NURS 6521 wk 3 Pharmacotherapy with Cardiovascular Drugs
Cardiovascular disease is commonly encountered when caring for patients both within the inpatient and outpatient settings. Advanced practice nurses will often encounter patients with multi-pharmacy and multi-physician requiring medication review as well as medical history review and exam. NURS 6521 wk 3 Pharmacotherapy with Cardiovascular Drugs
Scenario 2 presents with patient HM who has a history of atrial fibrillation, TIAs, type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease/failure. Current medications include Warfarin 5mg MWF and 2.5mg T, TH, Sat, Sun, Aspirin 81mg/day, Metformin 1000mg BID, Glyburide 10mg BID, Atenolol 100mg/day, and Motrin 200mg 1-3 tablets every 6 hours as needed.
Influencing Factor
Behaviors by individual patients can and do often affect medications and their actions. One such action is the use of over the counter vitamins and minerals. Vitamins and minerals can often compete for receptors or negate an active ingredient or potentiate the effects. For example, calcium products have been documented to affect the serum levels of atenolol and other beta blockers leading to subtherapeutic levels and poor bioavailability (Drugs.com, 2018). Warfarin can also be affected by multiple over the counter vitamins and minerals. Vitamin K is an antagonist to warfarin and can affect therapeutic levels and INR results. Vitamin A, fenugreek, chamomile, cranberry, and Ginkgo Biloba are just a few known to inhibit therapeutic levels of warfarin by interacting with different processes within the pharmacokinetics and pharmacodynamics of the medication (Beikang, Zhen, Zhong, 2014).
Treatment Plan
Initially a review of medications demonstrates the need to discontinue the aspirin and NSAID – ibuprofen. Both drugs demonstrate blood thinning action potentiating the affect of warfarin in the blood possibly leading to excessively thin blood and increased risk of bleeding. Aspirin and ibuprofen both also interact with glyburide by again potentiating the hypoglycemic effect on the body leading to increased risk for hypoglycemia (Drugs.com, 2018) Ibuprofen can also decrease the efficacy of Atenolol (Epocrates, 2018). Next due to the patients increased risk for ASCVD and diagnosis of diabetes, the American Heart Association and the American College of Cardiology recommends a high intensity statin therapy to reduce ASCVD risk and cardiac mortality (Lambert, 2014). Atorvastatin 40mg po daily would be appropriate to prescribe for improved patient cardiovascular event and mortality risk.NURS 6521 wk 3 Pharmacotherapy with Cardiovascular Drugs
When reviewing medications, the APRN also needs to clarify if any over the counter medications are being taken to determine possible interactions while taking this time to educate on the need to discuss any new medications, prescription or OTC, with them prior to initiating for safety. Education also needs to be completed concerning compliance to regimen and the need for routine follow up due to increased risk factors and the need for warfarin monitoring of PT/INR levels with a goal of 2-3
In conclusion, APRNs must evaluate the whole patient, the treatment plan, weigh pros and cons, and consider multiple individualized factors when prescribing medications to each patient.NURS 6521 wk 3 Pharmacotherapy with Cardiovascular Drugs