NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders
Sample Answer for NURS 6521 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.
A Sample Answer For the Assignment: NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders
Title: NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders
Patient AO has gained nine pounds of weight and is diagnosed with hyperlipidemia and hypertension. These patients require an effective plan of treatment to help them manage their health. Both hyperlipidemia and hypertension are connected, and one is a risk factor of the other. Using this case, it is evident that the treatment plan is not working out for patient AO. This is because the patient is still having weight gain and is diagnosed with two dangerous cardiovascular conditions. Approximately seventy million in the United States are diagnosed with hypertension. This translates to about one in every three people, and the statistics are not good (Arcangelo et al., 2017).
Impact of Age on Pharmacodynamics and Pharmacokinetics
In this scenario, the patient is suffering from three problems; high cholesterol level, high blood pressure, and obesity. As people age and need treatment, there is a need to understand the pharmacodynamics and pharmacokinetics in old age (Sera & Uritsky). As one ages, the process of drug absorption, metabolisms, distribution, and excretion are drastically decreased. Due to the decrease in hepatic flow in older people, the rate of drug metabolism by the hepatic cells is lowered. Therefore, drugs having high extraction ratios will have an increase in bioavailability. Therefore, to avoid drug toxicity, initial dosages of medicines need to be given to older patients. It is critical to note that aging also affects renal functions by reducing its excretory function. Hence, these factors show how healthcare providers need to know the dosage prescription for older patients.
Besides, older people are also marked with decreased gastric emptying, slow peristalsis, and colonic transit. These physiological changes in old age affect the rate of absorption (Arcangelo et al., 2017). It is essential to note that factors such as height, weight, behavioral characteristics, and weight are considered before selecting drugs and other treatment plans.
When the drug reaches its targeted site, the pharmacodynamics processes are triggered (Jaobson, 2013). When the drug comes to its targeted site, old age could alter the pharmacodynamics because of the changes in the binding site, differences in the post-receptor effects, and chemical interactions (Durakovic & Vitezic, n.d). The magnitude of drug response is dependent on other parameters. They include the receptors’ density, the affinity of the receptors to the drug, and the signal transduction pathways.
How to Improve the Patient’s Drug Therapy Plan
In determining the best treatment plan for the patient, detailed history taking should be conducted, more laboratory tests such as blood chemistry, EKG, liver, and renal function tests need to be undertaken. It is also noted that patient AO is on several blood pressure drugs (Topinková et al., 2012). It is challenging to know the types of drugs that are effective. There is a need to determine the cause to select the right medicine to use in control hypertension. Secondly, drug interaction needs to be investigated since patient AO is put on many medications. It is essential to start the patient on low dosages then increase the amount steadily to avoid toxicity. Additionally, Patient AO’s loss of weight should be part of the plan of treatment.
In older adults, to help ensure the dosages are prescribed as per the age, it will be necessary to conduct renal function tests. This will help determine the drug dosage, optimize the patient’s hydration status, and be aware of the nephrotoxic drugs to be avoided (Jacobson, 2013). Also, in the elderly, the use of SSRIs has been reported to have an increased risk of GI bleeding due to their antiplatelet properties (Carlo & Alpert, 2015). Because of this, the Sertraline for patient AO needs to be investigated for any potential risks before continuation.
In conclusion, I will recommend the entire medication regimen be stopped. However, I would also suggest more investigations be conducted to find the source of hypertension, obesity, and hyperlipidemia to properly select the drugs in managing the conditions and promote quick healing.
References
Arcangelo, V.P., Peterson, A.M., Wilbur, V., & Reinhold, J.A. (2017). Pharmacotherapeutics for Advanced Practice. A Practical Approach. (4th Ed.). Philadelphia, PA: Wolters Kluwer
Carlo, A. D., & Alpert, J. E. (2015). Geriatric Psychopharmacology: Pharmacokinetic and Pharmacodynamic Considerations. Psychiatric Annals, 45(7), 336. Doi: 10.3928/00485713-20150626-04
Durakovic, Z., & Vitezic, D. (n.d). Pharmacodynamics and pharmacokinetics in the elderly. Periodicum Biologorum, 115(4), 517-520.
Jacobson, S. (2013). Effects of pharmacokinetic and pharmacodynamic changes in the elderly. Psychiatric Times, (1),
Sera, L., & Uritsky, T. (2016). Pharmacokinetic and pharmacodynamic changes in older adults and implications for palliative care. Progress in Palliative Care, 24(5), 255-261. doi:10.1080/09699260.2016.1192319
Topinková, E., Baeyens, J.P., Michel, J.P. et al. (2012). Evidence-Based Strategies for the Optimization of Pharmacotherapy in Older People. Drugs Aging 29, 477–494. https://doi.org/10.2165/11632400-000000000-00000
A Sample Answer 2 For the Assignment: NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders
Title: NURS 6521 Assignment: 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 3 For the Assignment: NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders
Title: NURS 6521 Assignment: 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
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