NURS 6521 Week 2 Cardiovascular Case Study
When attempting to effectively manage any patient’s cardiovascular disease process, it always benefits the patient if the provider takes into account co-morbidities. For CB, an 88 year-old female patient with a history significant for strokes, it is no different. Considering CB’s concurrent diagnoses, which include diabetes mellitus type 2 (DM2), hypertension (HTN), and hyperlipidemia (HLD), it seems fairly straightforward which factors should be considered—advanced age and renal function. This writing will endeavor to explore how both advanced age and renal function influence the pharmacokinetic and pharmacodynamic processes, how they impact the current drug therapy, and how they may impact potential drug therapy changes.NURS 6521 Week 2 Cardiovascular Case Study
Influencing Factor
According to Munshi (2019), with advanced age, in terms of how it impacts drug therapies, a generalization can be made that the bodies systems will generally not be able to effectively process medications appropriately which can often lead to drug toxicities. Also, due to advancing age and decreased function of the body systems, polypharmacy is generally a concern and often leads to increased negative side effects. And when advanced age is coupled with decreased renal function, considering CB’s diagnosis of DM2 and HTN that generally leads to decreased renal function, drug therapy can be greatly affected. According to Collard, Brouwer, Peters, Vogt, and van den Born, (2018), patient’s with decreased renal function, have an inability to effectively filter out medication metabolites, and generally have a reduced creatinine clearance that can often limit the types and amounts of DM2 and HTN medication therapies. So, it would appear that certain medications will invariably be excluded for use in CB’s drug therapy regimen, or at the very least will require lower doses and increase frequency of monitoring of her renal function.
Current Therapy Impacted
Since CB’s advanced age and decreased renal function are a concern, it is important to identify potential pitfalls associated with her current drug therapy regimen. CB’s drug therapy regimen includes Glipizide 10mg daily, HCTZ 25mg daily, Atenolol 25mg daily, Simvastatin 80mg daily, and Verapamil 180mg CD daily. Though Glipizide, a sulfonylurea, has a slightly increased potential for hypoglycemia in elderly patients, due to CB’s impaired renal function, it is preferred over Metformin for monotherapy of DM2, due to Metformin’s known harshness on kidney function. For HCTZ, and considering the decreased renal function, this medication has a large propensity for affecting the kidneys further, potentially reducing filtration effectiveness, and also, due to CB’s age, could cause hyperkalemia. With Atenolol, if it is being used for angina, this would be good medication as it does not impact renal function. Due to CB’s HLD, Simvastatin’s dose being maxed out is critical to avoid potential cardiac issues, especially considering her age, despite the potential for myopathy. Lastly, Verapamil has two major impacts on CB, the first is that it has been known to cause sick-sinus syndrome in elderly patients, and secondly, it has been known to have a harsh effect on renal function as well (Vallerand, 2018).NURS 6521 Week 2 Cardiovascular Case Study
Drug Therapy Changes
CB’s drug therapy regimen, considering the information revealed earlier, is in definite need of a change to better optimize her therapy’s effectiveness. Although the Glipizide is appropriate for CB at this time, an A1c should be done to evaluate the effectiveness of it and to see if additional medicines could be needed. As for the HCTZ, it would need to be eliminated from her regimen, and if she was on the medication specifically for the need for a diuretic, and not simply to aid in blood pressure management, Bumex 1mg should be initiated as it would not effect her renal function. Next the Atenolol should remain untouched if being used for angina; however, if used for blood pressure management, Amlodipine 5mg could take its place as the need for a beta-blocker’s benefits are not needed. Next, due to Verapamil’s negative effects, Amlodipine 5mg is yet again the better choice, as it is in the same class, but has none of the adverse side effects of Verapamil. Though the Simvastatin should stay exactly the same due to the high potential of CB’s potential for developing cardiac issues, (myocardial infarction (MI), angina), the addition of an anticoagulant is sorely needed to ensure stroke prevention. Due to CB’s history of strokes, the recommendation would be to incorporate an 81mg Aspirin daily; as well as adding Plavix 75mg to ensure effective anticoagulation is achieved and the reduction of future strokes, and even prevention of MI’s are prevented (Rosenthal and Burchum, 2018).NURS 6521 Week 2 Cardiovascular Case Study
Conclusion
Having thoroughly explored the potential pitfalls of CB’s current drug therapy regimen, as well as her factors of advanced age and reduced renal function, and the recommended drug therapy changes, we now have a more focused picture of CB’s needs. I would encourage any provider to ensure they consider carefully any patient’s history in full, their factors that could impact their drug therapy regimen, and even their patient’s ability to procure those medications. For in the end, correct treatment brings about correct therapy, but only if the patient can afford said therapy.NURS 6521 Week 2 Cardiovascular Case Study