Feb 23, 2024 Pharmacotherapy For Cardiovascular Disorders
Pharmacotherapy For Cardiovascular Disorders
A Sample Answer For the Assignment: 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.
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Introduction
The processes that a medicine goes through in the body after administration are referred to as pharmacokinetics. Absorption, distribution, metabolism, and excretion are all included in this. Pharmacodynamics, on the other hand, deals with the effects that drugs have on the body, such as adverse effects. Variables like a patient’s genetics, gender, ethnicity, age, behavioral factors, medical history, and concurrent drugs all have an impact on pharmacokinetics and pharmacodynamics. According to the case study, these variables especially age do indeed change the drugs pharmacokinetics and pharmacodynamics (Rosenthal. & Burchum, 2018).
Age influencing pharmacodynamics and pharmacokinetics
The patient is of advanced age whereby it has been stated that they are 74 years old this is indeed can affect the pharmacodynamics and pharmacokinetics related to the drug. In advanced age you find the boy’s physiology has changed thus affecting the pharmacokinetics and elements such as absorption, distribution, metabolism and excretion. One of the most significant impacts in old age is whereby you’ll have a decreased glomeruli filtration rate which determines the level of drug elimination. Since it is decreased it could lead to the drug being retained in the system and leading to toxicity (Sieder et al., 2016).
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In old age there is also decreased gastrointestinal motility thus leading to delayed absorption rate.
Pharmacotherapy For Cardiovascular Disorders
This leads to delayed onset of pharmacological effects of drugs thus making them less effective. The peak drug concentrations are also affected hence the drug doesn’t reach its maximum capacity for effect (Mangoni & Jarmuzewska, 2019).
Age also increases the body fat which could lead to increase the volume of distribution increases. Therefore if the drug has to be distributed to a wider area than affection it will affect its expected performance thus not delivering the desired therapeutic effect. Due to the increased body fat there is also decreased body water levels thus leading to the drug’s elimination half-lives also getting increased (Sieder et al., 2016).
Having an advanced age also affects metabolism which mostly occurs in the liver. This occurs in due to the decreased required enzymes that may no longer be available due to the physiological changes that occur because of age. This also leads to decreased clearance hence the already metabolised drug aren’t cleared from the system (Mangoni & Jarmuzewska, 2019).
Age impacting pharmacodynamics occurs through decrease in effect for beta-adrenergic agents. This is due to decrease in response in the vascular, cardiac, and pulmonary tissues due to a decline in some required proteins. There is also reduced sensitivity to drugs due to the body’s receptors undergoing physiological changes. Therefore if the response and sensitivity is inhibited the desired therapeutic effect isn’t achieved.
Homeostatic mechanisms are also seen to influence the pharmacodynamics in that in advanced age it is reduced. The mechanisms are seen to reduce in old age. Therefore in the case the drugs lead to adverse effects the body takes a longer period of time to return to the initial state (Sieder et al., 2016).
Changes in the Process that Impact the Patient’s Recommended Drug Therapy
Due to the old age the pharmacodynamics and pharmacokinetics has been impacted. The absorption has been delayed due to decreased gastric motility, on the distribution end the volume of distribution has increased due to the increased body fat and the metabolism due to decreased enzymes has also decreased.
The physiological changes in the glomeruli has decreased the glomeruli filtration rate hence decreasing excretion and could lead to toxicity. The pharmacodynamics due to decrease in sensitivity, decrease in response and reduced homeostatic mechanisms negatively affect it (Mancia et al., 2014).
Therefore encompassing all this there is a definite change in the recommended drug therapy in order to benefit the patient. The changes are in medication such as atenolol will be used in place of the beta-blocker metoprolol, starting at 25 to 200 mg per day. However, fast response is attainable with longer release modules and can be delivered thrice daily, thus it’s advised to begin new medication, notably such as beta-blockers, with prolonged release formulae.
Instead of ibuprofen that is contraindicated with warfarin patients should be prescribed acetaminophen orally 500mg thrice daily to manage the pain. I would also advise using lipid-lowering drugs other than statins to lower the low-density lipoprotein cholesterol levels (Mangoni & Jarmuzewska, 2019).
How to Improve the Drug Therapy Plan
Patients with a high risk of cardiovascular disease, a heart attack, or is known diabetic, such as this patient, are advised to begin taking a moderate-intensity statin with the aim of reducing LDL-C levels by 30% or more. For this patient, it is advised to utilize Ezetimibe, administered orally at a dose of 10 mg each day. Cardiovascular diseases, diabetes mellitus, left ventricular dysfunction and diabetic neuropathy can receive treatment by use of angiotensin converting enzyme inhibitors. They can also be used to prevent strokes.
Starting doses of ramipril range from 1.25 mg to 2.5 mg orally every day. This medication is also recognized to lessen myocardial infarctions, strokes, and fatalities. Moreover aside from changes in medications can make other alterations such as diet change, smoking cessation, weight loss, provision of health education from medical professionals and physical activity is required (Mayor, 2017).
Conclusion
The majority of deaths globally are currently caused by cardiovascular disorders, and diabetes is frequently found in these people. It is thought that people with type diabetes are more likely than non-diabetics to die from cardiovascular illnesses. In order to get the best results in the management of cardiovascular diseases which aims to maximize the benefits of available treatments while minimizing patient harm clinicians must possess basic knowledge of pharmacokinetics and pharmacodynamics (Rosenthal. & Burchum, 2018).
References
Hoover, L. E. (2019). Cholesterol management: ACC/AHA Updates guideline.
Https://eds-a-ebscohost-com-ezp.waldenulibrary.org/eds/pdfviwer/
Mayor, S. (2017). Pharmacokinetics: Optimizing safe and effective prescribing. Https://onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1551
Rosenthal, L.D. & Burchum. J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Sieder, S. T., Kalus, J. & Lanfear, D. E. (2016). Cardiovascular pharmacokinetics, Pharmacodynamics and Pharmacogenomics for the clinical practitioner.
Https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/delivery/
Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., & Galderisi, M. (2014). 2013 ESH/ESC Practice guidelines for the management of arterial hypertension: ESH-ESC: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Pressure, 23(1), 3-16.
Mangoni, A. A., & Jarmuzewska, E. A. (2019). The influence of heart failure on the pharmacokinetics of cardiovascular and non‐cardiovascular drugs: A critical appraisal of the evidence. British Journal of Clinical Pharmacology, 85(1), 20-36.
Consider the following case study:
Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:
· Atenolol 12.5 mg daily
· Doxazosin 8 mg daily
· Hydralazine 10 mg qid
· Sertraline 25 mg daily
· Simvastatin 80 mg daily
To prepare:
Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.
Select one 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.
With these thoughts in mind:
Post an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study. Then, describe how changes in the processes might impact the patient’s recommended drug therapy. Finally, explain how you might improve the patient’s drug therapy plan.
– This work should have Introduction and conclusion
– This work should have at 3 to 5current references (Year 2012 and up)
– Use at least 2 references from class Learning Resources
The following Resources are not acceptable:
1. Wikipedia
2. Cdc.gov- nonhealthcare professionals section
3. Webmd.com
4. Mayoclinic.com
Required Readings
**Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 19, “Hypertension” (pp. 257-272)
This chapter examines the relationships between the cardiovascular, nervous, and renal systems. It then describes diagnostic criteria for hypertension patients, drugs used to treat hypertension and possible adverse reactions, monitoring patient response, and patient education.
Chapter 20, “Hyperlipidemia” (pp. 275-286)
This chapter explores causes of hyperlipidemia, treatments for hyperlipidemia patients, and methods for monitoring patient response. It also reviews strategies for risk assessment and patient education.
Chapter 21, “Chronic Stable Angina” (pp. 289-303)
This chapter begins by exploring factors that contribute to chronic stable angina, types of drugs used in treatment, and diagnostic criteria for initiating drug therapy. It also examines methods for monitoring patient response to treatment and educating patients on self-care.
Chapter 22, “Heart Failure” (pp. 305-322)
This chapter examines the process of prescribing drugs to treat heart failure and explores effects of prescribed drugs, proper dosages, and possible adverse reactions.
Chapter 50, “Pharmacotherapy for Venous Thromboembolism Prevention and Treatment, Stroke Prevention in Atrial Fibrillation, and Thromboembolism Prevention with Mechanical Heart Valves” (pp. 863-886)
This chapter covers drug therapy options for three disorders requiring anticoagulants: venous thromboembolism, atrial fibrillation, and ischemic stroke. It also explains the process of initiating and managing drug therapy for patients with these disorders.
**Drugs.com. (2012). Retrieved from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Hypertension and hyperlipidemia. Baltimore, MD: Author.
This media presentation outlines hypertension and hyperlipidemia including contributing factors, evaluation, treatment, and implications.
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