NURS 6521 Pharmacotherapy for Cardiovascular Disorders Essay
NURS 6521 Pharmacotherapy for Cardiovascular Disorders Essay
NURS 6521 Pharmacotherapy for Cardiovascular Disorders Sample Essay
An elderly African American male patient in the case study laments having a painfully sluggish heart rate. The patient had lightheadedness in the mornings as well. He began using Diltiazem CD six weeks ago to help manage his high blood pressure, and his dose of metoprolol was decreased from 75 to 50 mg twice a day. His lab tests revealed digoxin toxicity upon admission, as recommended by the patient’s PCP, as well as significantly decreased diastolic blood pressure, bradycardia, elevated levels of potassium, low hct, high creatinine, INP, BUN, INP, and glucose levels. This paper explores the relationship between pharmacodynamic and pharmacokinetic processes and patient age, as well as how these processes impact the medications that the patient is prescribed.
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Pharmacokinetic and Pharmacodynamic Processes
The patient is considered elderly because he is 74 years old. According to research, aging is marked by a reduction in the performance of several regulatory mechanisms within the body’s tissues that are in charge of ensuring coordination and integration between cells and organs (Thürmann, 2020). As a result, in some physiologically stressful conditions, they can end up not sustaining homeostasis. Reduced homeostasis has varied impacts on distinct regulatory systems in different individuals, leading to increased interindividual variability in older adults.
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Reduced liver and kidney clearance and extensive distribution volume of medications soluble in lipid medium are a few of the most prevalent pharmacokinetic alterations linked to aging (van den Anker et al., 2018). The aforementioned modifications also cause most medicines’ elimination half-lives to be lengthened. Aging is associated with a higher sensitivity of most pharmacological agents, including psychotropic, cardiac, and anticoagulant medicines. This is regarding pharmacodynamic alterations. The sensitivity, however, may differ based on additional elements including the patient’s body weight and coexisting medical disorders.
Impact on the Patient’s Recommended Drug Therapy
The patient is more likely to have impaired renal and hepatic clearance of several medications due to his senior age, as well as lower water-soluble drug distribution volume and a longer elimination half-life. For instance, the patient had decreased renal clearance of digoxin, which resulted in higher bioavailability and the lethal levels seen in the test results. The pharmacodynamic modifications of enhanced sensitivity to the medication further aggravated the elevated blood levels of digoxin (Angraal et al., 2019). Digoxin, which slows the conduction of electrical impulses in the AV node and stimulates the parasympathetic nervous system, can suppress the atrioventricular node in large dosages, which lowers the patient’s heart rate.
Life-threatening complications including metabolic acidosis, hypotension, and bradycardia have also been linked to calcium channel blockers like diltiazem due to decreased renal clearance and enhanced bioavailability (Alshaya et al., 2022). Due to the similar modifications in the pharmacokinetic and pharmacodynamic processes, the patient’s reported dizziness is related to metoprolol poisoning. Due to increased warfarin bioavailability brought on by decreased hepatic clearance, the patient’s INR was high (Sanghai et al., 2020). The raised blood sugar levels were caused by reduced sensitivity to Humalog. Moreover, the patient had symptoms of hyperkalemia, which, especially when combined with the use of diuretics like HCTZ, may have contributed to the loss of renal function. For senior people, medications including lisinopril, Imdur, Lantus, famotidine, multivitamins, and electrolyte supplements are thought to be safe.
Improving Patient’s Drug Therapy Plan
Due to the patient’s advanced age, it will be required to modify the dosages of the medications that have been influenced by changes in pharmacodynamic and pharmacokinetic processes to improve the treatment outcomes of the prescription pharmaceuticals (Christensen et al., 2019). The dosage should be decreased to 0.125 mg once daily beginning with digoxin (Angraal et al., 2019). To achieve the ideal therapeutic level, which is between 0.8 and 2.0 ng/mL, the patient’s serum concentration should be monitored. It seemed sensible to reduce the dosage of metoprolol from 75 mg to 50 mg. Nonetheless, the patient’s dizziness should be carefully watched for potential dose adjustments in the future. Due to the patient’s bradycardia, Diltiazem CD should be stopped (Alshaya et al., 2022). To assist treat hyperkalemia, HCTZ should be substituted with a potassium-sparing diuretic. In addition, the dosages of aspirin and warfarin should be changed while the patient’s INR is closely monitored (Sanghai et al., 2020). To improve treatment outcomes, the patient should nonetheless continue taking additional drugs as directed in addition to making lifestyle changes including exercising and eating a heart-healthy diet.
Conclusion
The patient in the case study offered has medication-related side effects, and the medication’s higher blood concentrations are blamed on pharmacokinetic and pharmacodynamic aging-related changes. The patient displayed signs of digoxin, Diltiazem CD, Hydrochlorothiazide, Warfarin, and metoprolol toxicity as a result of decreased renal and hepatic functioning. Since bradycardia might have fatal adverse effects, medications like Diltiazem CD have to be stopped. To encourage better results and lessen the negative effects related to polypharmacy, it was also required to take non-pharmacological measures such as nutrition and exercise into consideration.
References
Alshaya, O. A., Alhamed, A., Althewaibi, S., Fetyani, L., Alshehri, S., Alnashmi, F., … & Alshaya, A. I. (2022). Calcium Channel Blocker Toxicity: A Practical Approach. Journal of Multidisciplinary Healthcare, 15, 1851-1862. DOI:10.2147/JMDH.S374887
Angraal, S., Nuti, S. V., Masoudi, F. A., Freeman, J. V., Murugiah, K., Shah, N. D., Desai, N. R., Ranasinghe, I., Wang, Y., & Krumholz, H. M. (2019). Digoxin Use and Associated Adverse Events Among Older Adults. The American Journal of Medicine, 132(10), 1191–1198. https://doi.org/10.1016/j.amjmed.2019.04.022
Christensen, L. D., Reilev, M., Juul-Larsen, H. G., Jørgensen, L. M., Kaae, S., Andersen, O., Pottegård, A., & Petersen, J. (2019). Use of prescription drugs in the older adult population—a nationwide pharmacoepidemiological study. European Journal of Clinical Pharmacology, 75(8), 1125–1133. https://doi.org/10.1007/s00228-019-02669-2
Sanghai, S., Wong, C., Wang, Z., Clive, P., Tran, W., Waring, M., Goldberg, R., Hayward, R., Saczynski, J. S., & McManus, D. D. (2020). Rates of Potentially Inappropriate Dosing of Direct‐Acting Oral Anticoagulants and Associations With Geriatric Conditions Among Older Patients With Atrial Fibrillation: The SAGE‐AF Study. Journal of the American Heart Association, 9(6). https://doi.org/10.1161/jaha.119.014108
Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anaesthesiology, 33(1), 109–113. https://doi.org/10.1097/aco.0000000000000814
van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental Changes in Pharmacokinetics and Pharmacodynamics. The Journal of Clinical Pharmacology, 58(S10), S10–S25. https://doi.org/10.1002/jcph.1284
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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.
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
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)
Required Media
Cardiovascular Disorders
- Meet Dr. Norbert Myslinski as he discusses ACE inhibitors, angiotensin inhibitors, beta-blockers, calcium channel blockers, and diuretics as different categories of hypertension drugs. What potential drugs might be best recommended for patients suffering from hypertension? (8m)
- Walden University. (n.d.). Instructor feedback
Links to an external site.. https://cdn-media.waldenu.edu/2dett4d/Walden/WWOW/1001/pulse_check/instructor_feedback/index.html#/
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-20293632
Links to an external site.). All papers submitted must use this formatting.
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK2Assgn_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
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Rubric
NURS_6521_Week2_Assignment_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning Outcome Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. |
|
25 pts | ||||
| This criterion is linked to a Learning Outcome Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Explain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Written 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 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written 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 pts | ||||
| Total Points: 100 | ||||||
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