Assignment; Pharmacotherapy for Cardiovascular Disorders Essay

Assignment; Pharmacotherapy for Cardiovascular Disorders Essay

Pharmacotherapy for Cardiovascular Disorders Sample Essay

The patient case concerns LM, an 89-year-old female who is a resident at a long-term care facility. She has been having multiple falls that have caused skin bruises and tears. Her ambulation status has deteriorated in the past six months, and she now moves with a wheelchair and experiences leg pain when walking short distances. Her medical history is positive for HTN, Alzheimer’s, hypothyroidism, osteoarthritis, and diabetes. She is currently on Amlodipine, Donepezil, Levothyroxine, Celecoxib, Furosemide, Metformin, and Glyburide. The purpose of this paper is to discuss how her age may affect drug pharmacokinetic and pharmacodynamic processes and how to improve drug therapy.

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How Age Might Influence Pharmacokinetic and Pharmacodynamic Processes

Advanced age is associated with physiological changes that often affect pharmacokinetic (PK) processes like drug absorption, distribution, metabolism, and excretion. Aging physiological changes in the GI include a reduced surface area of the intestinal epithelium, decreased splanchnic blood flow, delayed gastric emptying, and raised gastric pH (Cossart et al., 2021). These changes alter the absorption of some oral drugs absorbed in the upper small intestine. In addition, aging is characterized by increased fat percentage, reduced lean muscle mass, and total body water. This increases the volume of distribution for lipophilic medications while reducing that of hydrophilic drugs.

The elderly also have reduced serum albumin levels which may lead to decreased total drug concentration and increased free drug fraction. Furthermore, aging is associated with a reduced liver size and hepatic blood flow, which can affect drug metabolism. Drugs with a high liver extraction ratio may have decreased clearance because of reduced hemoperfusion (Cossart et al., 2021). Renal excretion is also affected due to reduced glomerular filtration rate  (GFR) in aging, which reduces drug clearance. Pharmacodynamic (PD) changes in aging include increased or reduced sensitivity to drug effects attributed to changes in drug-receptor interaction, adaptive homeostatic responses, and post-receptor events (Polaka et al., 2022). For instance, the elderly are highly sensitive to anticholinergic and CNS drugs.

How PK and PD Changes May Impact the Drug Therapy

LM’s age may contribute to PK and PD changes affecting her drug therapy. She has a decreased GFR and elevated BUN and creatinine levels, indicating impaired renal function. This would affect medications excreted by kidneys like Metformin, Furosemide, Celecoxib, Amlodipine, and Glyburide. Thus, lower doses of these medications are needed due to a reduced drug clearance rate and minimizing adverse effects. In addition, the exaggerated response to CNS drugs in advanced age may necessitate a lower dose of Donepezil.

Improving the Medication Therapy

The patient’s drug therapy will be improved by modifying the drug doses. For example, Amlodipine will be reduced to 5 mg Q.D and Furosemide to 20 mg because of impaired renal excretion, reduced drug clearance, and to minimize side effects (Drenth‐van Maanen et al., 2020). Donepezil will be decreased to 5mg QHS to avoid an exaggerated CNS response. In addition, Levothyroxine will be lowered to 50 mcg/day since it is associated with a high risk of atrial fibrillation in advanced age. Metformin increases the risk of lactic acidosis in elderly persons with renal impairment and will thus be stopped (Maher et al., 2021). Furthermore, Glyburide will be lowered to 2.5 mg/day because of impaired renal function and its associated hypoglycemic effect on the elderly.

Conclusion

Aging is associated with physiological changes that affect PK processes, including drug absorption, distribution, metabolism, and excretion. PD changes in aging include increased or reduced sensitivity to drugs. The patient’s drug doses should be lowered to accommodate the aging physiological changes.

References

Cossart, A. R., Isbel, N. M., Scuderi, C., Campbell, S. B., & Staatz, C. E. (2021). Pharmacokinetic and pharmacodynamic considerations in relation to calcineurin usage in elderly kidney transplant recipients. Frontiers in Pharmacology, 12, 635165. https://doi.org/10.3389/fphar.2021.635165

Drenth‐van Maanen, A. C., Wilting, I., & Jansen, P. A. (2020). Prescribing medicines to older people—How to consider the impact of aging on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921-1930. https://doi.org/10.1111/bcp.14094

Maher, D., Ailabouni, N., Mangoni, A. A., Wiese, M. D., & Reeve, E. (2021). Alterations in drug disposition in older adults: a focus on geriatric syndromes. Expert opinion on drug metabolism & toxicology, 17(1), 41–52. https://doi.org/10.1080/17425255.2021.1839413

Polaka, S., Tella, J. D., Tekade, M., Sharma, M. C., & Tekade, R. K. (2022). Impact of aging on the pharmacokinetics and pharmacodynamics of the drugs. In Pharmacokinetics and Toxicokinetic Considerations (pp. 241-261). Academic Press. https://doi.org/10.1016/B978-0-323-98367-9.00008-1

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Case assignment for 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.

LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.

PMH:

• HTN
• Alzheimer’s disease
• Hypothyroidism
• Osteoarthritis
• Diabetes

MEDICATIONS:

• Amlodipine 10 mg QD
• Donepezil 10 mg QHS
• Levothyroxine 0.88 mg QAM
• Celecoxib 200 mg QD
• Furosemide 40 mg QAM
• Metformin 500mg, 1 BID
• Glyburide 5mg, 1 BID

ALLERGIES: NKA

SOCIAL HISTORY:

Widowed with 2 adult children living in town, retired photographer and owner of an art supply store

VITALS:	LABS:
Weight: 129 lbs	TSH 2.45        Free T4 0.98
Height: 64 inches	Na 135, K+ 3.8, Cl 99, CO2 25,
BP: Supine = 177/82	Glucose 101, SCr 0.9, BUN 42
HR: 78 bpm	WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1
Plt 255
Cr: 1.6 UA: Clear
eGFR: 45 ml/min

PE:

• HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes
• CV: RRR
• Respiratory: Clear to auscultation bilaterally
• Abdomen: Soft, non-tender, no masses or guarding
• G/U: Skin intact, assisted with toileting and personal hygiene by staff
• Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
• Neuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months.

PAIN ASSESSMENT:

Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to sever.

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.

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

RESOURCES

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

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.

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. 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-20293632Links to an external site.). All papers submitted must use this formatting.

SUBMISSION INFORMATION

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1. To submit your completed assignment, save your Assignment as WK2Assgn_LastName_Firstinitial
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Rubric

NURS_6521_Week2_Assignment_Rubric

Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeExplain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.	25 to >22.5 ptsExcellent The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. 22.5 to >19.75 ptsGood The response provides a basic explanation of how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. 19.75 to >17.25 ptsFair The response inaccurately or vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. 17.25 to >0 ptsPoor The response inaccurately and vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient, or is missing.	25 pts
This criterion is linked to a Learning OutcomeDescribe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.	30 to >26.7 ptsExcellent The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy. … Accurate, complete, and aligned examples are provided to support the response. 26.7 to >23.7 ptsGood The response accurately describes how changes in the processes might impact the patient’s recommended drug therapy. … Accurate examples may be provided to support the response. 23.7 to >20.7 ptsFair The response inaccurately or vaguely describes how changes in the processes might impact the patient’s recommended drug therapy. … Inaccurate or vague examples are provided to support the response. 20.7 to >0 ptsPoor The response inaccurately and vaguely describes how changes in the processes might impact the patient’s recommended drug therapy, or is missing. … Inaccurate and vague examples may be provided to support the response, or is missing.	30 pts
This criterion is linked to a Learning OutcomeExplain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements.	30 to >26.7 ptsExcellent The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan. … The response includes an accurate and detailed explanation to support the recommended improvements. 26.7 to >23.7 ptsGood The response accurately explains how to improve the patient’s drug therapy plan. … The response may include an accurate explanation to support the recommended improvements. 23.7 to >20.7 ptsFair The response inaccurately or vaguely explains how to improve the patient’s drug therapy plan. … The response may include an inaccurate, vague, or misaligned explanation to support the recommended improvements. 20.7 to >0 ptsPoor The response inaccurately and vaguely explains how to improve the patient’s drug therapy plan, or is missing. … The response may include an inaccurate and vague explanation to support the recommended improvements, or is missing.	30 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.	5 to >4.45 ptsExcellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity. 4.45 to >3.95 ptsGood Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 3.95 to >3.45 ptsFair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. 3.45 to >0 ptsPoor Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.45 ptsExcellent Uses correct grammar, spelling, and punctuation with no errors 4.45 to >3.95 ptsGood Contains a few (1–2) grammar, spelling, and punctuation errors 3.95 to >3.45 ptsFair Contains several (3–4) grammar, spelling, and punctuation errors 3.45 to >0 ptsPoor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.	5 to >4.45 ptsExcellent Uses correct APA format with no errors 4.45 to >3.95 ptsGood Contains a few (1–2) APA format errors 3.95 to >3.45 ptsFair Contains several (3–4) APA format errors 3.45 to >0 ptsPoor Contains many (≥ 5) APA format errors	5 pts
Total Points: 100 RESOURCES   Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources. WEEKLY RESOURCES 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. LEARNING RESOURCES Required Readings Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. Chapter 33, “Review of Hemodynamics” (pp. 285–289) Chapter 37, “Diuretics” (pp. 290–296) Chapter 38, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 297–307) Chapter 39, “Calcium Channel Blockers” (pp. 308–312) Chapter 40, “Vasodilators” (pp. 313–317) Chapter 41, “Drugs for Hypertension” (pp. 316–324) Chapter 42, “Drugs for Heart Failure” (pp. 325–336) Chapter 43, “Antidysrhythmic Drugs” (pp. 337–348) Chapter 44, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 349–363) Chapter 45, “Drugs for Angina Pectoris” (pp. 364–371) Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)