PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512
Sample Answer for PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512 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
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A Sample Answer For the Assignment: PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512
Title: PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512
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.
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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
A Sample Answer 2 For the Assignment: PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512
Title: PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512
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: PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512
Title: PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512
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
A Sample Answer 4 For the Assignment: PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512
Title: PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS NURS 6512
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.
Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
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Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three or more of the following elements
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| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in the all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three of the following elements
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| 10 Points | 9 Points | 6 Points | 0 Points | |||
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
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Demonstrated 3 of the following:
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Demonstrated 2 of the following:
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Demonstrated 1 or less of the following:
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| 8 Points | 7 Points | 6 Points | 5 Points | 4 Points | 0 Points | |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
AND
AND
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The following was present:
AND/OR
AND/OR
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The following was present:
AND/OR
AND/OR
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The following was present:
AND/OR
AND/OR
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The following was present:
AND/OR
AND/OR
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The following was present:
AND/OR
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| 0 Points Deducted | 5 Points Lost | |||||
| Participation
Requirements |
Demonstrated the following:
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Failed to demonstrate the following:
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| 0 Points Lost | 5 Points Lost | |||||
| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |