NURS 6521 Week 5 Discussion: Pharmacotherapy for Cardiovascular Disorders

Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact the
effects of prescribed drugs, as well as any measures you might take to help

reduce negative side effects.

With these thoughts in mind:

By Day 3

Post a description of the neurological disorder you selected
including types of drugs that would be prescribed to patients to treat
associated symptoms. Then, explain how the factor you selected might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.

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A Sample Answer For the Assignment: NURS 6521 Week 5 Discussion: Pharmacotherapy for Cardiovascular Disorders

Title: NURS 6521 Week 5 Discussion: Pharmacotherapy for Cardiovascular Disorders

Safety, quality, and efficiency are important in the management of health problems in nursing practice. Advanced nurse practitioners ensure that medication prescription considers patient, medication, and comorbid factors that affect the realization of the desired treatment outcomes. Therefore, this paper explores the effect of age on pharmacokinetic and pharmacodynamic processes in the assigned patient. The patient has a history of transient ischemic attack and atrial fibrillation. The patient also has been diagnosed with hypertension, type 2 diabetes mellitus, ischemic heart disease, and hyperlipidemia. The patient is currently using several medications that include warfarin, aspirin, metformin, glyburide, atenolol, and Motrin.

Effect of Age on Pharmacokinetic and Pharmacodynamic Processes

The multiple comorbidities the patient in this case study has points to the increased likelihood that he/she is elderly. Advancing age is associated with increased risk of comorbid conditions such as hypertension, diabetes, ischemic heart disease, and mental health issues. Age significantly affects pharmacokinetic and pharmacokinetic processes. Aging is associated with significant changes in the body’s processes involved in drug absorption, metabolism, and excretion. First, aging reduces first-pass metabolism due to decline in blood flow and liver mass. The reduction increases the first-pass metabolism that drugs metabolized in the liver undergo (van den Anker et al., 2018). Aging also results in changes in drug distribution. For example, water-soluble drugs have reduced distribution volume due to changes such as decreased gastrointestinal motility and elimination, hence, high serum levels in the elderly.

Aging also affects processes such as reduction in gastric sections, emptying, and splanchnic blood flow. The absorption capacity of the intestines also reduces. These changes affect pharmacokinetic processes, including drug absorption and the realization of the desired therapeutic effectiveness of the prescribed medications in the elderly (Cossart et al., 2019). Aging also lowers protein binding of drugs. The reduction is attributed to the decline in the concentrations of albumin with the advancing age. Drug clearance reduces significantly with aging. Changes such as the reduction in renal clearance affects the elimination of water-soluble drugs, digoxin, diuretics, and lithium among others (Farkouh et al., 2020). Therefore, the effects of change on pharmacokinetics and pharmacodynamics require a careful approach to prescribing medications for children and the elderly.

Impact of Changes on Recommended Drug Therapy

Changes in pharmacokinetics and pharmacodynamic processes affects the recommended drug therapy for the patient in the case study. For example, changes in the renal clearance of drug metabolites affect the patient’s health and wellbeing by increasing renal toxicity and high serum concentration of the drug. As a result, advanced nurse practitioners minimize nephrotoxic medications in such cases to optimize treatment effectiveness and minimize further deterioration in the client’s status (Farkouh et al., 2020). Skin changes such as redistribution of fat and adipose tissue affects the absorption of medications administered via intramuscular or subcutaneous routes. A reduction in gastric emptying and production of gastric juice may also affect absorption of drugs (van den Anker et al., 2018). Consequently, advanced nurse practitioners consider alternative routes of medication administration such as through the intravenous routes to increase drug absorption and distribution.

Liver is the largest organ involved in the metabolism of most drugs through the first-pass mechanism. However, liver diseases such as hepatitis and cirrhosis affect liver’s ability to undertake these roles. The patient in the case study has multiple comorbidities, which predisposes him to hepato-renal complications due to the disease processes and polypharmacy (Díez-Villanueva et al., 2019). Therefore, healthcare providers involved in developing the plan of the patient’s care should minimize the administration of hepatotoxic and nephrotoxic medications to prevent harm. An example is withholding aspirin due to its adverse hepatic effects.

Improving Patient’s Treatment Plan

The client’s treatment requires some improvements. Firstly, the client has hyperlipidemia. As a result, I would prescribe statins to help in lowering body lipid levels. This decision will lower harmful triglycerides, which improves cardiovascular symptoms and type 2 diabetes that the client has. The second improvement that I would consider is eliminating warfarin therapy (Díez-Villanueva et al., 2019). Combined use of warfarin and aspirin increases the risk of gastrointestinal bleeding and ulcers. Consequently, prescribing a platelet inhibitor such as Fondaparinux is appropriate to ensure safety in the treatment process. I would also perform liver function and renal function tests to help in developing an effective treatment plan. The results will help in adjusting the current plan. For example, I will replace Motrin with Tylenol if liver function tests are normal. In addition, I will select one oral hypoglycemic agent if the patient reports glycemic crises such as hypoglycemia or hyperglycemia (Strain et al., 2018). For instance, I will replace glyburide with dipeptidyl peptidase-IV inhibitors due to their associated enhanced therapeutic effectiveness.

Conclusion

In summary, safety is crucial in developing treatment plan for patients with multiple comorbidities. Advanced nurse practitioners should consider the different factors that affect pharmacokinetics and pharmacodynamics of the prescribed medications. Age is a crucial factor that affects these processes. Factors such as decreased renal and hepatic clearance of medications affect their effectiveness in disease management. Advanced nurse practitioners should make sound decisions to minimize the administration of drugs that may worsen the declining functioning in these organs. Therefore, I will improve the treatment plan for the patient in the case study to ensure safety, quality, and efficiency in the treatment of the comorbidities.

References

Cossart, A. R., Cottrell, W. N., Campbell, S. B., Isbel, N. M., & Staatz, C. E. (2019). Characterizing the pharmacokinetics and pharmacodynamics of immunosuppressant medicines and patient outcomes in elderly renal transplant patients. Translational Andrology and Urology, 8(Suppl 2), S198–S213. https://doi.org/10.21037/tau.2018.10.16

Díez-Villanueva, P., Arizá-Solé, A., Vidán, M. T., Bonanad, C., Formiga, F., Sanchis, J., Martín-Sánchez, F. J., Ruiz Ros, V., Sanmartín Fernández, M., Bueno, H., & Martínez-Sellés, M. (2019). Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the Assessment of Frailty in Elderly Patients With Heart Disease. Revista Española de Cardiología (English Edition), 72(1), 63–71. https://doi.org/10.1016/j.rec.2018.06.035

Farkouh, A., Riedl, T., Gottardi, R., Czejka, M., & Kautzky-Willer, A. (2020). Sex-Related Differences in Pharmacokinetics and Pharmacodynamics of Frequently Prescribed Drugs: A Review of the Literature. Advances in Therapy, 37(2), 644–655. https://doi.org/10.1007/s12325-019-01201-3

Strain, W. D., Hope, S. V., Green, A., Kar, P., Valabhji, J., & Sinclair, A. J. (2018). Type 2 diabetes mellitus in older people: A brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative. Diabetic Medicine, 35(7), 838–845. https://doi.org/10.1111/dme.13644

van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental Changes in Pharmacokinetics and Pharmacodynamics. The Journal of Clinical Pharmacology, 58(S10), S10–S25. https://doi.org/10.1002/jcph.1284

A Sample Answer 2 For the Assignment: NURS 6521 Week 5 Discussion: Pharmacotherapy for Cardiovascular Disorders

Title: NURS 6521 Week 5 Discussion: 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