NURS 6521 Week 2 Assignment

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…
—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.

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.
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.

Case Study
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

All other factors were purposely omitted from the case study. As you read through your course materials, please feel free to add those factors that you’d like to further discuss that may affect the decisions that you will make for this patient. For example, if you’d like to discuss how the factor age will affect your choices, include in your paper that your patient is a 86 year old male. Or if you’d like to provide details of how gender plays a role in what treatment the patient will receive, include that your patient is a female. Also, please view the Grading Rubric for this Assignment to ensure you’ve included all necessary entities before submitting your assignment.

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
• Chapter 33, “Review of Hemodynamics” (pp. 285–289)
• Chapter 37, “Diuretics” (pp. 290–296)
• Chapter 38, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 297–307)
• Chapter 39, “Calcium Channel Blockers” (pp. 308–312)
• Chapter 40, “Vasodilators” (pp. 313–317)
• Chapter 41, “Drugs for Hypertension” (pp. 316–324)
• Chapter 42, “Drugs for Heart Failure” (pp. 325–336)
• Chapter 43, “Antidysrhythmic Drugs” (pp. 337–348)
• Chapter 44, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 349–363)
• Chapter 45, “Drugs for Angina Pectoris” (pp. 364–371)
• Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)

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Solution

Case Study Analysis

Patient AO has a history of obesity and has previously gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. The following medications are presently being prescribed:

  • Atenolol 12.5 mg daily
  • Doxazosin 8 mg daily
  • Hydralazine 10 mg qid
  • Sertraline 25 mg daily
  • Simvastatin 80 mg daily

Obesity, Hypertension and Hyperlipidemia

Obesity is a complicated health problem caused by various variables, with individual variables such as behavior and heredity being the most predominant. Physical activity, immobility, dietary patterns, and medicine are behavioral factors (Hossain et al., 2018). Hypertension, obesity, hyperlipidemia are well-known consequences of obesity. This paper examines a case study of a patient AO who was recently diagnosed with hypertension and hyperlipidemia. It examines the effect of patient factors on pharmacokinetic and pharmacodynamics processes and the impact on suggested patient therapy and techniques to improve patient therapy.

Pharmacokinetic And Pharmacodynamics Processes

The patient factor I chose focuses on obesity, which is a substantial risk factor for several diseases such as hypertension, hyperlipidemia, and diabetes, potentially complicating therapy for cardiovascular disorders (Babu et al., 2018). Some of the variables influencing this patient’s pharmacokinetics include a poor diet and reduced circulation. This patient’s nutrition status is deemed poor, as this is commonly associated with obesity. Impaired circulation can be caused by a lack of physical exercise, vasoconstriction caused by hypertension, and the possibility of plaque buildup in hyperlipidemia (Petrie et al., 2018). It is important to recognize these risk factors and the possible implications for the patient’s capability to respond appropriately to prescribed drugs. After that, the patients should be encouraged to reconfigure their diet and lifestyle patterns, particularly transform to DASH diet.

Drug Therapy

AO’s medication strategy might be improved in several ways. For example, beta-blockers have been linked to hyperlipidemia. Furthermore, beta-blockers are rarely utilized as first-line therapy for hypertension (Stapff & Hilderbrand, 2019). Keeping this in mind, the second-generation beta-1 selective adrenergic blocker atenolol must be phased out. As atenolol is being phased out, hydralazine, an arterial vasodilator, must also be discontinued because it is not first line in treatment of essential hypertension.  Since diuretics, more specifically, thiazides are the first-line prescription for hypertension, a regular dose of 12.5 mg of hydrochlorothiazide must be started. Thiazide diuretics are deemed safe in diabetes with lower heart disease and stroke incidence (Burnier et al., 2019). While thiazide diuretics are typically safe and effective, the patient must be given the lowest possible dose. Although this patient is not a confirmed diabetic, they have multiple possible risk factors for the illness. There is a very strong likelihood that the patient has diabetes or will develop it soon.

Statins for instance Simvastatin, are fantastic choice for dyslipidemia; specific drug selection is influenced by cholesterol levels, which I was not clear in this case (Chen et al., 2018). Doxazosin, an alpha-1 blocker, routinely used to treat hypertension and benign prostatic hyperplasia. Its side effects included drowsiness, and depression, which I assume were counteracted by sertraline. Doxazosin should be discontinued for safer medications due to weight gain and other potential side effects.

 

References

Babu, G. R., Murthy, G. V. S., Ana, Y., Patel, P., Deepa, R., Neelon, S. E. B., … & Reddy, K. S. (2018). Association of obesity with hypertension and type 2 diabetes mellitus in India: A meta-analysis of observational studies. World journal of diabetes, 9(1), 40.

Burnier, M., Bakris, G., & Williams, B. (2019). Redefining diuretics use in hypertension: why select a thiazide-like diuretic? Journal of hypertension, 37(8), 1574.

Chen, Y. A., Lin, Y. J., Lin, C. L., Lin, H. J., Wu, H. S., Hsu, H. Y., … & Kao, C. H. (2018). Simvastatin therapy for drug repositioning to reduce the risk of prostate cancer mortality in patients with hyperlipidemia. Frontiers in pharmacology, 9, 225.

Hossain, M. A., Amin, A., Paul, A., Qaisar, H., Akula, M., Amirpour, A., … & Asif, A. (2018). Recognizing obesity in adult hospitalized patients: a retrospective cohort study assessing rates of documentation and prevalence of obesity. Journal of clinical medicine, 7(8), 203.

Stapff, Manfred, and Sarah Hilderbrand. “First‐line treatment of essential hypertension: A real‐world analysis across four antihypertensive treatment classes.” The Journal of Clinical Hypertension 21.5 (2019): 627-634.