Advanced Pharmacology DB Coagulation, CV, Shadow Health HTN-DM Essay

Advanced Pharmacology DB Coagulation, CV, Shadow Health HTN-DM Essay

Advanced Pharmacology DB Coagulation, CV, Shadow Health HTN-DM Essay

WEEK 6 Topic

COVID-19 is associated with thrombotic complications and leads to significant mortality and morbidity. Whiteley & Wood (2022) explain that persons with severe COVID-19 have a high risk of symptomatic and asymptomatic pulmonary emboli during hospitalization. Nevertheless, the long-term risks of thrombotic events following mild COVID-19 are not well-understood.

Moores et al. (2020) provide practical guidance from a CHEST panel on the most urgent questions on preventing, diagnosing, and treating venous thromboembolism (VTE) in persons diagnosed with COVID-19. This was driven by evidence showing that severe COVID-19 can be complicated by significant coagulopathy that possibly manifests as microthrombosis and VTE. The panel recommends anticoagulant thromboprophylaxis over no anticoagulant thromboprophylaxis in acute and critically ill patients with COVID-19 without contraindication. Besides, the panel recommends anticoagulant thromboprophylaxis with low-molecular-weight heparin (LMWH) or fondaparinux over unfractionated heparin (UFH) (Moores et al., 2020). This is because many patients receive concomitant therapy that can affect the pharmacodynamics of direct oral anticoagulants, causing the risk of bleeding.

ORDER A PLAGIARISM-FREE PAPER HERE ON; Advanced Pharmacology DB Coagulation, CV, Shadow Health HTN-DM Essay

The panel recommends against the administration of antiplatelet agents for VTE prevention. Regarding treatment, the panel recommends initial parenteral anticoagulation with therapeutic weight-adjusted LMWH or IV UFH for acutely ill hospitalized COVID-19 patients with proximal DVT or PE. In addition, it recommends dabigatran, apixaban, rivaroxaban, or edoxaban for outpatient COVID-19 patients with proximal DVT or PE with no drug-to-drug interactions. The article relates to my APN practice since APNs are tasked with developing treatment plans for patients hospitalized with COVID-19. The APN can use the information to determine the thromboprophylaxis drug to prescribe to a COVID-19 patient to prevent or treat VTE (Moores et al., 2020). Besides, the APN should start all hospitalized patients with COVID-19 with anticoagulant thromboprophylaxis if they have no contraindications to minimize the risk of VTE.

References

Moores, L. K., Tritschler, T., Brosnahan, S., Carrier, M., Collen, J. F., Doerschug, K., Holley, A. B., Jimenez, D., Le Gal, G., Rali, P., & Wells, P. (2020). Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019: CHEST Guideline and Expert Panel Report. Chest, 158(3), 1143–1163. https://doi.org/10.1016/j.chest.2020.05.559

Whiteley, W., & Wood, A. (2022). Risk of arterial and venous thromboses after COVID-19. The Lancet Infectious Diseases, 22(8), 1093–1094. https://doi.org/10.1016/S1473-3099(22)00314-0

Week 7 (cardiovascular meds)

Persons with metabolic conditions, like insulin resistance, cardiometabolic syndrome, and diabetes, have a high prevalence of hypertension (HTN). HTN is a major risk factor for cardiovascular disease (CVD), stroke, kidney disease, and microvascular complications. Jia & Sowers (2021) explain that hypertension is not only more prevalent in diabetic patients with diabetes, but also diabetes is more common in hypertensive persons than in the general population. The current guidelines recommend angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) as first-line treatment in diabetic hypertensive patients and secondary prevention for patients with obstructive coronary artery disease (OCAD).

Zhang et al. (2020) examined whether using ACEI/ARB before diagnosing OCAD can improve clinical outcomes in diabetic hypertensive patients. The study used 2501 diabetic hypertensive patients diagnosed with OCAD through coronary angiography. Of these participants, 1300 did not use ACEI/ARB before being diagnosed with OCAD, while 1201 used ACEI/ARB before OCAD diagnosis. The study found that administering ACEI/ARB before diagnosing OCAD reduced the incidence of acute myocardial infarction (AMI), decreased myocardial infarction size, and improved cardiac function (Zhang et al., 2020). Nonetheless, non-fatal stroke incidences and Major adverse cardiac and cerebral events (MACCE) were markedly high in the group that did not use ACEI/ARB before OCAD diagnosis.

The study findings relate to APN practice since APNs encounter many diabetic patients who develop comorbid hypertension. The APN needs to understand the guidelines on managing hypertension in diabetic patients, which recommend an ACEI or ARB as a first-line therapy (Zhang et al., 2020). APNs can use the article’s findings in prescribing ACEI/ARB therapy in diabetic hypertensive patients to reduce the incidence of AMI, improve cardiac function, reduce infarct size, and decrease incidences of non-fatal stroke and MACCE.

References

Jia, G., & Sowers, J. R. (2021). Hypertension in Diabetes: An Update of Basic Mechanisms and Clinical Disease. Hypertension (Dallas, Tex. : 1979), 78(5), 1197–1205. https://doi.org/10.1161/HYPERTENSIONAHA.121.17981

Zhang, Y., Ding, X., Hua, B., Liu, Q., Chen, H., Zhao, X. Q., … & Li, H. (2020). Real-world use of ACEI/ARB in diabetic hypertensive patients before the initial diagnosis of obstructive coronary artery disease: patient characteristics and long-term follow-up outcome. Journal of Translational Medicine, 18, 1–13. https://doi.org/10.1186/s12967-020-02314-y

Case Study 2 Discussion (HTN/DM)

This week’s case study depicted a 38-year-old Indian American male with a history of generalized anxiety disorder (GAD), hypertension, and type 2 diabetes mellitus (T2DM). I learned from the case study that lifestyle modification is crucial for patients with T2DM since it is predominantly a lifestyle disease. The patient lived a sedentary lifestyle with excessive consumption of fast foods and physical inactivity. This contributes to the worsening of hyperglycemia which causes patients to experience excessive thirst, increased urination, [and increased fatigue (Raveendran et al., 2018). I have learned that health education on lifestyle modification should be emphasized at each patient encounter. The healthcare provider should assess the patient’s current lifestyle practices, how they are coping with the recommendations, and any barriers to behavior change.

The case study has also enlightened me on the importance of patient involvement when prescribing medication. It is essential to educate a patient on the indications for each drug, how to take it, possible side effects, and how to avoid the side effects. This increases medication adherence. Furthermore, I have learned that referring a patient to a dietitian is important to help them develop an individualized diet plan (Uusitupa et al., 2019). Patients often adhere to a diet plan if they are actively engaged in developing it and are consulted on their preferences and the locally available foods.

References

Raveendran, A. V., Chacko, E. C., & Pappachan, J. M. (2018). Non-pharmacological Treatment Options in the Management of Diabetes Mellitus. European endocrinology, 14(2), 31–39. https://doi.org/10.17925/EE.2018.14.2.31

Uusitupa, M., Khan, T. A., Viguiliouk, E., Kahleova, H., Rivellese, A. A., Hermansen, K., Pfeiffer, A., Thanopoulou, A., Salas-Salvadó, J., Schwab, U., & Sievenpiper, J. L. (2019). Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis. Nutrients, 11(11), 2611. https://doi.org/10.3390/nu11112611

BUY A CUSTOM-PAPER HERE ON; Advanced Pharmacology DB Coagulation, CV, Shadow Health HTN-DM Essay

Write a peer reviewed research article that corresponds to Week 6 (blood forming/coagulating/thrombolytic meds) and Week 7 (cardiovascular meds). This can be a review article on a disease, research study, qualitative analysis etc. Summarize the article and discuss how it relates to your practice as an Advanced Practice Nurse. (Does not need a cover page. Just need the paragraphs for each week’s topics and references. I would prefer week6 paper to be on page 1, week7 paper to be on page 2, and case study 2 discussion to be on page 3. *Need 2 references each, so total of minimum 6 references should be included in this order. Thank you). On Page 3, Case Study 2 Discussion ( HTN/DM ). Create your post on the Case Study 2 (Shadow Health: HTN/DM) in response to the following: What did you learn from case study 2 that you can bring back to your peers or work environment? ** Please see attached sample papers. Thank you.

WEEK 6 Topic: Blood formation agents. Coagulation medication. Thrombotics

Identify current pharmacologic agents that are appropriate for blood formation, coagulation, and thrombosis.Recommend pharmacological management based on patient-specific factors.
Provide patient education for optimal medication management.

WEEK 7 Topic:  Cardiovascular medications. Antilipids. Vasodilators. Calcium channel blockers. ACE/ARBs.

Identify cardiovascular medications that are appropriate for each diagnosis.

Recommend cardiovascular medications based on patient specific data.

Provide patient education to optimize cardiovascular medication regimens.

ShadowHealth Case Study Discussion: Hypertension/Diabetes

BUY A CUSTOM-PAPER HERE ON; Advanced Pharmacology DB Coagulation, CV, Shadow Health HTN-DM Essay

Rubric for week 6 and 7 discussion, and case study 2 HTN/DM

Response is at least 250 words and addresses all elements of the discussion activity. Includes 2 scholarly references within the past 5 years (1 reference must be a source outside of the course textbook and materials). Response demonstrates an excellent understanding of the topic(s) through well-reasoned and thoughtful reflections; it is factually correct and substantive, with relevant references and examples and demonstrates a clear connection to the reading. Contributes regularly and on a timely basis, meets or exceeds the minimum requirement for replying to classmates, and always observes proper online etiquette (are respectful, courteous, and professional). Responses use correct APA format when indicated, are grammatically correct, and use proper sentence structure. May have 1-2 errors.

SHADOW HEALTH:

This is information that have for this week’s SHADOW HEALTH  HTN/DM Arun Patel.

CC: “I’m here for a checkup”

HPI: Arun Patel is a 38-year-old Indian American male with a history of generalized anxiety disorder, hypertension and type 2 diabetes mellitus who presents to the clinic today for a check-up. He has not been regularly monitoring his blood pressure or glucose levels at home. He is under financial stress, which has contributed to his health issues. He has gained 15 pounds in the last three months. He reports fatigue and generalized discomfort for the last three months. He also endorses increased thirst and urination for the past month. He is taking his medication as prescribed. He reports a sedentary lifestyle and eats take-out food frequently, which he eats to alleviate stress. Allergies: No allergies to medications, latex, food or environment Home Medications: hydrochlorothiazide 50 mg PO QD for hypertension metformin 500 mg PO BID for type 2 diabetes mellitus escitalopram 20 mg PO QD for anxiety

PMH: Generalized anxiety disorder, hypertension, type 2 diabetes mellitus PFH: Maternal hyperlipidemia and type 2 diabetes, paternal hypertension Social History: Graduate Student Eats take-out frequently, but denies binge-eating. Denies exercise and endorses sedentary lifestyle. Denies alcohol use or nicotine use. Health Promotion: Arun’s health is at significant risk for decline due to diabetes history, sedentary lifestyle, and diet. I will refer him to a dietician for intensive education on dietary interventions. Review of Systems: Constitutional: Positive for weight gain of 15 lbs in three months, fatigue, and generalized discomfort Cardiovascular: Denies palpitations, shortness of breath, chest pain, history of blood clot, claudication Genitourinary: Denies difficulty urinating, pain during urination, changes in urine characteristics

Arun Patel is a 38-year-old Indian American male with hypertension and type 2 diabetes mellitus who came to the clinic for a check-up. He has not been regularly monitoring his blood pressure or glucose levels at home. He is under financial stress, which has contributed to his health issues. He has gained 15 pounds in the last three months. He reports fatigue and generalized discomfort for the last three months.

I prescribed Mr. Patel: a combination lisinopril / hydrochlorothiazide to treat his hypertension, and a combination glipizide / metformin to treat his type 2 DM. I have recommended that he begin regularly monitoring his blood pressure numbers and glucose levels, and keeping a log at home. I have referred the patient to a dietician. I recommend that Mr. Patel consult with a dietician and come back for a follow up in three months.

Teaching done for glipizide / metformin:

Take the medication with meals, which may help avoid any adverse effects like gastrointestinal upset.

Taking medication at the same time every day ensures that the medication is in your system for the same amount of time, which makes it the most effective.

Stop taking your previous medication when you begin this new regimen.

This medication is designed to treat high blood sugar, so it is important to watch out for signs of your blood sugar getting too low. Signs of hypoglycemia include headaches, irritability, dizziness, confusion, hunger, and shakiness. Make sure to keep something with sugar in it on hand in case you experience these symptoms.

Self-monitoring your blood glucose and blood pressure is crucial to gauging your immediate and long-term health and determining if new courses of action are needed.

Teaching done for lisinopril / hydrochlorothiazide

Take the next dose immediately if you miss a dose

Discontinue previous medication

Seek emergency help if you show signs of a severe allergic reaction

Contact your healthcare provider if you experience signs of low blood pressure

Contact your healthcare provider if you experience signs of angioedema