NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Sample Answer for NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS Included After Question

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). All papers submitted must use this formatting.

A Sample Answer For the Assignment: NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Title: NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Cardiovascular disorders represent a spectrum of life-threatening medical disorders affecting the cardiovascular system. These include but are not limited to hypertension, heart failure, stroke, ischemic heart disease, and coronary artery diseases. These diversified arrays of conditions remain the second most leading cause of mortality in the United States of about 1 in every 4 deaths (Olvera Lopez et al., 2021). In this assignment, a factor influencing pharmacodynamic and pharmacokinetics will be selected and explored extensively in relation to a case study involving AO, a patient diagnosed with hypertension and hyperlipidemia with a history of obesity.

Effects of Age on the Pharmacodynamic and Pharmacokinetics Processes

A couple of factors influence pharmacodynamic and pharmacokinetic processes. For instance, age, genetics, behaviors, and ethnicity. Aging is designated by accelerated impairment of functional capabilities of entire organ systems, diminished homeostatic mechanisms, and altered reaction to receptor stimulation (Peeters et al., 2019). The aforementioned processes influence the pharmacodynamic and pharmacokinetic processes with the resultant need for dose adjustments or rather contraindication of some pharmacologic agents in the elderly.

Additionally, aging is associated with a reduction in the first-pass metabolism attributed to a decrease in the liver bulk and blood flow. Similarly, impaired hepatic and renal functions correlated with aging significantly hinder the renal and hepatic clearance of a majority of drugs (Laurent, 2017). Consequently, in the case of AO, 86-year-old taking atenolol, simvastatin, sertraline, hydralazine, and doxazosin, the bioavailability of the mentioned drugs will increase.

According to Peeters et al. (2019), aging is further associated with a reduction in cumulative muscle mass and total body water but with an increase in the percentage of body fat. As a result, the volume distribution of lipid-soluble drugs increases while it decreases for non-lipid soluble drugs. Pharmacodynamically, on the other hand, aging is accompanied by altered sensitivity to drugs with a general increase in sensitivity to drugs in the elderly. Ultimately, adjustments of the doses AO’s drug regimen are critical to avoid adverse side effects or rather toxicity.

Impact of Changes in Process on the Patient’s Recommended Drug Therapy

Atenolol which is indicated for therapeutic management of hypertension is largely metabolized by the liver and excreted by the kidney. Subsequently, the dose will be adjusted depending on the renal and liver function. Similarly, geriatric patients have decreased sensitivity to beta-blockers due to increased total peripheral resistance, and reduced cardiac and pulmonary function (Khalil & Zeltser, 2021). Therefore, the beta-blocker should be substituted with another class of antihypertensive. On the other hand, doxazosin also metabolized by the liver is associated with hypotension when utilized in the geriatric population and thus will necessitate periodic monitoring of vital signs and dose adjustments (Khalil & Zeltser, 2021).

Sertraline should be avoided in adolescents and children due to an increased risk of suicidal ideation. It is a good agent in the elderly as it reduces stress and depression which significantly perpetuate hypertension. It is a vital medication in the elderly as it reduces symptoms of BPH. Hydralazine dose should be adjusted depending on the individualized rate of acetylation. Lastly, the safety profile of simvastatin, atenolol, and doxazosin has not been established in children less than 10 years.

NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS
NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

How I would Improve the Patient’s Drug Plan

Patient AO is a geriatric hypertensive hyperlipidemic patient and at risk of BPH, therefore being on doxazosin is crucial. This medication reduces the blood pressure and symptoms of BPH in addition to decreasing LDL and cholesterol (Redon & Redon, 2019). However, this therapeutic agent is associated with orthostatic hypotension and edema especially in the elderly. Consequently, I will periodically monitor the vital signs, weight, edema, and liver function tests of AO and reduce the dose accordingly.

I will gradually taper down the dose while simultaneously monitoring the adverse effects. Atenolol is relatively contraindicated in the elderly and therefore I will consider substituting it with a first-line antihypertensive such as hydrochlorothiazide(Redon & Redon, 2019). AO has gained 9 pounds which might be due to edema associated with atenolol and doxazosin, therefore, a diuretic such as hydrochlorothiazide when deployed will control the blood pressure as well as edema (Redon & Redon, 2019).

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The doses of sertraline, hydralazine, and simvastatin will remain unadjusted. However, the patient will be assessed periodically and educated on the importance of taking medications as advised by the healthcare provider. Similarly, I will educate the patient on the side effects associated with these medications such as sexual dysfunction, fatigue, diarrhea, and drowsiness, and the need to consult the care provider if the symptoms persist or become intolerable (Redon & Redon, 2019). Additionally, I will advise and educate the patient on lifestyle modification and behavior changes to help control hypertension such as diet modification, smoking, and alcohol cessation, and regular physical activity. Finally, I will follow up with the patient at the medical outpatient clinic.

Conclusion

Pharmacological treatment alongside supportive measures form the mainstay treatment in patients with cardiovascular disorders. The drug regimen is largely affected by a variety of factors such as age, gender, ethnicity, and genetics which affect the pharmacodynamic and pharmacokinetic process. It is crucial for individualization of the drug regimen based on a critical evaluation of the above processes.

References

Khalil, H., & Zeltser, R. (2021). Antihypertensive Medications. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554579/

Laurent, S. (2017). Antihypertensive drugs. Pharmacological Research: The Official Journal of the Italian Pharmacological Society124, 116–125. https://doi.org/10.1016/j.phrs.2017.07.026

Olvera Lopez, E., Ballard, B. D., & Jan, A. (2021). Cardiovascular Disease. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535419/

Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opinion on Drug Metabolism & Toxicology15(4), 287–297. https://doi.org/10.1080/17425255.2019.1588249

Redon, J., & Redon, P. (2019). Evidence from clinical trials and use of antihypertensive drugs in children and adolescents. In Updates in Hypertension and Cardiovascular Protection (pp. 263–277). Springer International Publishing. https://doi.org/10.1007/978-3-030-18167-3_17

A Sample Answer 2 For the Assignment: NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Title: NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

The promotion of safety and quality in the treatment of patients with different conditions is important in nursing practice. Nurses and other healthcare providers utilize their knowledge in pharmacokinetics and pharmacodynamics to select treatments that will optimize outcomes while minimizing the potential of patient harm. Factors such as age, gender, ethnicity, and genetics among others influence the pharmacokinetics and pharmacodynamics of the medications prescribed to patients. Therefore, this essay examines the influence of age on LM’s pharmacokinetic and pharmacodynamics processes. The essay also discusses the impact of the changes in the patient’s recommended drug therapy and how the treatment can be improved.

Effect of Age on Patient’s Pharmacokinetic and Pharmacodynamics Processes

The selected factor that affects the pharmacokinetic and pharmacodynamics of LM processes is age. Age significantly affects pharmacokinetics of drugs. Aging is associated with decreased small-bowel surface area, reduced gastric emptying, and elevated gastric PH. Changes such as an increase in the gastric PH affects the absorption of drugs such as calcium and enteric coated medications (Koren et al., 2019).

Aging also results in the decrease in the total body water and increase in the total body fat. The increase in body fat volume increases the total volume of distribution of lipophilic drugs and their elimination half-lives. Aging also lowers hepatic metabolism of most drugs. The decrease in cytochrome P-450 lowers the metabolism of drugs in the liver. This also affects first-pass metabolism of drugs before they enter the circulatory system. Aging is also associated with a decline in renal elimination of medications. The elderly patients have reduced glomerular filtration rate, which affects the elimination of drug metabolites from the body (Drenth-van Maanen et al., 2020; Koren et al., 2019; Peeters et al., 2019). As a result, there is an increased risk of drug toxicity due to the accumulation of the metabolites in the body. These pharmacokinetic changes affect the treatment options and health status of LM.

Aging also affects pharmacodynamics of drugs. Pharmacodynamics refers to the study of the drug effect on the body. Aging is associated with reduced pharmacodynamics processes. One of the mechanisms contributing to the reduced pharmacodynamics is the limited functioning of drug receptor sites. There is also the reduction in the available drug receptors for drug binding. This reduces the effect of the drug on the body while increasing its blood bioavailability (Kratz & Diefenbacher, 2019). An example is seen in patients diagnosed with diabetes. They have low insulin receptors, which result in the elevated blood glucose levels.

The effect of aging on pharmacodynamics can also be seen from the exaggerated response to some drugs among this population. For example, older adults tend to show exaggerated responses to drugs that stimulate the central nervous system. The observation is because of the increased sensitivity to drugs by this population. In addition, aging reduces Gs protein interactions in the elderly patients. The decrease lowers cardiac, pulmonary, and vascular tissue to drugs such as those used in the treatment of hypertension(Stader et al., 2020). Therefore, nurses should consider these changes when prescribing drugs to elderly patients and other vulnerable populations.

Impact of the Changes in Processes on Patient’s Recommended Drug Therapy

The changes in the pharmacokinetic and pharmacodynamics processes affect the patient’s recommended drug therapy. A decline in the drug metabolism in the liver affects the selection of drugs for the patient. Nurses and other healthcare providers should prescribe medications that do not undergo first-pass metabolism to preserve optimum hepatic function. A decline in renal function also affects the client’s recommended drug therapy(Peeters et al., 2019). Nurse practitioners prescribe medications that have other routes of excretion such as feces to promote renal functioning.

There is also the consideration of drug dosages with the changes in the pharmacokinetics and pharmacodynamics. Accordingly, nurse practitioners lower the dosage and frequency of hepatotoxic and renal toxic medications in patients with advanced ages to minimize the risk of harm and drug toxicity (Thürmann, 2020). The reduction in drug absorption due to lowered gastric physiological processes also increases the need for prescribing drugs that are administered through other routes such as intravenously and intramuscularly.

Improving Patient’s Drug Therapy

I will improve the patient’s drug therapy by avoiding polypharmacy. The patient currently uses several drugs that predispose her to harm and medication errors. An effective approach to her treatment would be reducing the number of drugs taken at a time to promote her health, safety, and quality. The other way in which I will improve her drug therapy is by titrating the drug dosage upwards. Elderly patients should be initiated on low dosage and increased upwards based on tolerance and efficacy (Koren et al., 2019). I will modify the patient’s current treatment. I will lower the dosage of celecoxib to minimize the risk of hepatotoxicity and renal toxicity. I will also stop glyburide and retain metformin. Metformin has the benefit of reducing the risk of cardiovascular mortality in patients with multiple comorbidities that include cardiovascular conditions (Guo et al., 2019).

Conclusion

Aging affects pharmacokinetics and pharmacodynamics processes. Advancing age lowers pharmacokinetic processes such as drug absorption, metabolism, and elimination. It also affects pharmacodynamics processes such as drug binding to their receptor sites. These changes affect the recommended treatment plan for the patient in the case study. Polypharmacy should be avoided in treating LM for safety and quality outcomes.

References

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

Guo, L., Ma, J., Tang, J., Hu, D., Zhang, W., & Zhao, X. (2019). Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis. Journal of Diabetes Research, 2019, 9804708. https://doi.org/10.1155/2019/9804708

Koren, G., Nordon, G., Radinsky, K., & Shalev, V. (2019). Clinical pharmacology of old age. Expert Review of Clinical Pharmacology, 12(8), 749–755. https://doi.org/10.1080/17512433.2019.1632188

Kratz, T., & Diefenbacher, A. (2019). Psychopharmacological Treatment in Older People. Deutsches Ärzteblatt International, 116(29–30), 508–518. https://doi.org/10.3238/arztebl.2019.0508

Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opinion on Drug Metabolism & Toxicology, 15(4), 287–297. https://doi.org/10.1080/17425255.2019.1588249

Stader, F., Kinvig, H., Penny, M. A., Battegay, M., Siccardi, M., & Marzolini, C. (2020). Physiologically Based Pharmacokinetic Modelling to Identify Pharmacokinetic Parameters Driving Drug Exposure Changes in the Elderly. Clinical Pharmacokinetics, 59(3), 383–401. https://doi.org/10.1007/s40262-019-00822-9

Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anesthesiology, 33(1), 109. https://doi.org/10.1097/ACO.0000000000000814

A Sample Answer For the Assignment: NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Title: NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Pharmacotherapy for Cardiovascular Disorders in Elderly Patients with Multiple Co-Morbidities

Introduction

The prevalence and impact of cardiovascular disorders in the U.S. are undeniable, especially in contributing to the nation’s morbidity and mortality rates. Effective pharmacotherapeutic strategies are paramount, and these must be tailored according to individual patient characteristics. The case of LM, an 89-year-old female with a vast array of health complications, serves as a vivid representation of the complexities involved. Central to this discussion is the role of age, a factor with significant implications on both pharmacokinetics (the journey of a drug through the body) and pharmacodynamics (the body’s response to the drug).

Age’s Impact on Pharmacokinetics and Pharmacodynamics

Age plays a pivotal role in determining how drugs interact with the body. Elderly individuals often undergo physiological changes that can drastically alter the absorption, distribution, metabolism, and excretion of drugs. For instance, delayed gastric emptying and reduced gastrointestinal blood flow can result in a slower absorption rate for many medications in older adults. Similarly, reduced muscle mass and decreased serum albumin can impact how drugs are distributed throughout the body. When it comes to metabolism, the decrease in hepatic blood flow and liver mass commonly seen in elderly patients can reduce the body’s ability to process drugs effectively. Finally, diminished renal function, evident in LM’s eGFR of 45 ml/min, can affect drug excretion, posing potential risks for toxicity (Nightingale et al., 2019).

Moreover, the body’s response to drugs, or pharmacodynamics, undergoes changes with age. Older adults might experience heightened sensitivity to certain medications, leading to unpredictable or altered responses, thus increasing the potential for adverse reactions (McKearney & Coleman, 2020).

Implications for LM’s Drug Therapy

Given LM’s age and observed health metrics, there is a pressing need for keen scrutiny of her medication regimen. Amlodipine, prescribed for her hypertension, may be contributing to her experience (Rafeq & Salzman, 2022). The diuretic, Furosemide, when combined with her diabetes medications, Metformin and Glyburide, poses a potential risk for significant shifts in her electrolyte levels, which could be exacerbating her risk for falls (Ali et al., 2019). Celecoxib, prescribed for osteoarthritis, has known potential to aggravate hypertension and further decline kidney function, especially in the elderly (White et al., 2000).

Recommendations for Drug Therapy Modification

In light of the pharmacokinetic and pharmacodynamic considerations induced by age and LM’s evident health complexities, it is essential to revisit and possibly modify her medication regimen.

A thorough reevaluation of her antihypertensive medications is a priority. Given her recorded supine blood pressure, an adjustment in the dosage or a switch from amlodipine to another antihypertensive class with fewer side effects related to edema might be beneficial.

Regular monitoring of LM’s glucose, potassium, and overall renal function can ensure the safety of her diabetes medications combined with the diuretic (Davies et al., 2022). Additionally, her pain management strategy needs to be readdressed. It might be more advantageous to explore non-drug interventions or consider switching from celecoxib to acetaminophen, a medication with a better safety profile for the elderly (Alorfi, 2023).

Conclusion

The case of LM underscores the importance of meticulous pharmacotherapeutic planning, especially in elderly patients with multiple health challenges. Age-induced changes in pharmacokinetics and pharmacodynamics necessitate a tailored approach, ensuring not just effective treatment but also the well-being and safety of the patient. Collaborative and informed medical decisions remain the linchpin in achieving optimal therapeutic outcomes.

References

Ali, S., Peterson, G. M., Bereznicki, L. R., & Salahudeen, M. S. (2020). Association between anticholinergic drug burden and mortality in older people: a systematic review. European Journal of Clinical Pharmacology76(3), 319–335. https://doi.org/10.1007/s00228-019-02795-x

Alorfi NM. (2023). Pharmacological Methods of Pain Management: Narrative Review of Medication Used. International Journal of General Medicineume 16, 3247–3256.

Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S. E., Del Prato, S., Mathieu, C., Mingrone, G., Rossing, P., Tankova, T., Tsapas, A., & Buse, J. B. (2022, November 1). Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care45(11), 2753.

McKearney, K., & Coleman, J. J. (2020). Prescribing medicines for elderly patients. Medicine48(7), 463–467. https://doi.org/10.1016/j.mpmed.2020.04.004

Nightingale, G., Schwartz, R., Kachur, E., Dixon, B. N., Cote, C., Barlow, A., Barlow, B., & Medina, P. (2019). Clinical pharmacology of oncology agents in older adults: A comprehensive review of how chronologic and functional age can influence treatment-related effects. Journal of Geriatric Oncology10(1), 4–30. https://doi.org/10.1016/j.jgo.2018.06.008

Rafeq, R., & Salzman, M. (2022). Use of Concentrated Insulin in the Management of Calcium Channel Blocker Overdose: A Case Report. Journal of Pharmacy Practice, 1. https://doi.org/10.1177/08971900221116189

White, W. B., Faich, G., Whelton, A., & Maurath, C. (2000). Comparison of the renal effects of celecoxib, rofecoxib, and naproxen in elderly subjects. Journal of Clinical Pharmacology, 40(12 Pt 2), 1246-1256