NURS 6521 Week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders
Pharmacotherapy for Cardiovascular Disorders
Cardiovascular diseases (CVD), to date are the leading cause of death worldwide, and several patients are equally diagnosed with diabetes. People living with type 2 diabetes are believed to have a higher risk for cardiovascular diseases and death than their counterparts (Saeedi, Karuranga, Hammond, Kaundal, Malanda, Prystupiuk & Matos, 2020). Management of cardiovascular diseases requires clinician to have adequate knowledge of pharmacokinetics and pharmacodynamics, while adhering to current treatment guidelines, for optimal outcome (Sieder, Kalus & Lanfear, 2016), with the goal of maximizing the advantages of available therapeutics and reducing patient harm. NURS 6521 Week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders.
Week 2 Case Study
A patient presenting Atrial Fibrillation and Transient Ischemic Attack (TIA), with associating medical history of type 2 diabetes mellitus, hypertension, hyperlipidemia and Ischemic heart disease. On review of current medication list, patient is on Coumadin (Warfarin), Aspirin, Metformin and Glyburide. Ordered beta -blocker Atenolol (Tenormin), used in treatment of hypertension could be substituted with Metoprolol succinate ER (Lopressor), as atenolol increases the maximum serum level concentration of coumadin, while metoprolol has no interaction with coumadin (Rosenthal. & Burchum, 2018). NURS 6521 Week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders
Factors influencing pharmacokinetic and Pharmacodynamic Processes
Several intrinsic and extrinsic factors could influence pharmacokinetic and pharmacodynamic processes, factors age, gender, smoking, other drugs and other comorbidities (Mayor, 2017). Understanding pharmacokinetics is key to effective therapeutic modalities, bearing in mind factors like half-life, loading doses, absorption, metabolism and modes of excretion of medications (Mayor, 2017). Certain factors like changes in the subcutaneous tissue may alter the absorption of certain medication, like transdermal medication—like patches, while problems in the gastrointestinal tract may affect the absorption and metabolism of certain drugs like antacids (Sieder, Kalus & Lanfear, 2020).
Possible changes in recommended drug therapy
To improve drug therapy for this patient, changes on the medication regime is needed. Replacing beta-blocker Atenolol (Tenormin) with metoprolol succinate ER (Lopressor), starting with 25-200mg daily. It is recommended to start new medications especially beta-blockers with the extended release formulas while immediate response can be achieved with delayed release modules and can be administered three times a day (Sieder, Kalus & Lanfear, 2016). The substitution of ibuprofen (Motrin) with Acetaminophen (Tylenol) 650mg orally every 4-6 hours as needed for pain, because ibuprofen (Motrin) which is a Nonsteroidal anti-inflammatory drugs (NSAIDs) has drug interaction when used with warfarin, with high potential for bleeding (Rosenthal. & Burchum, 2018). The American college of Cardiology and American heart association (ACC/AHA), in a recent guideline has recommended the use of non-statin lipid-lowering medications to achieve low-density lipoprotein cholesterol (LDL-C) levels (Hoover, 2019).
Factors to improve drug therapy
Patients’ compliance to their medication regime is in many ways dependent on the health care clinicians and system’s ability to adequately support and engage them in their care. For several patients, especially those of poor socioeconomic status, poor access to health care providers, lack of funds to obtain needed medications and treatment result to poor understanding of necessary disease management and follow-up (Saeedi, et al, 2020). Health education with emphasis on heart healthy promotion is key to ensure patient adherence to treatment modalities. Increased effort on the federal, state and local health care systems, to create incentives to make life saving medications and treatments accessible and affordable to all.
Care plan recommendations
It is recommended that patients with high atherosclerotic cardiovascular disease (ASCVD) risk, or nonfatal myocardial infarction and a history of diabetes like the patient in the case to start with a moderate intensity statin (Hoover, 2019), for a goal of 30% or greater reduction in LDL-C levels. The use of Ezetimibe (Zetia) given 10mg orally daily is recommended for this patient. ACE inhibitors can now be used for treatment of heart failures, diabetes mellitus, LV dysfunction and diabetes neuropathy, and for stroke prevention (Rosenthal. & Burchum, 2018). Ramipril (Altace), starting doses between 1.25mg daily to 2.5mg orally daily is effective in lowering blood pressure readings, and known to reduce myocardial infarcts, strokes and death (Rosenthal. & Burchum, 2018). In addition to medication changes, health education on heart healthy diet is necessary, smoking cessation, weight loss with inclusion of physical activity to reduce ASCVD risk (Hoover, 2019). NURS 6521 Week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders
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.
Saeedi, P., Karuranga, S., Hammond, L., Kaundal, A., Malanda, B., Prystupiuk, M., & Matos, P. (2020). Cardiovascular diseases and risk factors knowledge and awareness in people with type 2 diabetes mellitus: a global evaluation. Https://www.sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/
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/ NURS 6521 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
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