Pharmacotherapy for Cardiovascular Disorder.
For Week 2, you will examine how patient factors may influence pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics used in the treatment of cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs. When writing your Week 2 Assignment, consider the following scenario:Pharmacotherapy for Cardiovascular Disorder.
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 Evidence-based clinical practice guidelines are fundamental to clinical practice, as they assist providers with clinical decision making. Pharmacotherapy for Cardiovascular Disorder. I have attached some applicable guidelines below for your reference. To Prepare 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.Pharmacotherapy for Cardiovascular Disorder. 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. Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.Pharmacotherapy for Cardiovascular Disorder. 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. Rubric Detail 1) Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. 2) Describe how changes in the processes might impact the patient\’s recommended drug therapy. Be specific and provide examples. 3) Explain how you might improve the patient\’s drug therapy plan, and explain why you would make these recommended improvements.Pharmacotherapy for Cardiovascular Disorder.
Pharmacotherapy for Hypertension, Ischemic Heart Disease, and Hyperlipidemia in Type II Diabetes Mellitus
There are several individual and lifestyle factors that affect the pharmacokinetics and pharmacodynamics of oral medications, such as the ones prescribed for patient HM. These factors include age, gender, genetics (heredity), and lifestyle factors such as obesity, lack of physical activity, and smoking. Because patient HM has hyperlipidemia, it can be surmised that they are either overweight or obese. However, for the purposes of this paper the factor that is chosen and that impacts the pharmacokinetics (PK) and pharmacodynamics (PD) of the medications prescribed is age. For the comorbidities of patient HM (hypertension, hyperlipidemia, ischemic heart disease, and type II diabetes), they have been put on a polypharmacy regimen of metformin, glyburide, aspirin, motrin, and atenolol (Katzung, 2018). Aspirin is a non-steroidal anti-inflammatory drug (NSAID) that has blood thinning properties hence preventing cardiovascular events. Warfarin is primarily a blood thinner, while atenolol is a beta-blocking agent that reduces blood pressure by relaxing vessels. Motrin, like aspirin, is a NSAID but is used in this case for pain relief. Lastly, metformin is a biguanide and glyburide a sulfonylurea. Both are oral antihyperglycaemic agents that are synergistic and used for the management of type II diabetes (Katzung, 2018). Metformin also helps in lowering weight and hence the hyperlipidemia (Malina & Kashyapb, 2014). The following discussion is about the effect of age as a factor on the PK and PD of these pharmacotherapeutic agents. Pharmacotherapy for Cardiovascular Disorder.
The Influence of Age on the Pharmacokinetic and Pharmacodynamic Processes in Patient HM on the Above Medications
Pharmacokinetics is concerned with what the body does to the drug. It encompasses absorption, distribution, metabolism, and excretion (ADME) of the drug. On the other hand, pharmacodynamics is about what the drug does to the body, or its mechanism of action (Katzung, 2018). P-glycoproteins are plasma membrane pumps that are instrumental in transporting drugs from the gut lumen (absorption) to be metabolized by cytochrome P3A4 isoenzymes. The efficiency of these p-glycoprotein pumps in old age is compromised, and so is the absorption of oral medications (Jacobson, 2013). Distribution of drugs once absorbed is also affected in old age because lean body mass becomes less. This impacts the plasma half-life of hydrophilic drugs which is reduced as that of lipophilic drugs increases. It has also been shown that the cytochrome P450 isoenzyme pathway involved in drug metabolism becomes less efficient with age. For excretion, renal insufficiency increases with age and therefore active drug metabolites can accumulate to dangerous levels in the body (Katzung, 218; Khoury & Sheikh-Taha, 2014; Jacobson, 2013).Pharmacotherapy for Cardiovascular Disorder.
On pharmacodynamics, it is worth noting that glyburide is the only drug in the regime above on which age has no influence. However, the effectiveness of transport channels and receptors declines with old age for most drugs. This means that their plasma concentrations are altered – either therapeutic concentrations will not be reached, or the drug will accumulate to dangerous levels in the body (Jacobson, 2013; Jaber et al., 1996).Pharmacotherapy for Cardiovascular Disorder.
How the PK and PD Changes Impact Drug Therapy and How to Improve Patient HM’s Drug Therapy
The above PK and PD changes that may occur with age mean that dose adjustments may be necessary if patient HM is an older patient. The dosages of aspirin, atenolol, and motrin may have to be reduced. Specifically, the aspirin dose of 81 mg may have to be lowered to 75 mg due to the reduced efficiency of the CYP450 metabolic pathway in the liver. In the same manner, the dose and frequency of motrin may have to go down to just 200 mg tds. I would improve the drug therapy for this patient by removing warfarin from this regime as aspirin would suffice as a blood thinner in these circumstances. The reason for this is that polypharmacy (many drugs prescribed at the same time) presents a danger of drug interactions and multiple side effects.Pharmacotherapy for Cardiovascular Disorder.
Pharmacodynamics and pharmacokinetics of medications are affected by factors such as age and lifestyle factors like obesity. For age, the decline in many bodily functions such as metabolic pathways is significant. This means that adjustments to the drug regimes of older patients must be made to reduce the chances of severe drug interactions and adverse effects.Pharmacotherapy for Cardiovascular Disorder.