). (2016). Basic pharmacokinetics and pharmacodynamics: An integrated textbook and computer simulations. John Wiley & Sons.
A Sample Answer 2 For the Assignment: NURS 6521 Pharmacotherapy for Cardiovascular Disorders
Title: NURS 6521 Pharmacotherapy for Cardiovascular Disorders
Asthma is one of the most common conditions affecting more than 20 million individuals in the United States and over 150 million across the globe. It takes up to $14 billion to treat asthma annually. Particularly hard hit are adolescents and children between the ages of 10 to 18 years. Studies show that up to 14% of children and adolescents in the inner city are diagnosed with asthma. A larger percentage of asthmatic patients in the emergency rooms are children and adolescents. Consequently, most patients hospitalized as a result of asthma or asthma-related problems are also children. As such, appropriate interventions must be implemented to help in managing asthma among children and adolescents hence reducing their visits to the ER or hospitalization. In the same line, Sentara Home Care Services came up with an innovative program to help in improving asthma management among children and adolescents through home-based strategies such as “Life Coaches” where they are educated on the proper use of medication and lifestyle behaviors for both the patient and their families. This paper reviews different pieces of literature for a better understanding of the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents.
Methods
Quite a significant number of internet sources were available talking about different approaches that can be utilized in managing asthma among children and adolescents. However, only peer-reviewed articles directly relating to the study PICOT questioned were used for this paper. These articles were arrived at by use of several inclusion and exclusion criteria. For instance, the inclusion criteria included studies that had been published within the last 5 years, in English, with participants who are children and adolescents. The studies however could be either experimental or literature review. Exclusion criteria included articles published more than 5 years, in languages other than English. Consequently, relevant keywords such as asthma, Sentara’s Asthma Disease Management plan, children and adolescents, and decreased ER/unscheduled PCP visits were utilized. A wide variety of search engines were used for this study, such as Google Scholar, PubMed/MEDLINE, and Cochrane. Generally, only peer-reviewed articles and experimental studies covering the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents, were used for this study.
Synthesize the Literature
Part A: Components of Each Article
The study carried out by Naar et al., 2018, was aimed at bridging the gap for proper interventions for the management of asthma among African American adolescents who appear to be at high risk of asthma morbidity and mortality. The randomized control trial study revealed the significance of comprehensive family and community-based treatment strategies for better medication adherence, reduction in the frequency of asthma symptoms, and reduced inpatient hospitalization among African American adolescents. The strategies revealed in this study align with the initiatives and goals outlined in Sentara’s Asthma Disease Management plan for children and adolescents.
According to Woods et al., 2016, the hospitalization rate of Black and Hispanic children diagnosed with asthma is quite high as compared to white children. As such Woods et al., 2016, carried out a study to evaluate the effectiveness of community asthma initiatives in the management of asthma, hence reducing the hospitalization rate among this high-risk population. Data was collected and analyzed using the longitudinal evaluation of the participants and comparing the results to the control sample. It was noted that the community asthma initiative helped in reducing the health disparities related to asthma, with reduced hospitalization rate among Blacks and Hispanic children. The results support the study PICOT question on the effectiveness of Sentara’s Asthma Disease Management plan in reducing visits to the ER and hospitalization among children and adolescents diagnosed with asthma.
Bellin et al., 2017, conducted a study aimed at finding out the knowledge of children diagnosed with asthma, from low-income families on home-based asthma management strategies. The study utilized a convenience sampling strategy to select appropriate participants. The collected data were analyzed using the grounded theory coding techniques. Based on the findings, it was recommended that more reinforcements need to be put towards providing a multipronged approach aimed at improving asthma control measures among this high-risk population. Such measures include ongoing child and family education, environmental control, and self-management home-based strategies, just like the ones illustrated in Sentara’s Asthma Disease Management plan.
The study carried out by Jonas, Leu, & Reznik, 2020, was aimed at evaluating the effects of utilizing Community Health Workers for the delivery of home-based Wee Wheezers asthma education program for better manage asthma symptoms among children. A randomized controlled trial was employed for this study. According to the results, delivery of home-based asthma education programs led to the improvement of symptoms, hence reduced disparities in children’s health outcomes. The study supports Sentara’s Asthma Disease Management plan, whose main goal is to educate patients and caregivers on the disease process of asthma, for better treatment outcomes.
Leas et al., 2018 carried out a study evaluating the effectiveness of home-based asthma prevention initiatives such as allergen reduction interventions on asthma outcomes. The utilized systematic literature review of both nonrandomized interventional studies and randomized controlled trials for this study. Based on the collected result, the effectiveness of indoor allergen reduction intervention helps in preventing an asthma attack. However, the effectiveness of this intervention was quite inconclusive as a result of inadequate support from previous studies. Indoor allergen reduction interventions are among the several home-based interventions outlined in Sentara’s Asthma Disease Management plan for children and adolescents.
Part B: Compare and contrast the articles:
All five studies revolve around the same goal of reducing disparities as a result of asthma among children and adolescents by utilizing community and home-based initiatives. According to Sentara’s Asthma Disease Management plan, “life coaches” and home-based strategies are utilized in assessing, teaching, and monitoring asthma through self-management strategies to reduce disparities hence reduced hospitalization and ER visits. The same concept, despite the use of different languages, has been addressed in all five studies. However, some of the studies were experimental such as Naar et al., 2018, Jonas, Leu, & Reznik, 2020 and Bellin et al., 2017, while others were literature reviews, Leas et al., 2018 and Woods et al., 2016.
Several limitations were however experienced in some of the reviewed studies. For instance, according to Leas et al., 2018, there was limited information availed by studies carried out on the effectiveness of some home-based asthma prevention initiatives such as indoor allergen reduction. Consequently, most of these studies only reveal the kind of home and community-based initiatives for the management and prevention of asthma among children and adolescents, instead of how effective these initiatives are in reducing ER visits and hospitalization rates among these individuals. Lastly, there were no recent studies, within the last five years, which evaluated the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents, making it hard to conclude on the PICOT question.
Areas of Further Study
Several studies have revealed the relevance of community and home-based interventions in reducing the disparities as a result of asthma among children and adolescents. These interventions have been proven to reduce the number of visits by this age group to the ER, in addition to a reduction in hospitalization rates. However, very few studies have established the effectiveness of distinct interventions in achieving such outcomes. Consequently, very few recent studies have also revealed the effectiveness of Sentara’s Asthma Disease Management plan for children and adolescents (Naar et al., 2018). As such, there is a need for further evaluation of the effectiveness of individual home-based interventions for better evidence-based practice in the management and prevention of asthma among children and adolescents.
References
Bellin, Melissa H., Angelica Newsome, Cassie Land, Joan Kub, Shawna S. Mudd, Mary Elizabeth Bollinger, and Arlene M. Butz. 2017. “Asthma Home Management in the Inner-City: What Can the Children Teach Us?” Journal of Paediatric Health Care. 31, no. 3: 362-371. https://doi.org/10.1016/j.pedhc.2016.11.002
Jonas, J. A., Leu, C. S., & Reznik, M. (January 01, 2020). A randomized controlled trial of a community health worker delivered home-based asthma intervention to improve pediatric asthma outcomes. The Journal of Asthma: Official Journal of the Association for the Care of Asthma, 2020, 1-12. https://doi.org/10.1080/02770903.2020.1846746
Leas BF, KE D’Anci, AJ Apter, T Bryant-Stephens, MP Lynch, JL Kaczmarek, and CA Umscheid. 2018. “Effectiveness of Indoor Allergen Reduction in Asthma Management: A systematic Review”. The Journal of Allergy and Clinical Immunology. 141, no. 5: 1854-1869. https://doi.org/10.1016/j.jaci.2018.02.001
Naar, S., Ellis, D., Cunningham, P., Pennar, A. L., Lam, P., Brownstein, N. C., & Bruzzese, J.-M. (October 01, 2018). Comprehensive Community-Based Intervention and Asthma Outcomes in African American Adolescents. Paediatrics, 142, 4.) DOI: https://doi.org/10.1542/peds.2017-3737
Woods, E. R., Bhaumik, U., Sommer, S. J., Chan, E., Tsopelas, L., Fleegler, E. W., Lorenzi, M., … Dulin, R. (February 12, 2016). Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma. Mmwr Supplements, 65, 1, 11-20. DOI: http://dx.doi.org/10.15585/mmwr.su6501a4.
A Sample Answer 3 For the Assignment: NURS 6521 Pharmacotherapy for Cardiovascular Disorders
Title: NURS 6521 Pharmacotherapy for Cardiovascular Disorders
Cardiovascular disorders represent a spectrum of life-threatening medical disorders affecting the cardiovascular system. These include but are not limited to hypertension, heart failure, stroke, ischemic heart disease, and coronary artery diseases. These diversified arrays of conditions remain the second most leading cause of mortality in the United States of about 1 in every 4 deaths (Olvera Lopez et al., 2021). In this assignment, a factor influencing pharmacodynamic and pharmacokinetics will be selected and explored extensively in relation to a case study involving AO, a patient diagnosed with hypertension and hyperlipidemia with a history of obesity.
Effects of Age on the Pharmacodynamic and Pharmacokinetics Processes
A couple of factors influence pharmacodynamic and pharmacokinetic processes. For instance, age, genetics, behaviors, and ethnicity. Aging is designated by accelerated impairment of functional capabilities of entire organ systems, diminished homeostatic mechanisms, and altered reaction to receptor stimulation (Peeters et al., 2019). The aforementioned processes influence the pharmacodynamic and pharmacokinetic processes with the resultant need for dose adjustments or rather contraindication of some pharmacologic agents in the elderly. Additionally, aging is associated with a reduction in the first-pass metabolism attributed to a decrease in the liver bulk and blood flow. Similarly, impaired hepatic and renal functions correlated with aging significantly hinder the renal and hepatic clearance of a majority of drugs (Laurent, 2017). Consequently, in the case of AO, 86-year-old taking atenolol, simvastatin, sertraline, hydralazine, and doxazosin, the bioavailability of the mentioned drugs will increase.
According to Peeters et al. (2019), aging is further associated with a reduction in cumulative muscle mass and total body water but with an increase in the percentage of body fat. As a result, the volume distribution of lipid-soluble drugs increases while it decreases for non-lipid soluble drugs. Pharmacodynamically, on the other hand, aging is accompanied by altered sensitivity to drugs with a general increase in sensitivity to drugs in the elderly. Ultimately, adjustments of the doses AO’s drug regimen are critical to avoid adverse side effects or rather toxicity.
Impact of Changes in Process on the Patient’s Recommended Drug Therapy
Atenolol which is indicated for therapeutic management of hypertension is largely metabolized by the liver and excreted by the kidney. Subsequently, the dose will be adjusted depending on the renal and liver function. Similarly, geriatric patients have decreased sensitivity to beta-blockers due to increased total peripheral resistance, and reduced cardiac and pulmonary function (Khalil & Zeltser, 2021). Therefore, the beta-blocker should be substituted with another class of antihypertensive. On the other hand, doxazosin also metabolized by the liver is associated with hypotension when utilized in the geriatric population and thus will necessitate periodic monitoring of vital signs and dose adjustments (Khalil & Zeltser, 2021). Sertraline should be avoided in adolescents and children due to an increased risk of suicidal ideation. It is a good agent in the elderly as it reduces stress and depression which significantly perpetuate hypertension. It is a vital medication in the elderly as it reduces symptoms of BPH. Hydralazine dose should be adjusted depending on the individualized rate of acetylation. Lastly, the safety profile of simvastatin, atenolol, and doxazosin has not been established in children less than 10 years.
How I would Improve the Patient’s Drug Plan
Patient AO is a geriatric hypertensive hyperlipidemic patient and at risk of BPH, therefore being on doxazosin is crucial. This medication reduces the blood pressure and symptoms of BPH in addition to decreasing LDL and cholesterol (Redon & Redon, 2019). However, this therapeutic agent is associated with orthostatic hypotension and edema especially in the elderly. Consequently, I will periodically monitor the vital signs, weight, edema, and liver function tests of AO and reduce the dose accordingly. I will gradually taper down the dose while simultaneously monitoring the adverse effects. Atenolol is relatively contraindicated in the elderly and therefore I will consider substituting it with a first-line antihypertensive such as hydrochlorothiazide(Redon & Redon, 2019). AO has gained 9 pounds which might be due to edema associated with atenolol and doxazosin, therefore, a diuretic such as hydrochlorothiazide when deployed will control the blood pressure as well as edema (Redon & Redon, 2019).
The doses of sertraline, hydralazine, and simvastatin will remain unadjusted. However, the patient will be assessed periodically and educated on the importance of taking medications as advised by the healthcare provider. Similarly, I will educate the patient on the side effects associated with these medications such as sexual dysfunction, fatigue, diarrhea, and drowsiness, and the need to consult the care provider if the symptoms persist or become intolerable (Redon & Redon, 2019). Additionally, I will advise and educate the patient on lifestyle modification and behavior changes to help control hypertension such as diet modification, smoking, and alcohol cessation, and regular physical activity. Finally, I will follow up with the patient at the medical outpatient clinic.
Conclusion
Pharmacological treatment alongside supportive measures form the mainstay treatment in patients with cardiovascular disorders. The drug regimen is largely affected by a variety of factors such as age, gender, ethnicity, and genetics which affect the pharmacodynamic and pharmacokinetic process. It is crucial for individualization of the drug regimen based on a critical evaluation of the above processes.
References
Khalil, H., & Zeltser, R. (2021). Antihypertensive Medications. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554579/
Laurent, S. (2017). Antihypertensive drugs. Pharmacological Research: The Official Journal of the Italian Pharmacological Society, 124, 116–125. https://doi.org/10.1016/j.phrs.2017.07.026
Olvera Lopez, E., Ballard, B. D., & Jan, A. (2021). Cardiovascular Disease. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535419/
Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opinion on Drug Metabolism & Toxicology, 15(4), 287–297. https://doi.org/10.1080/17425255.2019.1588249
Redon, J., & Redon, P. (2019). Evidence from clinical trials and use of antihypertensive drugs in children and adolescents. In Updates in Hypertension and Cardiovascular Protection (pp. 263–277). Springer International Publishing. https://doi.org/10.1007/978-3-030-18167-3_17