Case Study

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 daily
• Sertraline 25 mg daily
• Simvastatin 80 mg daily

Please keep in mind that there are multiple drugs for these disorders, and it is important to always think about the following when evaluating a case:

• Co-morbid conditions of the patient
• Differential—how do you rule out certain conditions
• Current medications and if the dose is appropriate
• Adverse effects
• Contraindications for the patient

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.  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.

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 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 (genetics, gender, ethnicity, age, or behavior factors) 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.

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Solution

Cardiovascular problems have a significant effect on the health and wellbeing of the affected patient populations. They act as a source of considerable disease burden. Nurses and other healthcare providers have a crucial role to play in facilitating the realization of the health needs of patients with cardiovascular problems. Therefore, this paper examines AO’s case study to determine the influence of age on pharmacokinetics and pharmacodynamics of the prescribed medications and the influence of changes on the recommended drug therapy. It also examines the ways of improving drug therapy.

Effect of the Selected Factor

Age is a significant factor that influences the pharmacokinetics and pharmacodynamics of medications prescribed for AO. The changes in the age of the patient affect drug metabolism. For example, the level of first metabolism being undertaken by cytochrome P450 declines with advancing age due to the liver being less effective. The effect is the reduction in drugs metabolized in the liver and an increase in the level of drug metabolites in the system (Kuprash et al., 2020). Renal function also declines with the advancing age. The elderly patients have reduced renal functions, which lower the elimination of drugs via the renal system. The effect of this change is that elderly patients are likely to suffer from drug toxicity due to reduced elimination of medications, hence, affecting the pharmacokinetics and pharmacodynamics of drugs (van den Anker et al., 2018). It can be seen from AO’s case study that the metabolism of hydralazine is likely to be reduced with the advancing age of the patient. Besides, drugs such as atenolol are likely to be minimally eliminated via the renal system, increasing the risk for its toxicity in elderly patients. The last effect of age on pharmacokinetics and pharmacodynamics is also seen in the reduction in the absorption of drugs via the gastrointestinal system with the advancing age (Groenland et al., 2021). As a result, the use of the oral route of medication should be avoided to ensure the optimum absorption of medications for the desired therapeutic effect.

Effect of Changes on Recommended Drug Therapy

The effect of changes attributed to age has implications on the recommended drug therapy for AO. Firstly, the effect of age on drug metabolism increases the need for the alteration in the dosage of the medications that undergo first-pass metabolism. The reduction in the dosage is to eliminate the risk of potential liver toxicity due to an increase in the level of drug metabolites in the blood (Peeters et al., 2019). The changes also increase the need for prescribing AO medications that are eliminated via other routes such as through feces for the drug metabolites. The consideration of other routes such as through feces will preserve optimal renal functioning in elderly patients. The dosage of medications such as atenolol and hydralazine also needs to be reduced to minimize renal damage and enhance excretion. The last implication of the effect is considering medications administered through other routes such as intravenous medications. Intravenous medications will enhance the absorption of medications by bypassing the gastrointestinal route that has a reduced rate of absorption in elderly patients (Farkouh et al., 2020).

Improving Patient’s Drug Therapy

An effective intervention that should be adopted for AO is reducing the dosage of the prescribed medications. Reducing the dosage of medications that undergo first-pass metabolism in the liver and elimination via the renal system will enhance their pharmacokinetics and pharmacodynamics. It will also minimize harm to the patient; ensuring safety in the care process is achieved (van den Anker et al., 2018). The reduction in the risk of harm will also ensure the protection of the patient’s right to high-quality care.

Conclusion

Age has a significant effect on the pharmacokinetics and pharmacodynamics of medications prescribed for AO. Advancing age alters the pharmacokinetics and pharmacodynamics of medications. Healthcare providers should ensure the prescription of patients with medications has minimal harm and optimum benefits to the patients. Through it, safety, quality, and efficiency in healthcare will be achieved.

References

Farkouh, A., Riedl, T., Gottardi, R., Czejka, M., & Kautzky-Willer, A. (2020). Sex-Related Differences in Pharmacokinetics and Pharmacodynamics of Frequently Prescribed Drugs: A Review of the Literature. Advances in Therapy, 37(2), 644–655. https://doi.org/10.1007/s12325-019-01201-3

Groenland, E. H., van Kleef, M. E. A. M., Bots, M. L., Visseren, F. L. J., van der Elst, K. C. M., & Spiering, W. (2021). Plasma Trough Concentrations of Antihypertensive Drugs for the Assessment of Treatment Adherence. Hypertension, 77(1), 85–93. https://doi.org/10.1161/HYPERTENSIONAHA.120.16061

Kuprash, L., Gudarenko, S., Kuprash, O., Gorchakova, N., & Khodakivska, O. (2020). Age peculiarities of pharmacokinetics and pharmacodynamics of medicines. Ageing and longevity, 1(1), Article 1. http://aging-longevity.org.ua/index.php/journal-description/article/view/9

Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opinion on Drug Metabolism & Toxicology, 15(4), 287–297. https://doi.org/10.1080/17425255.2019.1588249

van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental Changes in Pharmacokinetics and Pharmacodynamics. The Journal of Clinical Pharmacology, 58(S10), S10–S25. https://doi.org/10.1002/jcph.1284