Feb 23, 2024 Assignment: NURS 6521 Pharmacotherapy for Cardiovascular Disorders
Assignment NURS 6521 Pharmacotherapy for Cardiovascular Disorders
A Sample Answer For the Assignment: Assignment: NURS 6521 Pharmacotherapy for Cardiovascular Disorders
The promotion of safety and quality in the treatment of patients with different conditions is important in nursing practice. Nurses and other healthcare providers utilize their knowledge in pharmacokinetics and pharmacodynamics to select treatments that will optimize outcomes while minimizing the potential of patient harm.
Factors such as age, gender, ethnicity, and genetics among others influence the pharmacokinetics and pharmacodynamics of the medications prescribed to patients. Therefore, this essay examines the influence of age on LM’s pharmacokinetic and pharmacodynamics processes. The essay also discusses the impact of the changes in the patient’s recommended drug therapy and how the treatment can be improved.
Effect of Age on Patient’s Pharmacokinetic and Pharmacodynamics Processes
The selected factor that affects the pharmacokinetic and pharmacodynamics of LM processes is age. Age significantly affects pharmacokinetics of drugs. Aging is associated with decreased small-bowel surface area, reduced gastric emptying, and elevated gastric PH. Changes such as an increase in the gastric PH affects the absorption of drugs such as calcium and enteric coated medications (Koren et al., 2019).
Aging also results in the decrease in the total body water and increase in the total body fat. The increase in body fat volume increases the total volume of distribution of lipophilic drugs and their elimination half-lives. Aging also lowers hepatic metabolism of most drugs. The decrease in cytochrome P-450 lowers the metabolism of drugs in the liver. This also affects first-pass metabolism of drugs before they enter the circulatory system.
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Aging is also associated with a decline in renal elimination of medications. The elderly patients have reduced glomerular filtration rate, which affects the elimination of drug metabolites from the body (Drenth-van Maanen et al., 2020; Koren et al., 2019; Peeters et al., 2019). As a result, there is an increased risk of drug toxicity due to the accumulation of the metabolites in the body. These pharmacokinetic changes affect the treatment options and health status of LM.
Aging also affects pharmacodynamics of drugs. Pharmacodynamics refers to the study of the drug effect on the body. Aging is associated with reduced pharmacodynamics processes. One of the mechanisms contributing to the reduced pharmacodynamics is the limited functioning of drug receptor sites. There is also the reduction in the available drug receptors for drug binding. This reduces the effect of the drug on the body while increasing its blood bioavailability (Kratz & Diefenbacher, 2019). An example is seen in patients diagnosed with diabetes. They have low insulin receptors, which result in the elevated blood glucose levels.
Assignment NURS 6521 Pharmacotherapy for Cardiovascular Disorders
The effect of aging on pharmacodynamics can also be seen from the exaggerated response to some drugs among this population. For example, older adults tend to show exaggerated responses to drugs that stimulate the central nervous system. The observation is because of the increased sensitivity to drugs by this population. In addition, aging reduces Gs protein interactions in the elderly patients. The decrease lowers cardiac, pulmonary, and vascular tissue to drugs such as those used in the treatment of hypertension(Stader et al., 2020). Therefore, nurses should consider these changes when prescribing drugs to elderly patients and other vulnerable populations.
Impact of the Changes in Processes on Patient’s Recommended Drug Therapy
The changes in the pharmacokinetic and pharmacodynamics processes affect the patient’s recommended drug therapy. A decline in the drug metabolism in the liver affects the selection of drugs for the patient. Nurses and other healthcare providers should prescribe medications that do not undergo first-pass metabolism to preserve optimum hepatic function. A decline in renal function also affects the client’s recommended drug therapy(Peeters et al., 2019). Nurse practitioners prescribe medications that have other routes of excretion such as feces to promote renal functioning.
There is also the consideration of drug dosages with the changes in the pharmacokinetics and pharmacodynamics. Accordingly, nurse practitioners lower the dosage and frequency of hepatotoxic and renal toxic medications in patients with advanced ages to minimize the risk of harm and drug toxicity (Thürmann, 2020). The reduction in drug absorption due to lowered gastric physiological processes also increases the need for prescribing drugs that are administered through other routes such as intravenously and intramuscularly.
Improving Patient’s Drug Therapy
I will improve the patient’s drug therapy by avoiding polypharmacy. The patient currently uses several drugs that predispose her to harm and medication errors. An effective approach to her treatment would be reducing the number of drugs taken at a time to promote her health, safety, and quality. The other way in which I will improve her drug therapy is by titrating the drug dosage upwards. Elderly patients should be initiated on low dosage and increased upwards based on tolerance and efficacy (Koren et al., 2019).
I will modify the patient’s current treatment. I will lower the dosage of celecoxib to minimize the risk of hepatotoxicity and renal toxicity. I will also stop glyburide and retain metformin. Metformin has the benefit of reducing the risk of cardiovascular mortality in patients with multiple comorbidities that include cardiovascular conditions (Guo et al., 2019).
Conclusion
Aging affects pharmacokinetics and pharmacodynamics processes. Advancing age lowers pharmacokinetic processes such as drug absorption, metabolism, and elimination. It also affects pharmacodynamics processes such as drug binding to their receptor sites. These changes affect the recommended treatment plan for the patient in the case study. Polypharmacy should be avoided in treating LM for safety and quality outcomes.
References
Drenth-van Maanen, A. C., Wilting, I., & Jansen, P. A. F. (2020). Prescribing medicines to older people—How to consider the impact of ageing on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921–1930. https://doi.org/10.1111/bcp.14094
Guo, L., Ma, J., Tang, J., Hu, D., Zhang, W., & Zhao, X. (2019). Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis. Journal of Diabetes Research, 2019, 9804708. https://doi.org/10.1155/2019/9804708
Koren, G., Nordon, G., Radinsky, K., & Shalev, V. (2019). Clinical pharmacology of old age. Expert Review of Clinical Pharmacology, 12(8), 749–755. https://doi.org/10.1080/17512433.2019.1632188
Kratz, T., & Diefenbacher, A. (2019). Psychopharmacological Treatment in Older People. Deutsches Ärzteblatt International, 116(29–30), 508–518. https://doi.org/10.3238/arztebl.2019.0508
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
Stader, F., Kinvig, H., Penny, M. A., Battegay, M., Siccardi, M., & Marzolini, C. (2020). Physiologically Based Pharmacokinetic Modelling to Identify Pharmacokinetic Parameters Driving Drug Exposure Changes in the Elderly. Clinical Pharmacokinetics, 59(3), 383–401. https://doi.org/10.1007/s40262-019-00822-9
Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anesthesiology, 33(1), 109. https://doi.org/10.1097/ACO.0000000000000814
NURS 6521 Advanced Pharmacology
Week 2 Assignment Pharmacotherapy for Cardiovascular Disorders
..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.
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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.
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
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).
In old age there is also decreased gastrointestinal motility thus leading to delayed absorption rate. 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 guidel
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