Assignment: Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders

Introduction

Cardiovascular diseases are one of the leading causes of death for Americans and the world (Centers for Disease Control and Prevention, 2019). Cardiovascular disorders refer to diseases that affect the heart or blood vessels. These disorders usually interfere with the normal function of the heart and blood vessels (Centers for Disease Control and Prevention, 2019). Many factors contribute to cardiovascular disease development, including age, genetics, lifestyle, and habits. Thus, when managing cardiovascular diseases, it is important to consider several factors for each patient that could influence their drug therapy and lifestyle modification. Various factors influence the pharmacokinetic (PK) and pharmacodynamics (PD) of medications. Therefore, healthcare providers need to understand CVD’s pharmacokinetics and pharmacodynamics to manage and enhance medication therapy for patients with CVD effectively. This paper aims to analyze age as a factor that influences pharmacokinetics and pharmacodynamics for CVD patient AO. The paper will also discuss how age may affect drug therapy and suggestions on improving the patient’s drug therapy. Assignment: Pharmacotherapy for Cardiovascular Disorders

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How age might Influence the Pharmacokinetic and Pharmacodynamic Processes

Although heart disease can affect anyone, certain factors increase the risk of developing cardiovascular diseases, such as age, genetics, race, and sedentary lifestyle (Centers for Disease Control and Prevention, 2019). Many factors also affect the way the body responds to cardiovascular medications, just as many factors can affect the development of cardiovascular diseases. One of the factors that influence the pharmacodynamic and pharmacokinetics of cardiovascular medications is age. Age can influence the pharmacokinetic and pharmacodynamic of the patient AO in this case scenario. The aging process slows down gastric motility, the secretion of gastric acid, glomerular filtration, and renal clearance; this process may affect the way the body absorbs, metabolizes, and excretes drugs (HealthinAging.org, 2020).

For this patient, A/O, the therapeutic effects, as well as adverse and toxic effects, may be affected due to the aging process. Drug absorption and distribution for certain drugs may slow down for older patients, thus requiring lower doses; for example, hydralazine is rapidly absorbed in the GI tract, and the absorption rate varies from person to person. Hence the absorption rate for older adults may be slowed due to the aging process affecting the GI tract (Healthinaging.org, 2020). In addition to absorption and distribution, the excretion of drugs is affected by the decreased renal function in the elderly (National Kidney Foundation, 2020). For example, atenolol is primarily excreted by the kidneys; therefore, renal function assessment is imperative before prescribing this medication (Rehman et al., 2020). Age also affects PK and PD by

How Changes in the Processes might Impact the Patient’s Recommended Drug Therapy

Changes in the way drugs are absorbed, distributed, metabolized, utilized, and excreted affect how medications will be prescribed. Healthcare providers must assess potential factors that may affect the PK and PD of medications before choosing them. When treating an elderly patient with cardiovascular diseases, the provider, for example, must assess the patient’s renal and liver function, which may impact the dosage or choice of medication. Decreased renal function in the elderly may cause drugs needing renal clearance to be accumulated in the body, thus leading to toxicity and decreased hepatic function may cause drug-induced liver injury (HealthinAging.org, 2020). For example, this patient AO in this scenario was prescribed hydralazine, assuming there is decreased liver function in this patient, Drug induced liver injury could occur (Herman & Tivakaran, 2020).

Also, many elderly patients may have underlying health conditions or comorbidities. When choosing drug therapies, providers must assess for a potential drug to drug interaction and medications to be avoided with certain conditions, after which an alternative therapy can be recommended, or close monitoring can be done (Teka et al., 2016).  Changes in the elderly and comorbidities may increase the side effects of medications for patients. For example, verapamil acts by dilating blood vessels to decrease blood pressure. Therefore, it must be used with caution in the elderly or avoided if the patient has postural hypotension (Pavlou et al., 2018).

How to Improve the Patient’s Drug Therapy Plan

The patient AO in this scenario, is obese and reportedly gained 9 pounds. Although this patient is obese, this may be indicative of fluid overload, therefore indicating that the current regimen for hypertension needs to be modified. Firstly, this patient needs to be further assessed to determine the current blood pressure level and its effectiveness. Renal function also needs to be assessed to determine if changes need to be made for drugs needing renal clearance. This patient is prescribed hydralazine 10mg; hydralazine acts by dilating blood vessels to decrease blood pressure, thereby increasing cardiac output (Herman & Tivakaran, 2020). However, due to its first-pass effect, the dosage may need to be increased to be more effective (prescriber’s Digital Reference, 2020).

Atenolol is not a preferred choice as the first line of treatment for hypertension (Pavlou et al., 2018). Atenolol may also worsen this patient’s hyperlipidemia and increase the risk for diabetes; Therefore, atenolol can be removed and replaced with another beta-blocker like Coreg (Herink & Ito, 2018). A beta-blocker or diuretic in combination with hydralazine for patient AO to decrease cardiac volume due to the hydralazine. Finally, the combination of many blood pressure medications may be counter-productive for this patient. For example, doxazosin may cause hypotension, especially when combined with atenolol. Cutting off doxazosin may be needed to avoid complications from polypharmacy (Masnoon et al., 2017).

Conclusion

cardiovascular conditions, especially in the presence of other comorbidities, can be challenging. Therefore, providers must ensure they consider patients’ history, age, comorbidities, and ethnicity to impact their drug therapy and care. Adequate medication therapy is also heavily dependent on appropriate follow-up, including lab values assessment, to ensure that it is effective and prevents complications. With further history and assessment of patient AO, their drug therapy could be modified to be more effective in managing their cardiovascular disease and comorbidities.

References

Centers for Disease Control and Prevention. (2019). Centers for Disease Control and Prevention, 2019. Heart Disease: Know your Risk for Heart Disease. Retrieved from https://www.cdc.gov/heartdisease/risk_factors.htm

HealthinAging.org (2020). Medications work differently in older adults. Retrieved from https://www.healthinaging.org/medications-older-adults/medications-work-differently-older-adults

Herman, L. L. & Tivakaran, V. S. (2020). Hydralazine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470296/

Herink, M. & Ito, M. K. (2018). Medication Induced Changes in Lipid and Lipoproteins. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK326739/

Pavlou, D. I., Paschou, S. A., Anagnostis, P., Spartalis, M., Spartalis, E., & Vryonidou, A., Tentolouris, N., and Siasos, G. (2018). Hypertension in patients with type 2 diabetes mellitus: Targets and management. Maturitas, 112, 71-77. Retrieved from https://doi.org/10.1016/j.maturitas.2018.03.013

Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is

polypharmacy? A systematic review of definitions. BMC Geriatrics, 17, 230.Retrieved from

https://doi:10.1186/s12877-017-0621-2

National Kidney Foundation. (2020). GFR. Kidney.org. Retrieved from https://www.kidney.org/kidneydisease/siemens_hcp_gfr

Prescriber’s Digital Reference, 2020). hydralazine hydrochloride – Drug Summary. Retrieved from https://www.pdr.net/drug-summary/Hydralazine-Hydrochloride-Injection-hydralazine-hydrochloride-739

Rehman B., Sanchez, D. P, & Shah S. (2020). Atenolol. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539844/

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier

Teka, F., Teklay, G., Ayalew, E., & Teshome, T. (2016). Potential drug-drug interactions among elderly patients admitted to the medical ward of Ayder Referral Hospital, Northern Ethiopia: a cross-sectional study. BMC research notes, 9(1), 431. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009535/

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…

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—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 Assignment: Pharmacotherapy for Cardiovascular Disorders

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. Assignment: Pharmacotherapy for Cardiovascular Disorders
• 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. Assignment: Pharmacotherapy for Cardiovascular Disorders

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. Assignment: Pharmacotherapy for Cardiovascular Disorders