Pharmacotherapy for Cardiovascular Disorders
As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This is the result of the extensive treatment and care that is often required for patients with these disorders. While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011). Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors. As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.Pharmacotherapy for Cardiovascular Disorders
Consider the following case studies:
Case Study 1:
Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:
Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily
Case Study 2:
Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:
Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81 mg dailyPharmacotherapy for Cardiovascular Disorders
Metformin 1000 mg po bid
Glyburide 10 mg bid
Atenolol 100 mg po daily
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain
Case Study 3:
Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:
Glipizide 10 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily
To prepare:
Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.
Select one of the three case studies, as well as one the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
With these thoughts in mind:
By Day 3
Post an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected. Then, describe how changes in the processes might impact the patient’s recommended drug therapy. Finally, explain how you might improve the patient’s drug therapy plan.
Introduction
For the purpose of this assignment, case study 2 of a patient named HM who has a history of atrial fibrillation and a transient ischemic attack will be discussed. HM was currently diagnosed with type 2 diabetes mellitus, hyperlipidemia, ischemic heart disease, and hypertension. In his management, the following drugs were prescribed: Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun, Aspirin 81 mg daily, Metformin 1000 mg PO bid, Glyburide 10 mg bid, Atenolol 100 mg PO daily and Motrin 200 mg 1–3 tablets every 6 hours as needed for pain. Pharmacotherapy for Cardiovascular Disorders
How The Selected Patient Factor Might Influence the Client’s Pharmacokinetic and Pharmacodynamics Processes
The selected patient factor for this patient is dietary choices. Diet can greatly influence both the pharmacodynamics and pharmacokinetics of the prescribed drugs. It can also negatively influence the pathophysiology of the conditions that this patient suffers from. In this context, diets with a lot of sodium, fats, high glucose, low calcium, magnesium, and potassium increase the severity of hyperlipidemia, type 2diabetes mellitus and hypertension (Alissa & Ferns, 2017). It should also be noted that diet can affect the absorption, action and how effective the prescribed medications can be.
According to the National Institute of Health, the recommended dietary guidelines for such a patient includes plenty of vegetables, whole grains, fruits, chicken and dairy products that are low in fat. Sugar should also be avoided in diets since it can worsen the currently existing cardiovascular and metabolic issues (Alissa & Ferns, 2017). Alcohol has been noted to increase the levels of lipids in serum and that is why it should either be avoided or consumed in very small quantities.
How Changes In The Pharmacodynamics And Pharmacokinetic Processes Can Impact The Recommended Drug Therapy For The Patient
The action of Motrin, an NSAID, is affected by food such that, when taken on an empty stomach, has a rapid rate of absorption but can cause upsets and potentially increases the levels of blood pressure. On the other hand, when taken with food, the rate of absorption is delayed by approximately 3—60minutes. Motrin decreased high levels of prostaglandin by inhibition of synthesis and reducing inflammation (Balakumar, Maung-U & Jagadeesh, 2016). Since it is taken together with an ASA (aspirin) and warfarin it should not exceed the recommended maximum dosage as it can lead to bleeding and thinning of the blood. Warfarin, an anticoagulant has been prescribed to prevent the patient from experiencing a stroke. It acts by blocking an enzyme which reactivates vitamin k. Therefore, diets rich in vitamin k can either promote or inhibit its effectiveness and supplements with ginger can also increase bruising and bleeding (Balakumar, Maung-U & Jagadeesh, 2016). The combination of Motrin/Aspirin/Warfarin, therefore, increases the risk of ulcerations, discomfort, and bleeding of the GI. Pharmacotherapy for Cardiovascular Disorders
Aspirin has been prescribed to prevent the patient’s risk of experiencing a stroke in relation to TIA and atrial fibrillation. It acts by inhibiting the synthesis of prostaglandin to reduce the levels of blood pressure. It can, however, corrode the stomach lining and result to ulcers if not taken on a full stomach. Metformin, an oral anti-hyperglycemic agent used in the management of type 2 diabetes mellitus acts by reducing the production of hepatic glucose, reducing the absorption of intestinal glucose and improving the sensitivity of insulin (Balakumar, Maung-U & Jagadeesh, 2016). When not taken with the recommended low glucose diet, a patient may end by being hypoglycemic. Alcohol intake and carbohydrate-rich diets should also be avoided.
Glyburide, an oral hyperglycemic agent is usually combined with metformin o increase the sensitivity of the pancreas in releasing insulin to lower the levels of blood glucose. To prevent low blood sugars, it should be taken with a meal and patients should avoid alcohol which reduces its effectiveness. It should be noted that atenolol and glyberide can mask the symptoms of hypoglycemia (Arcangelo & Peterson, 2013). Therefore, continuous monitoring of blood glucose is necessary. Atenolol, a beta blocker has been prescribed to reduce the patients’ blood pressure. Since it is cardio-selective, it shouldn’t be taken during the first 4 hours of consuming orange or apple juice as it slows down absorption. In patients already diagnosed with hyperlipidemia, it can raise the serum lipid levels (Arcangelo & Peterson, 2013).
How I Would Modify the Drug Therapy Plan Based On the Pharmacodynamics and Pharmacokinetic Changes
Although the patient’s medications are within the appropriate dosages, the combination of Motrin, aspirin, and warfarin raises a lot of concern. Motrin increases the risk of kidney failure and is a blood thinning agent (Arcangelo & Peterson, 2013). The best alternative for pain control would, therefore, be acetaminophen 325mg PO, 1-3tabs each6-8hours as required but not to exceed 3000mg daily. This patient is also at high risk of heart failure which necessitates the need for a loop diuretic. The best choice would be hydrochlorothiazide, 25mg PO daily (Arcangelo & Peterson, 2013). There is also the need to add an ACE inhibitor since the patient has both hypertension and type 2 diabetes mellitus. The best choice would be Lisinopril 2.5mg PO daily. Lisinopril would safeguard the kidneys from injury and aid in blood pressure management (Arcangelo & Peterson, 2013). Although HM has been diagnosed with hyperlipidemia, his current medication list has no statin. The preferred statin would be simvastatin 10mg PO daily to reduce the risk of hyperlipidemia worsening (Arcangelo & Peterson, 2013). Therefore, the final list of prescribed medications would include:Pharmacotherapy for Cardiovascular Disorders
Simvastatin 10mg PO daily
Lisinopril 2.5mg PO daily
Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun PO daily
Aspirin 81 mg PO daily
Metformin 1000 mg PO bid
Glyburide 10 mg PO twice daily
Hydrochlorothiazide 25mg PO daily
Acetaminophen 325mg PO, 1-3 tabs, every 6-8 hours for pain as needed (not to exceed 3,000mg daily)
References
Arcangelo, V. P., and Peterson A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins
Balakumar, P., Maung-U, K., & Jagadeesh, G. (2016). Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacological research, 113, 600-609.
Alissa, E. M., & Ferns, G. A. (2017). Dietary fruits and vegetables and cardiovascular diseases risk. Critical reviews in food science and nutrition, 57(9), 1950-1962.Pharmacotherapy for Cardiovascular Disorders