NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders

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. NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Pharmacotherapy For Cardiovascular Conditions

Introduction

Cardiovascular diseases affect the heart and blood vessels causing abnormal heart rhythms, heart valve disease, or narrowing of the blood vessels in the heart. Therefore, causing arrhythmias, valve disease, coronary artery disease, peripheral artery disease, pericardial disease, and deep vein thrombosis. Causes of heart diseases are high blood pressure, diabetes, sedentary lifestyle, hyperlipidemia, and family history of heart disease (Lopez, et al, 2018). Treatment options for cardiovascular heart disease are medication, surgery, and rehabilitation NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders.

ORDER HERE

The medication improves blood flow, regulates rhythm, and reduces low-density lipoproteins. Cardiac rehabilitation includes lifestyle modification and exercise. Surgeries of the heart are coronary artery bypass, grafting, valve repair, or replacement surgery. In this case, the patient has cardiovascular disease due to his clinical presentation (slow heartbeat). He has a previous history of S/P angioplasty, MI three years ago, PVD s/p left femoral to posterior bypass, and A-Fib four years ago. In addition, he presents with the risk factors for cardiovascular heart disease like hypertension and diabetes. The patient’s age, body weight, drug interactions, and pathophysiology determine drug effectiveness.

How The Factor Selected Might Influence the Pharmacokinetic and Pharmacodynamic Processes In The Patient From The Assigned Case Study

Pharmacokinetics is how the drugs reach their site of action and their excretion from the body. This process includes absorption, distribution, metabolism, and excretion. Pharmacodynamics describes the intensity of a drug concerning its concentration in body fluid, usually at the site of drug action. Factors affecting the pharmacodynamics processes are drug interactions, pathophysiological factors, and patient factors. The factors affecting the patient’s pharmacokinetics and pharmacodynamics are drug interactions pathophysiology, lifestyle, habits, age, and multiple diagnoses (Chen, et al, 2017).  Diuretics, spironolactone, ACEIs low dose, beta-blockers, Digoxin, nitrates, and anticoagulants are recommended for a patient with cardiovascular disease. However, these drugs may not achieve their therapeutic effects due to drug-drug interactions.

Drug interaction is the reaction of a drug to food, another drug, or the disease itself. drug-to-drug interactions decrease the effectiveness of another drug. These interactions may cause therapeutic failure or adverse effects (Tornio, et al, 2019). Digoxin, diltiazem, metoprolol, imdur, and ASA EC are the prescribed drugs for heart failure. For example, drug interaction with metoprolol increases toxicity and increases the risk of bradycardia (Grassi, G. 2018). Co-administration of digoxin and aspirin increases the risk of hyperkalemia. These are severe side effects of a patient with heart failure because they worsen the function of the heart. Ibuprofen causes excessive accumulation of calcium and water retention. Co-administration of ibuprofen and diltiazem increases water retention thus worsening the symptoms. Lisinopril and aspirin reduce the renal function of the patient and diminish the antihypertensive activity in ACE inhibitors.

Medical history of hypertension, diabetes mellitus, and heart failure promotes polypharmacy in the patient. Being an elderly patient polypharmacy causes tiredness, diarrhea, weakness, confusion, and dizziness. These effects may cause skipping medication, obesity, and drug overdose thus affecting the pharmacokinetics and pharmacodynamics of a drug. This patient has multiple diagnoses like hypertension and diabetes mellitus. Co-administration of these drugs may affect renal function and therefore affect pharmacokinetics and pharmacodynamics. Patient pathophysiological problems such as hyperkalemia, chronic kidney disease, and hyperglycemia affect the choice of drugs for the patient (Tornio, et al, 2019). For example, aspirin increases hyperkalemia and warfarin affects the kidneys thus should be used cautiously in patients with CKD NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders.

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

A patient with cardiovascular disease should be on the follow-up to monitor the progress of the patient as well de-prescribe medication. This patient with diabetes mellitus, hypertension, and cardiovascular disease needs medicine that controls all the three parameters without increasing the risk of toxicity and excessive interactions. Drugs I would recommend the patient are Sitagliptin 50mg PO once daily for type two diabetes mellitus, Losartan 50mg PO once daily for hypertension, digoxin 0.25 mg for atrial fibrillation and heart rate control, and aspirin 81mg PO once daily for arthritic pain and antiplatelet prophylaxis. Changing the patient’s prescription reduced a load of drugs making it easier to comply with the medication. In addition, the patient achieves the maximum desired therapeutic effects with fewer side effects (Tornio, et al, 2019). For example, HCTZ is a diuretic that increases blood sugar levels thus antagonizing the Humalog and Lantus. Lisinopril also increases the risk of kidney failure and heart failure.

How To Improve the Patient’s Drug Therapy Plan and Why the Recommended Improvements

The purpose of improving a patient’s drug therapy is to achieve therapeutic effects with no side effects and minimal drug interactions. Therefore, the care provider should understand the patient’s medication-taking behavior, talk about the side effects, assess health literacy, and reduce complexity (Qaseem, et al, 2017). The care provider should list the desired objectives before prescribing medicine to the patient. Other factors to consider when changing the therapy plan are the physiological changes that come with age and the adverse effects of drugs. The reason I would make these improvements on this patient is to control blood pressure, blood glucose and improve bradycardia. The cause of bradycardia in the patient is due to metoprolol. Lisinopril also decreases the function of the kidneys.

Conclusion

Elderly patients’ prescriptions should be written by authorized healthcare providers to avoid medication errors. However, in patients with cardiovascular diseases, the choice of drugs should suit the therapeutic needs. The care provider should also check the drug-drug interactions as well as long-term effects of a drug. 

References

Chen, N., Zhou, S., & Palmisano, M. (2017). Clinical pharmacokinetics and pharmacodynamics of lenalidomide. Clinical pharmacokinetics, 56(2), 139-152.

Grassi, G. (2018). Metoprolol in the treatment of cardiovascular disease: a critical reappraisal. Current Medical Research and Opinion, 34(9), 1635-1643.

Lopez, E. O., Ballard, B. D., & Jan, A. (2021). Cardiovascular disease. StatPearls [Internet].

Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & Clinical Guidelines Committee of the American College of Physicians*. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 166(7), 514-530.

Tornio, A., Filppula, A. M., Niemi, M., & Backman, J. T. (2019). Clinical studies on drug–drug interactions involving metabolism and transport: methodology, pitfalls, and interpretation. Clinical Pharmacology & Therapeutics, 105(6), 1345-1361 NURS 6521 Assignment: Pharmacotherapy for Cardiovascular Disorders.