Pharmacotherapy for Cardiovascular Disorders Essay
Cardiovascular diseases cause significant morbidity and mortality globally and in the US. Besides, their prevalence in the US is increasing gradually thus, they pose potential threats and challenges to the American healthcare system. Despite the advancement in treatment, patients with cardiovascular diseases do not receive optimal care. This is attributed to their complex nature, which requires a good understanding of their risk factors and pathophysiology and how these factors influence pharmacodynamics and pharmacokinetic processes. Pharmacotherapy for Cardiovascular Disorders Essay.
Case Overview
The selected case study for this assignment involves a patient named AO who was obese and has subsequently gained 9 pounds. AO has a diagnosis of hyperlipidemia and hypertension with the following prescribed medications: Sertraline 25 mg, doxazosin 8 mg, atenolol 12.5 mg and Simvastatin 80 mg daily, with hydralazine 10 mg qid.
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Patient Factors
The selected patient factor is behavior concerning AOs obesity. This means that AO’s lifestyle has a high-calorie intake and decreased physical activity. As explained by Shattat (2015), the pathophysiology of obesity-related hypertension is attributed to the accumulation of fat in the intravascular space and intra-abdominal muscles, it activates the renin-angiotensin system and leads to retention of sodium hence increased renal absorption.
Obesity and hyperlipidemia complicate the management of cardiovascular disorders. Therefore, poor circulation and poor nutrition affect the pharmacokinetics and pharmacodynamics of this patient. It is inarguable that AO has poor nutrition and reduced circulation, which is influenced by obesity and limited physical activity respectively. The two factors lead to vasoconstriction that accompanies hypertension and the build-up of plaque as observed in hyperlipidemia. As emphasized by Arcangelo & Peterson (2013), it is necessary to understand how these risk factors affect the management of cardiovascular disorders and their side effects on the patient’s ability to respond to drug therapy to achieve desired therapeutic outcomes. This understanding will also influence clinical decision making on appropriate dietary and therapeutic modifications to attain specific treatment goals. AO should consider making modifications to his diet and have a regular physical exercise to improve his cardiovascular health and efficacy of the recommended treatment plan. Pharmacotherapy for Cardiovascular Disorders Essay
Pharmacodynamics & Pharmacokinetics
It is not clear if AO adheres to prescribed medications since he has several pills to take daily. Based on the recommendations provided by the AHA (American Heart Association), patients with hypertension should be given combined therapy to reduce the risks of side effects and non-compliance. AO is at a high risk of hydralazine associated SLE. Besides, the combination of doxazosin and atenolol produces synergistic effects such that, the latter blocks alpha 1 receptors resulting in the dilation of blood vessels reducing the peripheral resistance (Pokrovsky, Polishchuk & Polischuk, 2017). However, atenolol is cardio-selective thus blocks beta 1 receptors even at the lowest doses.
Improving the Drug Therapy Plan
AO’s drug plan has numerous areas that need improvement. First, AO’s prescription has atenolol, which is a beta-blocker. Beta-blockers act by blocking the effects of adrenaline to influence vasodilation, improve the flow of blood and lower blood pressure. Beta-blockers are major contributors to hyperlipidemia according to currently existing research (Carey & Wheaton, 2018). Besides, according to the recommendations provided by the FDA, it is not the 1st line dug of choice in hypertension management. Based on these reasons, atenolol must be discontinued in this patient’s drug therapy. Discontinuation of atenolol should also prompt the discontinuation of hydralazine since the latter is administered alongside a diuretic and a beta-blocker. Pharmacotherapy for Cardiovascular Disorders Essay.
The FDA recommends diuretics for hypertension 1st line managements. For this patient, a daily dose of 12.5mg hydrochlorothiazide (HCTZ) is the most appropriate. As a thiazide diuretic, HCTZ acts on the renal system by decreasing the reabsorption of sodium in the distal convoluted tubule (Roush & Sica, 2016). It is also worth mentioning that thiazides are not only beneficial but also safe in patients with diabetes and reduce the risk of high mortalities from stroke and heart disease. However, it should be administered in the lowest dose possible. AO is not a known diabetic. However, she has several risk factors for diabetes, which should prompt the need to determine whether she has diabetes.
Simvastatin, a statin, is appropriate for managing this patient’s hyperlipidemia. Simvastatin acts by decreasing cholesterol production in the liver by blocking the HMG CoA enzyme (Arcangelo & Peterson, 2013). Besides, it is the FDA‘s recommended drug for the 1st line management of hyperlipidemia based on a patient’s blood cholesterol levels. Therefore, to determine if simvastatin is still effective, I would order for a blood cholesterol test. On the other hand, I would recommend that AO take doxazosin at night since it causes orthostatic hypotension as a major side effect. Pharmacotherapy for Cardiovascular Disorders Essay.
References
Arcangelo, V. P., and Peterson A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins
Carey, R. M., & Wheaton, P. K. (2018). Prevention, detection, evaluation, and management of high blood pressure in adults: Synopsis of the 2017 American College of Cardiology/American Heart Association hypertensive guideline. Annals of Internal Medicine, 168(5), 351-358.
Pokrovsky, V., Polishchuk, L., & Polischuk, S. (2017). The methodology for assessing the effectiveness of the therapy. Research Results in Pharmacology, 3, 91.
Roush, G. C., & Sica, D. A. (2016). Diuretics for hypertension: a review and update. American journal of hypertension, 29(10), 1130-1137. Pharmacotherapy for Cardiovascular Disorders Essay
Shattat, G. F. (2015). A review article on hyperlipidemia: types, treatments and new drug targets. Biomedical and Pharmacology Journal, 7(1), 399-409.
Paper details
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/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 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. Pharmacotherapy for Cardiovascular Disorders Essay
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.
- 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
- Sertaline 25 mg daily
- Pharmacotherapy for Cardiovascular Disorders Essay