Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

This case involves an 86-year-old female, AB, admitted with delirium, presenting complex cardiovascular and comorbid conditions, including atrial fibrillation, hypertension, and chronic kidney disease (Agarwal et al., 2020). The patient’s altered consciousness raises concerns about medication adherence and the impact on pharmacokinetic and pharmacodynamic processes. The purpose of this analysis is to examine how patient-specific factors, such as age, cognitive impairment, and comorbidities, may influence the pharmacokinetic and pharmacodynamic processes of cardiovascular medications (Patel et al., 2020). The aim is to formulate recommendations for optimizing drug therapy plans tailored to the individual needs and challenges presented by this elderly patient. Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

Effects of Behavioral Factors on Pharmacokinetics and Pharmacodynamics

Behavioral factors can significantly impact pharmacokinetic and pharmacodynamic processes in patients. In the case of AB, an 86-year-old female with delirium, her altered level of consciousness may affect her ability to adhere to the prescribed medication regimen. Cognitive impairment can lead to irregular dosing patterns, potentially causing fluctuations in drug concentrations. Additionally, limited daily exercise and potential nutritional deficits may influence the patient’s overall health, impacting drug metabolism and absorption (Law et al., 2020). The absence of self-monitoring for blood pressure and heart rate suggests a reliance on external sources for health information, which could affect early detection of medication-related issues. Effective communication and education about the importance of medication adherence, regular monitoring, and lifestyle modifications become crucial in addressing behavioral factors to ensure optimal therapeutic outcomes in elderly patients with cardiovascular disorders.

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Effects on Change in Pharmacokinetics and Pharmacokinetics on Drug Therapy

Changes in pharmacokinetic and pharmacodynamic processes in a patient can have profound implications for recommended drug therapy. In the case of AB, an 86-year-old with altered consciousness, the potential alterations in drug metabolism and clearance due to age-related changes and chronic kidney disease may necessitate adjustments in drug dosages (Chen et al., 2019). The elevated INR and low heart rate suggest a risk of over-anticoagulation, which could influence the management of warfarin (Lomonaco et al., 2018). The patient’s cognitive impairment may affect adherence, requiring simplified medication regimens or alternative formulations. Fluctuations in drug concentrations due to irregular dosing patterns may compromise the efficacy of medications like digoxin. Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

Moreover, limited exercise and potential nutritional deficits might affect drug absorption and metabolism, influencing the therapeutic response. The healthcare team may need to consider alternative medications or carefully monitor for adverse effects (Lee et al., 2022). Regular follow-up and close collaboration between healthcare providers are essential to assess the evolving pharmacokinetic and pharmacodynamic factors, allowing timely adjustments to the drug therapy plan and ensuring its safety and effectiveness in managing cardiovascular disorders in this complex patient.

Recommendations for Improving the Patient’s Outcome

Considering the pharmacokinetic and pharmacodynamic changes in the elderly patient AB, modifications to the drug therapy plan are warranted (Peeters et al., 2019). Given her altered level of consciousness, a simplified medication regimen may enhance adherence. Considering the elevated INR and low heart rate, a re-evaluation of warfarin dosage is crucial to mitigate bleeding risks (Allaham et al., 2021). The patient’s chronic kidney disease suggests potential accumulation of renally cleared drugs, necessitating dosage adjustments for medications like digoxin. Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

Alternative treatment options might be explored, such as direct oral anticoagulants (DOACs) instead of warfarin, as they have more predictable pharmacokinetics and may require less frequent monitoring (Chan et al., 2020). For cardiovascular management, consideration of beta-blockers with less reliance on renal excretion might be prudent (Martin et al., 2021). Collaborating with specialists, such as a nephrologist, can provide insights into optimal drug choices (Virani et al., 2023). Regular follow-up, patient education, and involvement of the spouse in medication management are crucial for enhancing the safety and efficacy of the drug therapy plan for this elderly patient with cardiovascular disorders. Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

Conclusion

To sum it up, the comprehensive assessment of AB’s case underscores the importance of individualized drug therapy plans for elderly patients with cardiovascular disorders. Considering the complex interplay of age-related changes, comorbidities, and altered consciousness, healthcare providers must meticulously adjust medications, monitor for adverse effects, and engage in ongoing patient education. Collaborative efforts among healthcare professionals are crucial for optimizing treatment outcomes, ensuring patient safety, and addressing the unique challenges presented by this elderly individual. Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

References

Agarwal, M. A., Potukuchi, P. K., Sumida, K., Naseer, A., Molnar, M. Z., George, L. K., … & Kovesdy, C. P. (2020). Clinical outcomes of warfarin initiation in advanced chronic kidney disease patients with incident atrial fibrillation. Clinical Electrophysiology, 6(13), 1658-1668.

Allahham, M., Lerman, A., Atar, D., & Birnbaum, Y. (2021). Why not dipyridamole: a review of current guidelines and re-evaluation of utility in the modern era. Cardiovascular Drugs and Therapy, 1-8.

Chan, N., Sobieraj-Teague, M., & Eikelboom, J. W. (2020). Direct oral anticoagulants: evidence and unresolved issues. Lancet (London, England), 396(10264), 1767–1776. https://doi.org/10.1016/S0140-6736(20)32439-9

Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic Kidney Disease Diagnosis and Management: A Review. JAMA, 322(13), 1294–1304. https://doi.org/10.1001/jama.2019.14745

Law, C. K., Lam, F. M., Chung, R. C., & Pang, M. Y. (2020). Physical exercise attenuates cognitive decline and reduces behavioural problems in people with mild cognitive impairment and dementia: a systematic review. Journal of physiotherapy, 66(1), 9-18. https://doi.org/10.1016/j.jphys.2019.11.014

Lee, A. Y. L., Wong, A. K. C., Hung, T. T. M., Yan, J., & Yang, S. (2022). Nurse-led Telehealth Intervention for Rehabilitation (Telerehabilitation) Among Community-Dwelling Patients With Chronic Diseases: Systematic Review and Meta-analysis. Journal of medical Internet research, 24(11), e40364. https://doi.org/10.2196/40364

Lomonaco, T., Ghimenti, S., Piga, I., Biagini, D., Onor, M., Fuoco, R., … & Di Francesco, F. (2018). Monitoring of warfarin therapy: Preliminary results from a longitudinal pilot study. Microchemical Journal, 136, 170-176. https://doi.org/10.1016/j.microc.2017.02.010

Martin, K. A., Beyer-Westendorf, J., Davidson, B. L., Huisman, M. V., Sandset, P. M., & Moll, S. (2021). Use of direct oral anticoagulants in patients with obesity for treatment and prevention of venous thromboembolism: Updated communication from the ISTH SSC Subcommittee on Control of Anticoagulation. Journal of thrombosis and haemostasis : JTH, 19(8), 1874–1882. https://doi.org/10.1111/jth.15358

Patel, R., Barker, J., & ElShaer, A. (2020). Pharmaceutical Excipients and Drug Metabolism: A Mini-Review. International journal of molecular sciences, 21(21), 8224. https://doi.org/10.3390/ijms21218224

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. Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., Kazi, D. S., Kolte, D., Kumbhani, D. J., LoFaso, J., Mahtta, D., Mark, D. B., Minissian, M., Navar, A. M., Patel, A. R., Piano, M. R., … Williams, M. S. (2023). 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 148(9), e9–e119.

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. Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

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 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. Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

For Week 2, you will examine how patient factors may influence the 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: 

AB is an 86-year-old female admitted to the emergency department with delirium. Her spouse is with her and verifies that AB adheres to the medications she is currently prescribed. She does not self-monitor her BP or heart rate at home. 

PMH: 

A fib x 1 month

HTN x 10 years 

CKD x 5 years 

Osteoarthritis x 7 years 

GERD x 20 years 

Allergies:  Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

NKDA 

Medications:  

Digoxin 0.25mg once daily 

Metoprolol succinate 25mg once daily

Warfarin 3 mg once daily

APAP 650mg three times daily

Omeprazole 20mg once daily

MVI once daily

Social History: 

Married to husband for 57 years 

No smoking, alcohol, limited daily exercise (short walks each morning) 

Family History: 

None reported 

Vitals:                                    

Ht: 5’4”

Wt: 113 lbs

HR: 52 bpm

BP: 101/58

Labs: 

Gluc 109

Na 138

K 4.0

Cl 99

CO2 27  

BUN 33

Scr 1.2 

INR 3.8

Dig 2.4 

Physical Exam: 

Elderly female with an altered level of consciousness

No signs of bruising, bleeding, or other injury Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay

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.   

2017 ACC-AHA Guideline Mgmt HTN in Adults.pdfDownload 2017 ACC-AHA Guideline Mgmt HTN in Adults.pdf

2018 AHA-ACC Guideline on Mgmt Blood Cholesterol.pdfDownload 2018 AHA-ACC Guideline on Mgmt Blood Cholesterol.pdf

2019 AHA-ACC-HRS Guideline for Mgmt A Fib.pdfDownload 2019 AHA-ACC-HRS Guideline for Mgmt A Fib.pdf

2020 ACC-AHA Guideline for Mgmt Valvular Heart Dz.pdfDownload 2020 ACC-AHA Guideline for Mgmt Valvular Heart Dz.pdf

2022 AHA-ACC-HFSA Guideline for the Management of Heart Failure.pdfDownload 2022 AHA-ACC-HFSA Guideline for the Management of Heart Failure.pdf

Antithrombotic Thx for VTE Dz_Update of CHEST Guideline_2021.pdfDownload Antithrombotic Thx for VTE Dz_Update of CHEST Guideline_2021.pdf

ASH 2020 Guidelines Mgmt VTE_Trx of DVT-PE.pdfDownload ASH 2020 Guidelines Mgmt VTE_Trx of DVT-PE.pdf

Treatment of HTN – A Review_JAMA_2022.Impact of Potential Pharmacotherapeutics for Cardiovascular Disorders Essay