Assignment: Pharmacotherapy for Cardiovascular Disorders
Assignment: Pharmacotherapy for Cardiovascular Disorders
NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders
The patient is dealing with a major cardiovascular issue based on the case study. All the current medication prescribed to the patient needs to be reviewed for appropriate changes. Cardiovascular disease counts as a major cause of disability and leads to a cause of death globally. The statistic indicates that approximately a person dies within approximately 36 seconds in the United States due to cardiovascular disease (Benjamin et al., 2019). Therefore, cardiovascular disease is the major cause of health disparities and increases the cost of health care. It is vital to consider the patient’s lifestyle, history, and review to manage HH’s illness effectively. This paper addresses the factors that influence a patient’s pharmacokinetics and pharmacodynamics process and gives changes that impact the recommended drug therapy.
Factor Influencing Pharmacokinetic and Pharmacodynamics Process in the Patient
Based on the case study, the factor that I have selected is age, which can lead to drug toxicity and influence the pharmacokinetics of different medications. Age causes an increase in the altered metabolism and blood concentration of drugs (Giri et al., 2018). A decrease in renal function causes an alteration of drug pharmacokinetics such as glomerular filtration rate and reduces blood flow. Age-related changes that occur in a patient include physiological factors and temperature (Giri et al., 2018). The physiological factors cognition, ventricular aerial stiffness, endothelial function, and electric conduction (Rosenthal & Burchum, 2021). Most people are sensitive to antihypertensive medication due to sympathetic neuronal and baroreceptor response (Giri et al., 2018).
Glipizide is used to cure an adult with type 2 diabetes mellitus. The drug effectively promotes insulin release from the beta cells since it reduces glucose output from the liver (Addul-Ghani et al., 2021). For patients with inadequate metabolic control, the combination of metformin and Glipizide helps reach the goal of HbA1c within three months (Addul-Ghani et al., 2021). Glipizide is effective since it has a short life and effect duration, thus lowering the risk of long-lasting hypoglycemia (Addul-Ghani et al., 2021). Patients taking Glipizide with thyroid hormone, estrogen-containing contraceptives, thiazide diuretics, nicotinic acid, and calcium channel blockers have a high potential for hyperglycemia (Rosenthal & Burchum, 2021).
Metformin effectively improves glycemic control, which takes place without inducing hypoglycemia or causing obesity, thus considered a first-line pharmacologic treatment (Shurrab & Arafa, 2020). The drug inhibits gluconeogenesis by causing a block on the mitochondrial redox shuttle, thus acting in the liver (Shurrab & Arafa, 2020). Metformin is identified to cause gastrointestinal adverse effects such as nausea, diarrhea, and vomiting (Shurrab & Arafa, 2020). FDA labels warn against prescribing Metformin drug therapy for patients with acute heart failure when supplemented with hypoxemia and hypoperfusion.
Hydrochlorothiazide (HCTZ) is used to treat hypertension since it is a thiazide-type diuretic (Rosenthal & Burchum, 2021). The drug inhibits the sodium chloride co-transparent system leading to the distal of the convoluted tubules (Rosenthal & Burchum, 2021). A lower level of blood pressure is achieved due to the diuretic action. However, studies have declined hydrochloride as an ACE inhibitor for reducing the risk of cardiovascular disease (Handelsman et al., 2020). The adverse effect caused by the use of hydrochlorothiazide is the development of hyperglycemia (Rosenthal & Burchum, 2021). The drug therapy effectively manages latent diabetes and causes an increase in triglycerides and cholesterol (Rosenthal & Burchum, 2021). The combination of HCTZ with calcium channel blockers and ACE inhibitors effectively reduces hypertension.
Atenolol acts as a beta blocker that causes an effect on blood circulation and the heart. The drug helps treat hypertension and angina, effectively bind the beta-1 adrenergic receptors in the vascular smooth muscle (Habib et al., 2021). This affects the chronotropic actions of the endogenous catecholamine. The process leads to a decrease in myocardial contractility heart rate and lowers blood pressure. The drug therapy is limited for a patient with moderate severely impaired renal (Habib et al., 2021). The side effects of Atenolol use include causing weight gain and heart failure for some patients.
Hydralazine drug causes direct relaxation of the arteriolar smooth muscle. This is considered an antihypertensive agent and phthalazine derivative (Sangshetti et al., 2019). A reverse antihypertensive effect is likely to be experienced due to vasodilation (Sangshetti et al., 2019). This is caused by hydralazine followed by a reflex sympathetic response. The drug therapy is effective when combined with isosorbide dinitrate in reducing hypertension. The side effects of using hydralazine cause a lupus-like syndrome in rare cases. However, the drug leads to discontinuation of the drug (Sangshetti et al., 2019).
Simvastatin is used as an adjunct to diet thus used as an oral HMG-CoA reductase inhibitor. A patient using Simvastatin gain a reduction in dyslipidemia and a decline in cholesterol production (Di Bello et al., 2020). The cholesterol synthesis is catalyzed by converting HMC-CoA to mevalonate, completely inhibited by hepatic hydroxymethyl-glutaryl coenzyme A (HMG-CoA) reductase (Di Bello et al., 2020). The agent effectively reduces the lipoprotein level and lowers the plasma cholesterol. The side effect of using Simvastatin 80mg is that it has a higher risk of possible rhabdomyolysis and myopathy after 12 months of use (Di Bello et al., 2020).
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Assignment: Pharmacotherapy for Cardiovascular Disorders
Verapamil is used to treat hypertension, atrial tachyarrhythmia, and angina pectoris and is classified in the class of calcium channel blockers. It helps block the cardiac muscle cells and influx of calcium ions into the vascular smooth muscle in the membrane depolarization (Savage et al., 2020). The action helps in decreasing the oxygen consumption and the cardiac work. The drug is also effective in causing a reduction in atrial–ventricular conduction. This helps in controlling the supraventricular tachyarrhythmia (Savage et al., 2020). The side effect of using verapamil include causing transient serum enzyme elevation to be mild to moderate and the liver injury from mild (Savage et al., 2020).
Improving Drug Therapy Plan
The patient can experience congestive heart failure (CHF) when there is a combination of verapamil, atenolol, and Hydrochlorothiazide (HCTZ) (Rosenthal & Burchum, 2021). For effective control of stroke, it is important to control blood pressure. It is important to avoid duplicitous therapy, which causes harm. Interaction between verapamil and Simvastatin leads to an increase in the blood level of Simvastatin (Di Bello et al., 2020). The act leads to kidney damage and rhabdomyolysis and causing liver damage. Atenolol can cause an increase in the duration of hypoglycemic symptoms along with Glipizide (Habib et al., 2021).
It is important to ensure that a patient is educated on the need to consider frequent blood glucose monitoring. This is a result of atenolol due to the symptom of hypoglycemia. The symptom of hypoglycemia include heart palpitations, rapid heartbeat, and tremor (Rosenthal & Burchum, 2021).
Abdul-Ghani, M., Puckett, C., Adams, J., Khattab, A., Baskoy, G., Cersosimo, E., … & DeFronzo, R. A. (2021). Durability of triple combination therapy versus stepwise addition therapy in patients with new-onset T2DM: 3-year follow-up of EDICT. Diabetes care, 44(2), 433-439. https://diabetesjournals.org/care/article-abstract/44/2/433/35501
Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., … & American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(10), e56-e528. https://www.ahajournals.org/doi/abs/10.1161/cir.0000000000000659
Di Bello, E., Zwergel, C., Mai, A., & Valente, S. (2020). The innovative potential of statins in cancer: new targets for new therapies. Frontiers in Chemistry, 8, 516. https://www.frontiersin.org/articles/10.3389/fchem.2020.00516/full
Giri, B., Dey, S., Das, T., Sarkar, M., Banerjee, J., & Dash, S. K. (2018). Chronic hyperglycemia mediated physiological alteration and metabolic distortion leads to organ dysfunction, infection, cancer progression and other pathophysiological consequences: an update on glucose toxicity. Biomedicine & Pharmacotherapy, 107, 306-328. https://www.sciencedirect.com/science/article/pii/S0753332218322406
Habib, S., Alam, M., Mustafa, M., & Verma, A. K(2021). Role of Beta-Blockers as an Effective Cardio protective Agents, an insight in to Tackling with Cardiovascular Diseases (CVDs) and Hypertension. https://www.researchgate.net/profile/Abhishek-Kumar-Verma-2/publication/354694288
Handelsman, Y., Jellinger, P. S., Guerin, C. K., Bloomgarden, Z. T., Brinton, E. A., Budoff, M. J., … & Wyne, K. L. (2020). Consensus statement by the American association of clinical Endocrinologists and American College of Endocrinology on the management of dyslipidemia and prevention of cardiovascular disease algorithm–2020 executive summary. Endocrine Practice, 26(10), 1196-1224. https://www.sciencedirect.com/science/article/pii/S1530891X20482047
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier.
Sangshetti, J., Pathan, S. K., Patil, R., Ansari, S. A., Chhajed, S., Arote, R., & Shinde, D. B. (2019). Synthesis and biological activity of structurally diverse phthalazine derivatives: A systematic review. Bioorganic & Medicinal Chemistry, 27(18), 3979-3997. https://www.sciencedirect.com/science/article/pii/S0968089619310193
Savage, R. D., Visentin, J. D., Bronskill, S. E., Wang, X., Gruneir, A., Giannakeas, V., … & McCarthy, L. M. (2020). Evaluation of a common prescribing cascade of calcium channel blockers and diuretics in older adults with hypertension. JAMA Internal Medicine, 180(5), 643-651. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2761272
Shurrab, N. T., & Arafa, E. S. A. (2020). Metformin: A review of its therapeutic efficacy and adverse effects. Obesity Medicine, 17, 100186. https://www.sciencedirect.com/science/article/pii/S2451847620300063
APA Writing Checklist
Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.
☐ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout.
☐ The title page is present. APA format is applied correctly. There are no errors.
☐ The introduction is present. APA format is applied correctly. There are no errors.
☐ Topic is well defined.
☐ Strong thesis statement is included in the introduction of the paper.
☐ The thesis statement is consistently threaded throughout the paper and included in the conclusion.
☐ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.
☐ All sources are cited. APA style and format are correctly applied and are free from error.
☐ Sources are completely and correctly documented on a References page, as appropriate to assignment and APA style, and format is free of error.
Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.
Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.
Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.
Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion.
Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.
☐ The writer is clearly in command of standard, written, academic English. Utilize writing resources such as Grammarly, LopesWrite report, and ThinkingStorm to check your writing.