Pharmacotherapy for Cardiovascular Disorders
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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
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 on or before Day 3 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.
Read a selection of your colleagues’ responses.
Respond on or before Day 6 to at least two of your colleagues on two different days who selected a different case study than you did, in one or more of the following ways:
SAMPLE ANSWER
Pharmacotherapy for Cardiovascular Disorders
HM client is diagnosed with hypertension, atrial fibrillation and TIA. This puts the patient at risk of developing stroke. There are various aspects which should be put into consideration during the decision making process. These include age, gender, genetics, and ethnic group. This article selects age as the key factor. Age causes modification in the metabolism process of the drug and the elimination process. This is due to altered body pH, water content level, and hepatic metabolism. This interferes with the patient’s ability to clear drugs; which results to toxicity and exacerbation of the disease (Kaufman, 2013).
Warfarin 5mg po daily and 2.5mg in an alternating pattern is appropriate. The patient INR must be monitored to guide the dosage. This dosage is most appropriate to cover thrombo-embolic stroke associated with atrial fibrillation. Aspirin 81mg dosage is high putting into consideration that the patient had previously suffered from TIA, and could result to bleeding. In this case, Plavix 75mg (clopiogrel) could be used instead. Glyburide 10mg could interact with warfarin and could lead to hypoglycemia. Therefore, the patient should be monitored closely. Metformin dosage is appropriate to maintain the right blood sugar level. Atenolol 100mg (beta blocker) is normally discouraged for use in diabetic patients, and thus the patient should be changed to ACE inhibitor such as Lisinopril 5mg daily. If pain reduces, discontinue Motrin 200mg (Arcangelo & Peterson, 2013).
The most important aspect is to empower the patient. This is through patient education on ways to control blood sugar levels, hypertension and cholesterol. The patient would be advised warning signs of stroke so as to seek medication as soon as possible. Patients should also be advised of lifestyle modification process (Kaufman, 2013).
Reference list
Arcangelo, V. P., & Peterson, A. M. (2013). Pharmacotherapeutics for advanced practice: A practical approach. Philadelphia, PA: Lippincott Williams & Wilkins
Kaufman, G. (2013). Prescribing and medicines management in older people. Nursing Older People, 25(7), 33-41. https://www.doi:10.7748/nop2013.09.25.7.33.e441
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