NURS 6521 Pharm Week 3 Discussion Pharmacotherapy for Cardiovascular Disorders

NURS 6521 Pharm Week 3 Discussion Pharmacotherapy for Cardiovascular Disorders

A Sample Answer For the Assignment: NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders

Asthma is one of the most common conditions affecting more than 20 million individuals in the United States and over 150 million across the globe. It takes up to $14 billion to treat asthma annually. Particularly hard hit are adolescents and children between the ages of 10 to 18 years. Studies show that up to 14% of children and adolescents in the inner city are diagnosed with asthma. A larger percentage of asthmatic patients in the emergency rooms are children and adolescents. Consequently, most patients hospitalized as a result of asthma or asthma-related problems are also children.

As such, appropriate interventions must be implemented to help in managing asthma among children and adolescents hence reducing their visits to the ER or hospitalization. In the same line, Sentara Home Care Services came up with an innovative program to help in improving asthma management among children and adolescents through home-based strategies such as “Life Coaches” where they are educated on the proper use of medication and lifestyle behaviors for both the patient and their families. This paper reviews different pieces of literature for a better understanding of the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents.

Methods

Quite a significant number of internet sources were available talking about different approaches that can be utilized in managing asthma among children and adolescents. However, only peer-reviewed articles directly relating to the study PICOT questioned were used for this paper. These articles were arrived at by use of several inclusion and exclusion criteria. For instance, the inclusion criteria included studies that had been published within the last 5 years, in English, with participants who are children and adolescents.

The studies however could be either experimental or literature review. Exclusion criteria included articles published more than 5 years, in languages other than English. Consequently, relevant keywords such as asthma,  Sentara’s Asthma Disease Management plan, children and adolescents, and decreased ER/unscheduled PCP visits were utilized. A wide variety of search engines were used for this study, such as Google Scholar, PubMed/MEDLINE, and Cochrane. Generally, only peer-reviewed articles and experimental studies covering the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents, were used for this study.

Introduction

The processes that a medicine goes through in the body after administration are referred to as pharmacokinetics. Absorption, distribution, metabolism, and excretion are all included in this. Pharmacodynamics, on the other hand, deals with the effects that drugs have on the body, such as adverse effects. Variables like a patient’s genetics, gender, ethnicity, age, behavioral factors, medical history, and concurrent drugs all have an impact on pharmacokinetics and pharmacodynamics. According to the case study, these variables especially age do indeed change the drugs pharmacokinetics and pharmacodynamics (Rosenthal. & Burchum, 2018).

Age influencing pharmacodynamics and pharmacokinetics

The patient is of advanced age whereby it has been stated that they are 74 years old this is indeed can affect the pharmacodynamics and pharmacokinetics related to the drug. In advanced age you find the boy’s physiology has changed thus affecting the pharmacokinetics and elements such as absorption, distribution, metabolism and excretion.

One of the most significant impacts in old age is whereby you’ll have a decreased glomeruli filtration rate which determines the level of drug elimination. Since it is decreased it could lead to the drug being retained in the system and leading to toxicity (Sieder et al., 2016).

In old age there is also decreased gastrointestinal motility thus leading to delayed absorption rate. This leads to delayed onset of pharmacological effects of drugs thus making them less effective. The peak drug concentrations are also affected hence the drug doesn’t reach its maximum capacity for effect (Mangoni & Jarmuzewska, 2019).

Age also increases the body fat which could lead to increase the volume of distribution increases. Therefore if the drug has to be distributed to a wider area than affection it will affect its expected performance thus not delivering the desired therapeutic effect. Due to the increased body fat there is also decreased body water levels thus leading to the drug’s elimination half-lives also getting increased (Sieder et al., 2016).

Having an advanced age also affects metabolism which mostly occurs in the liver. This occurs in due to the decreased required enzymes that may no longer be available due to the physiological changes that occur because of age. This also leads to decreased clearance hence the already metabolised drug aren’t cleared from the system (Mangoni & Jarmuzewska, 2019).

Age impacting pharmacodynamics occurs through decrease in effect for beta-adrenergic agents. This is due to decrease in response in the vascular, cardiac, and pulmonary tissues due to a decline in some required proteins. There is also reduced sensitivity to drugs due to the body’s receptors undergoing physiological changes.

Therefore if the response and sensitivity is inhibited the desired therapeutic effect isn’t achieved. Homeostatic mechanisms are also seen to influence the pharmacodynamics in that in advanced age it is reduced. The mechanisms are seen to reduce in old age. Therefore in the case the drugs lead to adverse effects the body takes a longer period of time to return to the initial state (Sieder et al., 2016).

Changes in the Process that Impact the Patient’s Recommended Drug Therapy

Due to the old age the pharmacodynamics and pharmacokinetics has been impacted. The absorption has been delayed due to decreased gastric motility, on the distribution end the volume of distribution has increased due to the increased body fat and the metabolism due to decreased enzymes has also decreased.

The physiological changes in the glomeruli has decreased the glomeruli filtration rate hence decreasing excretion and could lead to toxicity. The pharmacodynamics due to decrease in sensitivity, decrease in response and reduced homeostatic mechanisms negatively affect it (Mancia et al., 2014).

Therefore encompassing all this there is a definite change in the recommended drug therapy in order to benefit the patient. The changes are in medication such as atenolol will be used in place of the beta-blocker metoprolol, starting at 25 to 200 mg per day. However, fast response is attainable with longer release modules and can be delivered thrice daily, thus it’s advised to begin new medication, notably such as beta-blockers, with prolonged release formulae.

Instead of ibuprofen that is contraindicated with warfarin patients should be prescribed acetaminophen orally 500mg thrice daily to manage the pain. I would also advise using lipid-lowering drugs other than statins to lower the low-density lipoprotein cholesterol levels (Mangoni & Jarmuzewska, 2019).

How to Improve the Drug Therapy Plan

Patients with a high risk of cardiovascular disease, a heart attack, or is known diabetic, such as this patient, are advised to begin taking a moderate-intensity statin with the aim of reducing LDL-C levels by 30% or more. For this patient, it is advised to utilize Ezetimibe, administered orally at a dose of 10 mg each day. Cardiovascular diseases, diabetes mellitus, left ventricular dysfunction and diabetic neuropathy can receive treatment by use of angiotensin converting enzyme inhibitors.

They can also be used to prevent strokes. Starting doses of ramipril range from 1.25 mg to 2.5 mg orally every day. This medication is also recognized to lessen myocardial infarctions, strokes, and fatalities. Moreover aside from changes in medications can make other alterations such as diet change, smoking cessation, weight loss, provision of health education from medical professionals and physical activity is required (Mayor, 2017).

Conclusion

The majority of deaths globally are currently caused by cardiovascular disorders, and diabetes is frequently found in these people. It is thought that people with type diabetes are more likely than non-diabetics to die from cardiovascular illnesses. In order to get the best results in the management of cardiovascular diseases which aims to maximize the benefits of available treatments while minimizing patient harm clinicians must possess basic knowledge of pharmacokinetics and pharmacodynamics (Rosenthal. & Burchum, 2018).

References

Hoover, L. E. (2019). Cholesterol management: ACC/AHA Updates guideline. Https://eds-a-       ebscohost-com-ezp.waldenulibrary.org/eds/pdfviwer/

Mayor, S. (2017). Pharmacokinetics: Optimizing safe and effective prescribing.             Https://onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1551

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

Sieder, S. T., Kalus, J. & Lanfear, D. E. (2016). Cardiovascular pharmacokinetics,            Pharmacodynamics and Pharmacogenomics for the clinical practitioner. Https://eds-a-  ebscohost-com.ezp.waldenulibrary.org/eds/delivery/

Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., & Galderisi, M.       (2014). 2013 ESH/ESC Practice guidelines for the management of arterial hypertension:            ESH-ESC: The Task Force for the management of arterial hypertension of the European           Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood          Pressure, 23(1), 3-16.

Mangoni, A. A., & Jarmuzewska, E. A. (2019). The influence of heart failure on the         pharmacokinetics of cardiovascular and non‐cardiovascular drugs: A critical appraisal of           the evidence. British Journal of Clinical Pharmacology, 85(1), 20-36.

Pharmacotherapy for Cardiovascular Disorders – As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This is the result of the extensive treatment and care that is often required for patients with these disorders. While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011).

Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors. 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.

Consider the following case studies:

Case Study 1:

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

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Case Study 2:

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:

• Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
• Aspirin 81 mg daily
• Metformin 1000 mg po bid
• Glyburide 10 mg bid
• Atenolol 100 mg po daily
• Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

Case Study 3:

Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:

• Glipizide 10 mg po daily
• HCTZ 25 mg daily
• Atenolol 25 mg po daily
• Hydralazine 25 mg qid
• Simvastatin 80 mg daily
• Verapamil 180 mg CD daily

To prepare:

• Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.
• Select one of the three case studies, as well as 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.

Post a 1 page paper APA format 

•   an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected.
• Then, describe how changes in the processes might impact the patient’s recommended drug therapy.
• Finally, explain how you might improve the patient’s drug therapy plan.

Readings

• Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

o   Chapter 19, “Hypertension” (pp. 230–246) . This chapter examines the relationships between the cardiovascular, nervous, and renal systems. It then describes diagnostic criteria for hypertension patients, drugs used to treat hypertension and possible adverse reactions, monitoring patient response, and patient education.

o   Chapter 20, “Hyperlipidemia” (pp. 247–262). This chapter explores causes of hyperlipidemia, treatments for hyperlipidemia patients, and methods for monitoring patient response. It also reviews strategies for risk assessment and patient education.

o   Chapter 21, “Chronic Stable Angina” (pp. 263–277) . This chapter begins by exploring factors that contribute to chronic stable angina, types of drugs used in treatment, and diagnostic criteria for initiating drug therapy. It also examines methods for monitoring patient response to treatment and educating patients on self-care.

o   Chapter 22, “Heart Failure” (pp. 278–297) . This chapter examines the process of prescribing drugs to treat heart failure and explores effects of prescribed drugs, proper dosages, and possible adverse reactions.

o   Chapter 49, “Anticoagulation Disturbances” (pp. 764–803) . This chapter covers drug therapy options for three disorders requiring anticoagulants: venous thromboembolism, atrial fibrillation, and ischemic stroke. It also explains the process of initiating and managing drug therapy for patients with these disorders.

• Drugs.com. (2012). Retrieved from http://www.drugs.com/. This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

Media

•  Laureate Education, Inc. (Executive Producer). (2012). Hypertension and hyperlipidemia. Baltimore, MD: Author. This media presentation outlines hypertension and hyperlipidemia including contributing factors, evaluation, treatment, and implications.Note: The approximate length of this media piece is 10 minutes.

NURS 6521 Pharm Week 10 Discussion Hormone Replacement Therapy

In recent years, hormone replacement therapy has become a controversial issue. When prescribing therapies, advanced practice nurses must weigh the strengths and limitations of the prescribed supplemental hormones. If advanced practice nurses determine that the limitations outweigh the strengths, then they might suggest alternative treatment options such as herbs or other natural remedies, changes in diet, and increase in exercise.

Consider the following scenario:

As an advanced practice nurse at a community health clinic, you often treat female (and sometimes male patients) with hormone deficiencies. One of your patients requests that you prescribe supplemental hormones. This poses the questions: How will you determine what kind of treatment to suggest? What patient factors should you consider? Are supplemental hormones the best option for the patient, or would they benefit from alternative treatments?

To prepare:

• Review Chapter 56 of the Arcangelo and Peterson text, as well as the Holloway and Makinen and Huhtaniemi articles in the Learning Resources.
• Review the provided scenario and reflect on whether or not you would support hormone replacement therapy.
• Locate and review additional articles about research on hormone replacement therapy for women and/or men. Consider the strengths and limitations of hormone replacement therapy.
• Based on your research of the strengths and limitations, again reflect on whether or not you would support hormone replacement therapy.
• Consider whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies.

Post A 1 page paper APA format ( no title page)

1. a description of the strengths and limitations of hormone replacement therapy.
2. Based on these strengths and limitations, explain why you would or why you would not support hormone replacement therapy.
3. Explain whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies and why.

Drug therapy is affected by factors that affect pharmacokinetics (PK) and pharmacodynamics (PD), like age, gender, ethnicity, body weight, and genetics. The case study is about patient AO with a history of obesity and has gained 9 pounds. AO has a medical history of hypertension and hyperlipidemia. The current drug therapy includes Atenolol 12.5 mg OD, Doxazosin 8 mg OD, Hydralazine 10 mg QID, Sertraline 25 mg OD, and Simvastatin 80 mg OD. The purpose of this paper is to discuss how gender may influence the patient’s PK and PD processes and affect drug therapy.

How Gender Might Influence the PK and PD Processes in the Patient

The physiologic differences between males and females affect drug activity, including PK and PD processes. Females produce less gastric acid and have slower GI transit times than men. Consequently, medications that need an acidic environment for absorption have lower bioavailability in women. A prolonged GI transit time can reduce the absorption of drugs like metoprolol, verapamil, and theophylline (Mauvais-Jarvis et al., 2021). Drug distribution in the body is affected by body composition, BMI, plasma volume, and plasma protein-binding capacity.

Men are generally heavier and have a higher BMI and larger organs than women. Thus, drug distribution is less in women, and they should receive lower doses to avoid unnecessary adverse reactions. In addition, females have larger fat stores than males, accounting for greater drug distribution volumes based on a drug’s hydrophilic or hydrophobic properties (Mauvais-Jarvis et al., 2021). Lipophilic drugs have a longer duration of action in females due to large volumes of adipose tissue than in men.

The metabolic processes in the phase II metabolism of drugs are typically accelerated in men leading to some drugs being cleared faster in men than women. Thus, women may need lower doses of drugs that undergo this metabolism. In addition, the Glomerular filtration rate (GFR) is higher in men, and when considering body size, GFRs are 10-25 % slower in females (Zucker & Prendergast, 2020). Drugs excreted unchanged in the urine are cleared slower in women, and they should receive lower dosages of these drugs based on GFR.

Regarding PD, Beta blockers have an enhanced BP-lowering effect when exercising in females. Some drugs have an enhanced effect in females, like opioids, SSRIs, and Typical antipsychotics, while TCAs have a reduced effect (Madla et al., 2021). Besides, Aspirin is associated with poor platelet inhibition and heart attack protection in females and poor stroke prevention in males. Digoxin is linked with increased mortality in females.

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

If AO is a female, changes in PD and PK processes may affect drug therapy on the basis of gender. For example, Atenolol would be affected since it has greater sensitivity and improved effectiveness in women. However, if AO were a man, the metabolic process of Atenolol would be accelerated, causing the drug to clear faster, and he would need a higher dose or increased frequency (Mauvais-Jarvis et al., 2021).

In addition, the patient’s gender would affect the PD of Sertraline since it has greater sensitivity and better effectiveness in women. In depression treatment, men respond better to TCAs and women better to SSRIs. Therefore, if AO were female, Sertraline would be preferred (Madla et al., 2021). The tissue distribution rate of Simvastatin depends on the degree of lipophilicity. More lipophilic statins are associated with greater extrahepatic effects.

How You Might Improve the Patient’s Drug Therapy Plan

If AO were a female, I would maintain Atenolol at 12.5 mg but monitor BP and heart rate due to its high sensitivity in lowering HR and BP. Sertraline would also be maintained at 25 mg since it is more effective in women. However, if AO were a man, a TCA like Amitriptyline or Imipramine would be preferred since men respond better to TCAs (Madla et al., 2021). In addition, I would reduce Simvastatin to 40 mg OD because the high-fat stores in the patient would lead to a greater volume of distribution of the drug. Thus the patient would need lower doses owing to a longer duration of action caused by a large volume of adipose tissue.

Conclusion

Drug PK processes in females are affected by lower body weight, slow GI motility, reduced intestinal enzymatic activity, and slower GFR. Drug renal clearance is slower in females, and drugs excreted in the kidneys may need a dose adjustment. PD processes in women include greater sensitivity and better effectiveness in beta blockers, opioids, SSRIs, and typical antipsychotics. Due to the PD and PK differences, females are more likely than males to experience worse side/adverse effects.

References

Madla, C. M., Gavins, F. K., Merchant, H. A., Orlu, M., Murdan, S., & Basit, A. W. (2021). Let’s talk about sex: Differences in drug therapy in males and females. Advanced Drug Delivery Reviews, 175, 113804. https://doi.org/10.1016/j.addr.2021.05.014

Mauvais-Jarvis, F., Berthold, H. K., Campesi, I., Carrero, J. J., Dhakal, S., Franconi, F., … & Rubin, J. B. (2021). Sex-and gender-based pharmacological response to drugs. Pharmacological reviews, 73(2), 730-762. https://doi.org/10.1124/pharmrev.120.000206

Zucker, I., & Prendergast, B. J. (2020). Sex differences in pharmacokinetics predict adverse drug reactions in women. Biology of sex differences, 11(1), 1-14. https://doi.org/10.1186/s13293-020-00308-5

Resources

• Holloway, D. (2010). Clinical update on hormone replacement therapy. British Journal of Nursing, 19(8), 496–504.Retrieved from the Walden Library databases.This article examines the purpose, components, and administration of hormone replacement therapy (HRT). It also presents benefits, risks, potential side effects, and alternative treatment options of HRT.
• Mäkinen, J. I., & Huhtaniemi, I. (2011). Androgen replacement therapy in late-onset hypogonadism: Current concepts and controversies—A mini-review. Gerontology, 57(3), 193–202.Retrieved from the Walden Library databases.This article examines the role of testosterone levels in the development of hypogonadism. It also explores health issues that