Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia.
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
2019 AHA-ACC-HRS Guideline for Mgmt A Fib.pdf
2017 AHA-ACC Guideline Mgmt Valvular Heart Disease.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.
- 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/
- 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.
EXPERT ANSWER AND EXPLANATION
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.
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.
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Which drug can increase metabolic rate?
There are several drugs that can increase metabolic rate, but it is important to note that these drugs should only be used under the guidance of a healthcare professional and should not be taken without a prescription.
One example of a drug that can increase metabolic rate is thyroxine, also known as T4. Thyroxine is a hormone produced by the thyroid gland that plays a key role in regulating metabolism. In people with hypothyroidism, the thyroid gland does not produce enough thyroxine, which can result in a slow metabolism. Taking thyroxine supplements can help to increase metabolic rate and improve energy levels.
Another example of a drug that can increase metabolic rate is Clenbuterol, which is a bronchodilator that is sometimes used to treat respiratory conditions such as asthma. However, it is also used by some athletes as a performance-enhancing drug because it has been shown to increase metabolic rate and promote weight loss.
It is important to note that both of these drugs can have serious side effects and should only be taken under the guidance of a healthcare professional. There are also non-drug methods to increase metabolic rate, such as exercise and a healthy diet, which can be effective and safer in the long term.
How does body weight affect drug action?
Body weight can affect drug action in several ways, as the dosage and pharmacokinetics (how the body processes the drug) of a drug can vary depending on a person’s body weight. Here are some ways in which body weight can impact drug action:
- Dosage: The recommended dosage of a drug is usually based on the weight of the patient. A drug dose that is appropriate for a person with a higher body weight may be too high for a person with a lower body weight, and vice versa. For example, a higher dose of a medication may be required to achieve the desired therapeutic effect in a person who weighs more.
- Distribution: The distribution of a drug throughout the body can be influenced by a person’s body weight. Some drugs are distributed primarily in body fat, and therefore may have a longer duration of action in individuals with a higher body weight due to the increased amount of fat tissue in their bodies.
- Metabolism: The rate at which a drug is metabolized by the body can be influenced by body weight. For example, some drugs are metabolized more slowly in individuals with a higher body weight due to the increased amount of body fat, which can prolong the duration of action of the drug.
- Clearance: The clearance of a drug from the body can also be influenced by body weight. Some drugs are cleared more rapidly in individuals with a higher body weight due to their increased metabolic rate, which can lead to a shorter duration of action of the drug.
How does body fat affect drug distribution?
Body fat can affect drug distribution in several ways. Some drugs have a high affinity for fat tissue, which means that they may be more readily absorbed and stored in adipose tissue (body fat) than in other tissues in the body. As a result, the distribution of the drug in the body may be affected by the amount of body fat present.
Here are some ways in which body fat can impact drug distribution:
- Increased volume of distribution: The volume of distribution (Vd) is a pharmacokinetic parameter that describes the extent to which a drug is distributed throughout the body. In general, drugs that have a high affinity for fat tissue tend to have a larger Vd, which means that they are distributed more extensively throughout the body and can potentially accumulate in adipose tissue.
- Delayed onset of action: Because drugs that are highly bound to fat tissue may accumulate in adipose tissue, their distribution to other tissues in the body may be delayed. This can result in a delayed onset of action, as the drug may take longer to reach its target site in the body.
- Prolonged duration of action: Similarly, drugs that are highly bound to fat tissue may be released more slowly from adipose tissue into the bloodstream, which can result in a prolonged duration of action of the drug.
- Altered pharmacokinetics: The pharmacokinetics of a drug, such as its metabolism and clearance from the body, can also be affected by body fat. For example, some drugs may be metabolized more slowly in individuals with a higher body fat percentage, which can lead to a longer duration of action and potential toxicity.
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