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
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 one of 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.
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
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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 Psychiatry, 6(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.