Pharmacotherapy for Cardiovascular Disorders Essay.

Introduction

In the United States, strokes caused by cardiovascular diseases are a major occurrence among patients aged 60 years and older. It is estimated that more than 80 million people have a cardiovascular illness in the US and more than 40 million of this population are aged 60 years or older. Other risk factors that have been associated with an increase in the prevalence of strokes secondary to cardiovascular illnesses are obesity, ethnicity, gender, and type 2DM.Pharmacotherapy for Cardiovascular Disorders Essay.

ORDER A PLAGIARISM-FREE PAPER HERE

Case Overview

Patient CB with a history of strokes who has also been diagnosed with hypertension, type 2 diabetes, and hyperlipidemia.  Currently, he has been prescribed the following drugs;

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

Changes That Might Impact Recommended Drug Therapy

Age is one of the most significant factors that influence the pharmacokinetics and pharmacodynamics of drugs.  People aged 50 years and older have a weak neuronal sympathetic response and baroreceptors, which increases their sensitivity to antihypertensives. Besides, the renal and hepatic clearance rates decrease with age (Arcangelo & Peterson, 2017). This implies that, after the administration of drugs, they can progressively circulate in the body for longer. This is important for clinicians to note since it increases the risk of geriatric patients to drug toxicity, drug-drug interactions, and adverse events. In the gastrointestinal (GI) system of the geriatric patient population, the GI motility decreases with age and this negatively impacts the absorption of drugs. Drug metabolism, distribution, and excretion are also influenced by a decrease in the total body water (TBW), rate of hepatic clearance, renal function, and BMI.Pharmacotherapy for Cardiovascular Disorders Essay.

Patient CB is diagnosed with diabetes which can also influence the absorption, distribution, metabolism, and excretion of the drug regimen. Patients with diabetes mellitus have a decreased flow of blood in the gastric mucosa. While this can delay gastric emptying, it negatively impacts the absorption rate of medications administered via the oral route among diabetics (Tran & Elbarbry, 2016). Ethnopharmacology is also an important factor to consider that can alter a patient’s response to a drug regimen based on ethnicity. The biological and genetic differences that occur in different ethnicities determine the disposition, metabolism, drug-receptor variance, and binding to proteins (Woods et al, 2017). Currently, existing studies reveal that African Americans are particularly less responsive to ACE inhibitors. Pharmacotherapy for Cardiovascular Disorders Essay.

Treatment Plan

If this patient were an African American aged 50 years and older, with the prescribed medications and outlined underlying chronic conditions of hyperlipidemia, hypertension, and type 2 DM, he would be at a high risk of significant side effects and averse drug-drug interactions. To reduce this risk, the author would prescribe a different drug regimen. Currently, existing evidence reveals that diuretics and calcium channel blockers are more effective among African Americans. On the other hand, beta-blockers and ACE inhibitors have proven to be less effective in the same patient population (Ferdinand & Nasser, 2015). Besides, it is contraindicated to combine verapamil with simvastatin. To develop the most appropriate drug regimen, the author would first order for a laboratory diagnostic workup of a lipid panel, a renal panel and fasting blood glucose (FBG), and HbA1C.Pharmacotherapy for Cardiovascular Disorders Essay. It will also be important to ascertain the patient’s level of compliance to previously prescribed medications, and affordability of drugs. Based on the patient’s age (50 years and older), the author would discontinue hydralazine and atenolol and let him continue taking one antihypertensive. The history of strokes would influence the author’s decision to maintain him on verapamil 180mg PO daily and combine it with pravastatin 40 mg QD low dose for hyperlipidemia. The author will also continue with the HCTZ 25 mg PO QD and glipizide 10 mg PO. However, since glipizide has been evidenced to reduce the effectiveness of verapamil, there will be a need for close monitoring. Pharmacotherapy for Cardiovascular Disorders Essay.

After prescribing the above medications, the author would educate the patient on the possible side effects and adverse events of each drug and the need to return immediately to visit the nearest healthcare facility in case the side effects worsen. The patient will also be educated to observe a DASH diet, decrease the intake of high-calorie diets, excess sugars, and to restrict the intake of salt (Arcangelo & Peterson, 2017).  The patient will return for follow-up after three months to assess his adherence to prescribed drugs, dietary, and lifestyle modifications.

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…Pharmacotherapy for Cardiovascular Disorders Essay.

—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.

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.
• 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.Pharmacotherapy for Cardiovascular Disorders Essay.

By Day 5 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.

Case study assigned:

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

• 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. Would you discontinue any medications, change the dosage, and/or add medications to the patient’s regimen?

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.

Pharmacotherapy for Cardiovascular Disorders Essay.

Rubric

• Grid View

• List View

Pharmacotherapy for Cardiovascular Disorders Essay.