Advanced Pharmacology

Advanced Pharmacology

 

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.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

  • Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece – Cardiovascular Disorders Media:

Meet Dr. Norbert Myslinski as he discusses ACE inhibitors, angiotensin inhibitors, beta-blockers, calcium channel blockers, and diuretics as different categories of hypertension drugs. What potential drugs might be best recommended for patients suffering from hypertension? (8m)

Review the case study assigned by your Instructor for this Assignment.

  • Select onethe 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.

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.

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

Warm regards,

 

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Solution

The Factor Selected and How It Might Influence the Pharmacokinetic and Pharmacodynamic Processes in The Patient

The factor selected is behavior factors. Behavioral factors focus mainly on diet and exercise. Behavioral factors are a major risk for obesity, which increases the risk for hypertension and hyperlipidemia. Two factors related to behavior affecting pharmacokinetics include nutrition and reduced circulation. Obesity has an impact on all four aspects of pharmacokinetics, including absorption, metabolism, distribution, and excretion. The patient may require a higher dose for effectiveness, have a higher risk of critical illness from a drug interaction, increased GFRs and decreased absorption of SC. This is due to changes in normal physiology, including alterations in metabolizing enzymes, plasma protein, lipid content, and blood flow (Moore, 2020). The current weight gain of the patient is a threat to their health and their obesity status. Reduced circulation may be associated with limited exercise or physical exercise, vasoconstriction linked to hypertension, and plague building, which occurs with hyperlipidemia. Obesity also has a significant impact on organs that plays a role in the pharmacodynamics of the drugs.

How Changes in The Processes Might Impact the Patient’s Recommended Drug Therapy

            The changes in especially in the metabolic process, have a significant impact on the drug therapy of the patient. Obesity increases the risk of antidepressant-induced weight gain. With the patient being prescribed sertraline, they are at an increased risk of weight gain. According to Lee et al. (2016), the hypothalamic-pituitary-adrenal axis is usually dysregulated in metabolic syndrome and obesity, increasing the risk of major depressive disorder. For example, the patient has gained nine pounds. This can be attributed to sertraline drug therapy. The association of the drug therapy, however, need to be reviewed adequately to ensure that the weight gain is not a result of other factors such as the sedentary lifestyle of the patient. Obesity, however, does not have any effects on the pharmacokinetics of water-soluble beta-blockers such as atenolol.

How You Might Improve the Patient’s Drug Therapy Plan

            There are various ways that I can improve the patient’s drug therapy. Bet-blockers are not commonly used as the first line of treatment in patients with hypertension. This class of medication is known to contribute to hyperlipidemia. This would result in to change in the atenolol drug therapy. I would discontinue the atenolol and recommend hydrochlorothiazide. I would recommend a dose of 12.5 mg of hydrochlorothiazide daily as the first line of treatment for hypertension. I would also discontinue the hydralazine drug therapy as drug therapy should comprise of a beta-blocker and a diuretic. Hydrochlorothiazide drug therapy was selected since it is safe and beneficial and is associated with reduced mortality linked to heart disease and stroke. It is easy to administer, and dose and the once-a-day dosing increases the patient’s compliance to the drug therapy (Herman & Bashir, 2020). It is usually safer to start the drug therapy at a lower dosage. Based on the information provided, the patient has gained weight, linked to sertraline drug therapy. An improvement would be including a lifestyle improvement plan for the patient. I would issue the patient with a diet and physical activity plan to help them deal with weight issues. Lifestyle interventions are also effective in managing hypertension and reduces the risk of damage to various body organs such as kidneys, heart, blood vessels, stroke, brain, and others.

 

References

Herman, L. L., & Bashir, K. (2020). Hydrochlorothiazide. Stat Pearls [Internet].

Lee, S. H., Paz-Filho, G., Mastronardi, C., Licinio, J., & Wong, M. L. (2016). Is Increased Antidepressant Exposure a Contributory Factor to The Obesity Pandemic? Translational Psychiatry6(3), E759-E759.

Moore, K. T. (2020). Special Populations: Profiling the Effect of Obesity on Drug Disposition and Pharmacodynamics. Drug Discovery and Evaluation: Methods in Clinical Pharmacology, 723-747.

Advanced Pharmacology

Advanced Pharmacology

Week 11 last assignment Advanced Pharmacology

Final Review for NURS 6521
For all classes of medications, you will need to understand the mechanism of action, side effects, appropriate use and contraindications for the classes of drugs and individual drugs listed below. Also, know the key patient education points including cautions, expected effects, and appropriate use (with food, empty stomach, etc.).
Week 8: Pharmacology for Psychological Disorders
Review for the different classes: How they will affect the patient, side effects (major side effects), when to use vs when not to use for the following:
• Antipsychotics
• Bipolar medications
• Sedatives
• Anxiety Medications
• Stimulants like: methylphenidate, dextroamphetamine, Adderall, etc.
Week 9: Women’s and Men’s Health Women’s heath:
• Pregnancy: How does it affect pharmacokinetics, what to stay away from, how do different trimesters affect the medications, medications to get pregnant, medications to prevent pregnancy, what is the purpose of oxytocin, bethanechol, magnesium sulfate in pregnancy and how the effects of these medications during breast feedings?
• Oral contraceptives, benefits of using one vs another.
• Estrogen/Progesterone Therapy
• Bisphosphonates, alendronate, tests to diagnosis need for these.
• Review following meds:
o cyclophosphamide o Meridia
o Terbutaline
o oxybutynin
o tolterodine
o radiotherapy
Men’s Health
• Testosterone therapy, different types, when to use, when not use, when to stop
• erectile dysfunction (ED), different medications, when to use one agent over
another, what not to mix with them.

Week 10: Infections and Hematologic Systems
Lots of information to review, want to focus on side effects, use, when to use, when not to use, difference in treating ethnicities, allergies with antibiotics, which antibiotics to use with different infections. Infections and treating a diabetic patient, what to watch for.
• Success or failure of a patient’s chemotherapy / targeted therapies / thrombophlebitis and thromboembolism
• epoetin alfa
• Casodex
• Dronabinol for cancer side effects
• permethrin
• oprelvekin
• silver sulfadiazine
• Neupogen
• quinine
• Infectious Disease:
• Narrow-spectrum antibiotic vs a broad-spectrum drug, what’s the difference?
• Each class of antibiotics and how they are used.
• Antibiotics vs antivirals
• What characteristic of the drug makes it a conjugated drug?
• Antibiotics and antivirals for STI treatment/prevention
• Resistant strains of microbes
• MTX
• Sulconazole
• MRSA
• Permethrin
Week 11: Pediatrics
• What is the effect on children who are prescribed adult medications
• Teaching medication use to parents, kids, etc.
• Medication administration to an infant, children, and adolescents best practices-
what not to do
• Best ways to reducing drug errors and how to prevent them
• What is the difference between adult and children dosing?
Terminology:
• Efficacy
• Pharmacokinetics
• Pharmacodynamics
• Drug tolerance
• Addiction
• Dependence

• Withdrawal
• First pass effect
• Idiosyncratic response
• Medication Reconciliation
Other Topics:
• Which drug classes produce withdrawal if stopped abruptly? When is withdrawal life threatening?
• How can adverse drug events be minimized?
• Why do drugs require clinical study and FDA approval?

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Solution

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