Feb 23, 2024 NURS 6521 Week 3: Cardiovascular System
NURS 6521 Week 3: Cardiovascular System
Week 3: Cardiovascular System
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.
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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.
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
Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. Consider hypertension. An estimated 68 million people in the United States have this disorder (CDC, 2012). However, about 30 percent of these patients are not treated at all, and of those who are treated, less than 50 percent have properly controlled blood pressure levels (University of Maryland Medical Center, 2009). In clinical settings, patients often present with symptoms of hypertension and other cardiovascular disorders making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options.
This week you examine the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for these disorders.
Learning Objectives: Week 3: Cardiovascular System
By the end of this week, students will:
Evaluate the influence of patient factors on pharmacokinetic and pharmacodynamics processes
Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy
Evaluate drug therapy plans for cardiovascular disorders
Understand and apply key terms, concepts, and principles related to prescribing drugs to treat cardiovascular disorders
Photo Credit: GIPhotoStock/Cultura/Getty Images
Learning Resources – Week 3: Cardiovascular System
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.
Required Readings – Week 3: Cardiovascular System
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)
Required Media: Week 3: Cardiovascular System
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.
Note: The approximate length of this media piece is 10 minutes.
Optional Resources
Refer to the Optional Resources listed in Week 1.
NURS 6521 Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders
As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This is the result of the extensive treatment and care that is often required for patients with these disorders. While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011). Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors.
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.
Consider the following case studies:
Case Study 1:
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
Case Study 2:
Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:
Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81 mg daily
Metformin 1000 mg po bid
Glyburide 10 mg bid
Atenolol 100 mg po daily
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain
Case Study 3:
Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:
Glipizide 10 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD 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 of the three case studies, as well as 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:
By Day 3
Post an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected. 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.
By Day 6
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different case study than you did, in one or more of the following ways:
Provide alternative recommendations for drug treatments.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Discussion Rubric
Submission
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 3 Discussion
Week 3 Quiz
This week’s Quiz covers the content you have explored this week. The Quiz may include the following topics:
Drug classifications by indication—ACE-I, ARB, anticoagulants, antiplatelet, beta blockers, calcium channel blockers, cardiovascular system, DRI
Drug dosage calculations
Drug interactions
By Day 7
You have 60 minutes to complete this 26-question Quiz.
This quiz is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this quiz. You are expected to comply with Walden University’s Code of Conduct.
Submission and Grading Information
Submit Your Quiz by Day 7
Case Study 2
Patient HM has an extensive cardiovascular history. There is a history of atrial fibrillation, ischemic attack (TIA), type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease. The patient is prescribed a list of medications that include:
Warfarin 5 mg daily po MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81mg daily po
Metformin 1000 mg PO
Glyburide 10 mg PO BID
Atenolol 100 mg PO daily
Motrin 200 mg 1-3 tablets every 6 hours as needed for pain
Cardiovascular disease affects many people worldwide annually. Kendir et al. 2018 state that cardiovascular diseases are the most common cause of death from non-communicable diseases (p.46). Cardiovascular disease can refer to many diseases that affect the heart, and it’s vessels. Our patient HM had many diagnosed cardiovascular disorders. Atrial fibrillation which is an arrhythmia the heart due to loss of coordination of electrical and mechanical activity in the atria (Arcangelo, Petterson, Wilbur, & Reinhold, 2017, p.864). Clots or thrombi can develop from atrial fibrillation causing strokes or ischemic attacks. Unfortunately, HM had a history of ischemic attacks (TIA).
According to Arcangelo et al. 2017, an ischemic stroke is described as a sudden or progressive onset of focal neurologic sign due to the inadequate blood supply to the brain (p.868). Having hyperlipidemia which is a high blood level of cholesterol further makes heart disease worse because the cholesterol builds up in vessels affecting blood flow. Hypertension heightens the potential of developing cardiovascular disease and chronic kidney disease. Hypertension can go for a long period of time going undetected because it can be asymptomatic. Finally, HM was diagnosed with type II diabetes, which is caused when adipose and muscle cells become less sensitive to the actions of insulin or the pancreas produces less insulin than the body needs (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.785).
Patient Factor
The disorders that HM has been diagnosed with can happen at any age, however, in elderly patients, they may have a poorer prognosis because medications are not always processed by the body as well or as intended. The development and worsening of cardiovascular disease are associated with many factors such as genetics, lifestyle choices/behaviors, ethnicity, and age. With so many other factors as a person ages, it is worsening the disease because that is a factor that cannot be changed. With the patient HM’s medical history as a provider, you have to be cautious when prescribing because medications are absorption may be affected because of age.
Drug Therapy Plan
The patient’s medical history puts him at higher risk of having a heart attack or stroke from complications of cardiovascular disease. With this patient, we want to control his diabetes, hypertension, hyperlipidemia, and atrial fibrillation keeping levels within normal limits without over prescribing to this patient. The first thing that was noticed when looking at the patient’s medication list is that he is talking two medications with anticoagulant effects.
Warfin which is a strong anticoagulant and aspirin. When taking Warfin routine lab work is needed to check the PT, INR, and aPTT levels in the blood to determine if the medication dose needs to be adjusted. Added aspirin in could cause increased bleeding, the elderly population with underlying malignancy and those taking interacting drugs that increase warfarins effect are at high risk for bleeding and should receive lower initial doses (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.874).
HM has type two diabetes and is taking Atenolol 100mg daily which is a beta-blocker. Arcangelo et al. 2017 stated, in diabetic patients, beta-blockers can mask all symptom of hypoglycemia except sweating (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.266). Being on this medication, the patient would have to consistent with monitoring his glucose levels and educated well on signs and symptoms of hypoglycemia. This patient may benefit better from an Angiotensin II Receptor Blocker such as losartan. For diabetics, losartan is a better choice because it is more effective than atenolol in lower cardiovascular morbidity and mortality in diabetic patients with hypertension and left ventricular hypertrophy (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.267). Being that HM is elderly, his initial dose should be losartan 50 mg Po daily. Starting at 50 mg daily leaves enough room to adjust up if needed depending on the patient’s blood pressure (Kizior,2018).
Reference:
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
Kendir, C., van den Akker, M., Vos, R., & Metsemakers, J. (2018). Cardiovascular disease
patients have increased risk for comorbidity: A cross-sectional study in the Netherlands. The European Journal Of General Practice, 24(1), 45–50. https://doi-org.ezp.waldenulibrary.org/10.1080/13814788.2017.1398318
Kizior, R. (2018). Saunders Nursing Drug Handbook 2019. Elsevier – Health Sciences Division.
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2 months ago
Antoinette Joseph
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 visi
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