NURS 6521 Advanced Pharmacology, module 1
Week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders
Assignment: Pharmacotherapy for Cardiovascular Disorders
Heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…
—Murphy et al., 2018
Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.
Photo Credit: Getty Images/Science Photo Library RF
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.
- Review the case study assigned by your Instructor for this Assignment.
- Select 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.
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.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
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Cardiovascular System Assignment: Pharmacotherapy for Cardiovascular Disorders
Pharmacokinetics and pharmacodynamics describe the interaction of the drug with the body and its consequent effect on the body. Pharmacokinetics and pharmacodynamics vary from one patient to another because of various factors that affect the processes. For example, old age manifests with profound biological changes that influence pharmacokinetics and pharmacodynamics processes. For instance, old people maybe more susceptible to side effects of certain medications than the younger population. Hence, understanding such factors as the age that influence these processes is critical in prescribing and effectively managing a patient’s pharmacotherapy. The purpose of this paper is to describe how age influences the pharmacokinetics and pharmacodynamics processes using the case study of LM.
Influence of Age on the Pharmacokinetics and Pharmacodynamics
The patient, LM, is 89 years-old, meaning she is old age. Age is one of the factors that might influence the pharmacokinetics and pharmacodynamic processes in LM. According to Maanen et al. (2019), physiological body changes occur in old age that affectsdrug absorption, activity, and elimination. Aging is associated with reduced drug absorption because of reduced gastric emptying, splanchnic blood flow, and gastric acid secretion. Similarly, aging leads to a reduction in blood flow and body mass that affects first-class metabolism. As a result, the first-class metabolism of drugs that take place in the liver becomes reduced while the bioavailability of medications that under extensive first-pass metabolism increases, for example, propranolol. Aging also affects drug distribution as water-soluble drugs tend to present with smaller volumes of distribution (Maanen et al., 2019). As a result, a dose reduction in such cases might be necessary to accommodate the new requirements. Similarly, lipid-soluble drugs tend to have a longer half-life and increased volume of distribution in old people.Aging patients also experience reduced renal functioning and other organs involved in the elimination of drugs from the body. As a result, drug elimination is often slow in older adults such as LM.
How Changes Affect the Patient’s Drug Therapy
LM is taking various drugs for hypertension, hypothyroidism, diabetes, and other minor issues, making her case complex. The effectiveness of these medications depends on several factors including age, affecting the absorption, distribution, metabolism, or excretion of certain medications. Changes in organs and body functioning at old age might alter the pharmacokinetics and pharmacology of LM’s medication therapy (Lim et al., 2018).The alteration can lead to adverse event occurrence. For example, Donepezil is safe for use in the elderly population, but care must be taken because of the risk of gastrointestinal and neurological adverse events. Reduced functioning of body organs can cause cholinergic action, causing an adverse reaction. Similarly, Levothyroxine is effective drug therapy for overt hypothyroidism. However, when using the drugs with the elderly population, caution must be taken especially in patients with cardiovascular issues.
In elderly patients as demonstrated in LM’s case, disease comorbidity is common complicating the diagnosis and management of diseases. For example, Levothyroxine can cause cardiac ischemia increasing the risk of mortality (Effraimidis et al., 2021). Similarly, improper functioning of the kidneys, stomach, and heart can impact the safety of the patient’s medication therapy. For example, elderly patients with kidney or heart-related problems are not advised to take Celecoxib. In addition, reduced kidney functioning may cause inefficient excretion of Furosemide, causing a buildup and toxicity (Lim et al., 2018). Another example of a medication that demonstrates how age factors influence pharmacokinetic and pharmacodynamic processes of drugs is Glyburide. While the medication is well-tolerated in younger adults, with the elderly, it presents the risk of hypoglycemia. The American Geriatrics Society strongly recommends avoiding the use of the drug for the elderly population because of potential risks (Greenberg, 2021).
Plan for Improvement
I would adjust the patient’s drug therapy to reduce the risk of harm. For example, I would recommend replacing Glyburide with insulin glargine because it is well-tolerated by older people and has a lower risk of hypoglycemia. I would also prescribe a lower dose of Levothyroxine than the standard dose for younger adults. Lowering the dose reduces the risk of adverse events (Kim, 2020). Further, I will apply caution and constant monitoring for any reactions that might arise from Donepezil, Furosemide, and Celecoxib. I will also exercise caution if there is a need to increase the dosage of Amlodipine. The medicine is well-tolerated, but dose increases can cause adverse events. Thus, it is crucial to evaluate the risks and benefits before dose increase. Finally, I would improve monitoring of the patient’s drug therapy because she has comorbidities, which increases the risk of drug interactions and may reduce the therapeutic effects of the medications.
Conclusion
LM’s situation is a complex case of comorbidities requiring multiple medications, creating a challenge for management because of possible drug interactions. Additionally, the patient’s age further complicates the pharmacokinetics and pharmacodynamics processes of the medications. An effective management approach requires replacing some medicines such as Glyburide with insulin glargine to lower the risk of hypoglycemia. Additionally, some medications require lowering doses and constant monitoring in case of side effects. The focus of effective drug therapy is to enhance the safety and effectiveness of the medications.
References
Effraimidis, G., Watt, T., & Feldt-Rasmussen, U. (2021). Levothyroxine Therapy in Elderly Patients With Hypothyroidism. Frontiers in endocrinology, 12, 641560. https://doi.org/10.3389/fendo.2021.641560.
Greenberg, S. A. (2021). The 2019 American Geriatrics Society Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. The Hartford Institute for Geriatric Nursing.
Kim, M. I. (2020). Hypothyroidism in Older Adults. South Dartmouth (MA): Open Text.
Lim, E. Y., Yang, D. W., Kim, J. S., & Cho, A. H. (2018). Safety and Efficacy of Anti-dementia Agents in the Extremely Elderly Patients with Dementia. Journal of Korean medical science, 33(19), e133. https://doi.org/10.3346/jkms.2018.33.e133.
Maanen, A. C.-v., Wilting, I., & Jansen, P. (2019). Prescribing medicines to older people—How to consider the impact of ageing on human organ and body functions. British Journal of Clinical Pharmacology, 86(10). https://doi.org/10.1111/bcp.14094.