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:
For Week 2, you will examine how patient factors may influence pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics used in the treatment of cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.
When writing your Week 2 Assignment, consider the following scenario:
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
Evidence-based clinical practice guidelines are fundamental to clinical practice, as they assist providers with clinical decision making. I have attached some applicable guidelines below for your reference. I would strongly suggest you review the applicable guidelines prior to making treatment recommendations for the case study.
2014 Evidence-Based Guideline for Mgmt of HTN in Adults_JNC8.pdf
2017 ACC-AHA Guideline Mgmt HTN in Adults.pdf
2018 AHA-ACC Guideline on Mgmt Blood Cholesterol.pdf
2017 ACC-AHA-HFSA Guideline Mgmt HF.pdf
ASH 2018 Guidelines Mgmt of VTE_Optimal Anticoag.pdf
Week 2: Cardiovascular System
Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. In clinical settings, patients often present with symptoms of several cardiovascular disorders, making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options.
This week, you examine the impact of patient factors that may lead to changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.
Learning Objectives
Students will:
- Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes
- Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies
- Evaluate drug therapy plans 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.
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/
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.
ANSWER
Pharmacotherapy for Cardiovascular Disorders
Cardiovascular disorders are among the chronic conditions that profoundly threaten human life. One of the most common cardiovascular conditions is hypertension. According to Arcangelo et al. (2017), about 70 million US citizens have hypertension. Other cardiovascular diseases affect more than 20% of the American population. The report shows that heart-related diseases are a threat to human life. The pharmacotherapy knowledge of cardiovascular conditions profoundly affects treatment therapies. Thus, nurses should have proper knowledge about factors affecting the pharmacokinetic and pharmacodynamic processes in their respective patients before prescribing the medication (Fongemie & Felix-Getzik, 2015). Therefore, this paper discusses the pharmacotherapy of cardiovascular diseases by looking at factors that influence pharmacodynamics and pharmacokinetic process, describe how the transformation might affect the drug therapy, and give an explanation on how the treatment can be improved.
How Gender Might Influence Pharmacokinetic and Pharmacodynamic Processes
Gender can determine how patients respond to various cardiovascular drugs. According to Rosenthal and Burchum (2018), medicine can be more reactive in women compared to men and vice versa. The following are examples of how gender determines drug response between men and women. Digoxin does not affect men in any way in terms of mortality. However, when women take the same dosage of the medication, their mortality rate may increase (Luepke et al., 2017).
Another example is derived from the assigned case. When men take Atenolol 12.5 mg daily, they are likely to experience erectile dysfunction signs (Rosenthal & Burchum, 2018). In other words, they may have problems having sexual intercourse. However, women’s sexual function is not affected by the drug. Also, Hydralazine can cause erectile dysfunction in men. However, the medicine does not cause any sexual problems in women. Lastly, women react more to opioids compared to men, and thus they can be relieved from pain by fewer painkillers compared to men. Metabolism of drugs is also different in women and men Fongemie and Felix-Getzik (2015) report that enzyme expression is lower in men and higher in men.
Impact of Changes in Process on The Patient’s Recommended Drug Therapy
Gender can play a huge role in a patient’s recommended medication. For instance, when prescribing drugs that are metabolized by CYP2B6 enzyme, the nurse should increase the dosage in women and decrease dosage in men (Fongemie & Felix-Getzik, 2015). In this case, if the patient AO is a man, the nurse should reduce the dosage of Sertraline therapy, and if the patient is a woman, the nurse should maintain the dosage. Also, the nurse should monitor the patient closely to see how the individual reacts to Atenolol and Hydralazine in case the patient is a man. If the patient exhibits erectile dysfunction at higher levels, then the nurse will have to change the medication. However, if can the patient is a woman, the nurse will not worry about erectile dysfunction issues.
How to Improve the Patient’s Drug Therapy Plan
The drug therapy plan will be improved in the following ways. First, I would enhance the dose of Sertraline if the patient is a woman and reduce the treatment in case the patient is a man. Also, in case the patient is a woman, I would educate her to include exercise in her routine to improve the metabolic rate of the medication (Murphy et al., 2018). Also, I will closely monitor the patient to see how he or she reacts to drugs.
In conclusion, understanding the pharmacokinetic and pharmacodynamic processes of drug therapies is so essential. The knowledge can help a nurse know how drugs respond in various factors and develop a proper treatment to improve the patient’s condition.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Fongemie, J., & Felix-Getzik, E. (2015). A Review of Nebivolol Pharmacology and Clinical Evidence. Drugs, 75(12), 1349–1371. https://doi.org/10.1007/s40265-015-0435-5
Luepke, K. H., Suda, K. J., Boucher, H., Russo, R. L., Bonney, M. W., Hunt, T. D., & Mohr III, J. F. (2017). Past, present, and future of antibacterial economics: increasing bacterial resistance, limited antibiotic pipeline, and societal implications. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 37(1), 71-84. https://doi.org/10.1002/phar.1868
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
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
