Feb 23, 2024 Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521
Assignment Pharmacotherapy for Cardiovascular Disorders NURS 6521
A Sample Answer For the Assignment: Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521
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.
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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.
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 Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521 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, I chose age as a factor that can cause drug toxicity and influence the pharmacokinetics of various medications. The altered metabolism and blood concentration of drugs increase with age (Giri et al., 2018). Reduced renal function alters drug pharmacokinetics such as glomerular filtration rate and reduces blood flow. Physiological factors and temperature are two examples of age-related changes in a patient (Giri et al., 2018).
Cognitive function, ventricular aerial stiffness, endothelial function, and electric conduction are all physiological factors (Rosenthal & Burchum, 2021). Because of sympathetic neuronal and baroreceptor responses, most people are sensitive to antihypertensive medication (Giri et al., 2018).
Glipizide is used to treat type 2 diabetes in adults. Because it reduces glucose output from the liver, the drug effectively promotes insulin release from beta cells (Addul-Ghani et al., 2021). For patients with poor metabolic control, the combination of metformin and Glipizide can help them achieve their HbA1c goal in three months (Addul-Ghani et al., 2021).
Glipizide is effective because it has a short half-life and effect duration, reducing the risk of long-term hypoglycemia (Addul-Ghani et al., 2021). Patients who combine Glipizide with thyroid hormone, estrogen-containing contraception, thiazide diuretics, nicotinic acid, or calcium channel blockers are at high risk of hyperglycemia (Rosenthal & Burchum, 2021).
Metformin effectively improves glycemic control without causing hypoglycemia or obesity, and is thus considered a first-line pharmacologic treatment (Shurrab & Arafa, 2020). The drug works in the liver to inhibit gluconeogenesis by blocking the mitochondrial redox shuttle (Shurrab & Arafa, 2020). Metformin has been linked to gastrointestinal side effects such as nausea, diarrhea, and vomiting (Shurrab & Arafa, 2020). When combined with hypoxemia and hypoperfusion, FDA labels warn against prescribing Metformin drug therapy to patients with acute heart failure.
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). This paper aims to analyze how old age affects the patient’s pharmacokinetics and pharmacodynamics processes. It also suggests how to improve patient AO treatment plan for cardiovascular condition.
Impact of Age on Pharmacodynamics and Pharmacokinetics
In this scenario, the patient has 3 major medical issues namely high cholesterol level, high blood pressure,
Assignment Pharmacotherapy for Cardiovascular Disorders NURS 6521
and obesity. As people age and need treatment, there is a need to understand the pharmacodynamics and pharmacokinetics in old age. As one ages, the process of drug absorption, metabolisms, distribution, and excretion are drastically decreased (Thürmann, 2020). 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 (Reeve et al., 2017).
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. 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. 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 (Kapoor, 2021). It is also noted that patient AO is on several blood pressure drugs. 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 (Peterson et al., 2018). Also, in the elderly, the use of SSRIs has been reported to have an increased risk of GI bleeding due to their antiplatelet properties. Because of this, the Sertraline for patient AO needs to be investigated for any potential risks before continuation (Drenth‐van Maanen, Wilting & Jansen, 2019).
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.
Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521
…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.
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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 for Assignment Pharmacotherapy for Cardiovascular Disorders NURS 6521
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 of Assignment Pharmacotherapy for Cardiovascular Disorders NURS 6521
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.
Pharmacology 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.
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.
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.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.Click on the Submit button to complete your submission.Grading Criteria
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.
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