NURS 6521 Week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders Essay

NURS 6521 Week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders Essay

NURS 6521 Week 2 Assignment: Pharmacotherapy for Cardiovascular Disorders Essay

            The patient in the provided case study presents with a history of obesity and recently gained 9 pounds. She was diagnosed with hyperlipidemia and hypertension and is currently taking Atenolol 12.5 mg daily, Doxazosin 8 mg daily, Hydralazine 10 mg twice a day, Sertraline 25 mg daily, Simvastatin 80 mg daily for the management of these conditions. The purpose of this paper is to elaborate on behavioral factors and how they might influence the pharmacokinetic and pharmacodynamic processes in the patient described above, in addition to improving the patient’s drug therapy plan.

Behavioral Factors and their Impact on Pharmacokinetic and Pharmacodynamic Processes

            The patient in the provided case study is obese, with comorbid hyperlipidemia and hypertension. Behavioral factors which contribute to these conditions include physical inactivity and an unhealthy diet. Physical inactivity is associated with reduced blood circulation affecting the pharmacokinetic and pharmacodynamic processes of administered drugs. Pharmacokinetics of drugs comprises mainly of four steps, absorption, distribution, metabolism, and excretion (Glassman & Muzykantov, 2019). Physical inactivity is associated with reduced blood flow affects the prescribed drugs in all these four steps, as the rate of absorption is reduced in the GI tract, distribution of the drugs through the blood will also be reduced hence decreased efficacy (Smit et al., 2018). Physical inactivity can also lead to decreased flow of blood in the liver and deactivation of prescribed drugs with flow-limited (high clearance) hepatic metabolism such as hydralazine. Consequently, Renal plasma flow, urine pH, and urine excretion rate are also reduced by physical inactivity.

            Nevertheless, pharmacodynamics is associated with the response of the body towards the drug administered. Furthermore, physical inactivity and an unhealthy diet decrease the patient’s response towards the administered drug due to reduced bioavailability of the drug and significant impact on the medical condition (Glassman & Muzykantov, 2019). Understanding the associated risk factor like obesity in this case along with potential effects on the patient’s ability to respond to the medication or regimen, there is a need to encourage the patient to modify his lifestyle habits like a healthy diet and taking part in physical exercise.

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Changes in the Pharmacokinetic and Pharmacodynamic Processes

            Behavioral factors such as physical inactivity and an unhealthy diet are associated with several changes in the pharmacokinetic and pharmacodynamic processes. These changes include reduced blood flow, reduced hydration, increased bowel transit time, decreased cardiac output, decreased activity of metabolic enzymes, decreased plasma protein concentration, decreased respiratory rate, decreased skin temperature, and decreased tidal volume (Telessy & Buttar, 2018). These changes in processes can affect the choice of mode of drug administration and regulation of the dosage to avoid toxic levels in the blood or under-dosing the patient. For example, the patient is taking  Sertraline 25 mg daily, which is associated with weight gain. Behavioral factors such as poor diet and physical inactivity will worsen this side effect contributing to more complications associated with obesity. 

Improved Drug Therapy

            The treatment plan for the patient will focus on two main diagnoses hyperlipidemia and hypertension associated with a history of obesity. Statins are recommended for the management of hyperlipidemia. As such, it is necessary to advise the patient to continue taking, Simvastatin 80 mg daily as usual. However, atenolol is usually recommended for the management of hypertension either alone or in combination with a diuretic (Peeters et al., 2019). As such, it will be necessary to discontinue hydralazine and replace it with hydrochlorothiazide 25mg once daily. Doxazosin on the other hand is safer when used with atenolol in patients with blood pressure refractory to atenolol alone. As such the patient should continue taking doxazosin 8 mg daily as prescribed. The patient should however discontinue taking sertraline. Studies show that selective serotonin reuptake inhibitors such as sertraline are associated with increased body weight as a common side effect (Rachdi et al., 2019). Given that the patient is already obese, this drug will only worsen the patient’s condition, hence its risks outweigh its benefits. The patient should also be advised to see a dietician for advice on what to eat and what not to eat to control her body weight. Physical exercise is also necessary to promote breathing, heart rate and reduce body weight.

References

Glassman, P. M., & Muzykantov, V. R. (2019). Pharmacokinetic and pharmacodynamic properties of drug delivery systems. Journal of Pharmacology and Experimental Therapeutics, 370(3), 570-580. https://doi.org/10.1124/jpet.119.257113

Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert opinion on drug metabolism & toxicology, 15(4), 287-297. https://doi.org/10.1080/17425255.2019.1588249

Rachdi, C., Damak, R., Romdhane, F. F., Ouertani, H., & Cheour, M. (2019). Impact of sertraline on weight, waist circumference, and glycemic control: A prospective clinical trial on depressive diabetic type 2 patients. Primary care diabetes, 13(1), 57-62. https://doi.org/10.1016/j.pcd.2018.09.003

Smit, C., De Hoogd, S., Brüggemann, R. J., & Knibbe, C. A. (2018). Obesity and drug pharmacology: a review of the influence of obesity on pharmacokinetic and pharmacodynamic parameters. Expert opinion on drug metabolism & toxicology, 14(3), 275-285. https://doi.org/10.1080/17425255.2018.1440287

Telessy, I. G., & Buttar, H. S. (2018). Obesity-related alterations in pharmacokinetics and pharmacodynamics of drugs: emerging clinical implications in obese patients-part I. Adipobiology, 9, 29-38. DOI:10.14748/adipo.v9.4990

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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.

Photo Credit: Getty Images/Science Photo Library RF
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.
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)

Required Media (click to expand/reduce)

Cardiovascular Disorders
Meet Dr. Norbert Myslinski as he discusses ACE inhibitors, angiotensin inhibitors, beta-blockers, calcium channel blockers, and diuretics as different categories of hypertension drugs. What potential drugs might be best recommended for patients suffering from hypertension? (8m)
Accessible player

Walden University. (n.d.). Instructor feedback. https://cdn-media.waldenu.edu/2dett4d/Walden/WWOW/1001/pulse_check/instructor_feedback/index.html#/

Excellent Good Fair Poor
Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. 23 (23%) – 25 (25%)
The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. 20 (20%) – 22 (22%)
The response provides a basic explanation of how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. 18 (18%) – 19 (19%)
The response inaccurately or vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. 0 (0%) – 17 (17%)
The response inaccurately and vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient, or is missing.
Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. 27 (27%) – 30 (30%)
The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy.

Accurate, complete, and aligned examples are provided to support the response. 24 (24%) – 26 (26%)
The response accurately describes how changes in the processes might impact the patient’s recommended drug therapy.

Accurate examples may be provided to support the response. 21 (21%) – 23 (23%)
The response inaccurately or vaguely describes how changes in the processes might impact the patient’s recommended drug therapy.

Inaccurate or vague examples are provided to support the response. 0 (0%) – 20 (20%)
The response inaccurately and vaguely describes how changes in the processes might impact the patient’s recommended drug therapy, or is missing.

Inaccurate and vague examples may be provided to support the response, or is missing.
Explain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements. 27 (27%) – 30 (30%)
The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan.

The response includes an accurate and detailed explanation to support the recommended improvements. 24 (24%) – 26 (26%)
The response accurately explains how to improve the patient’s drug therapy plan.

The response may include an accurate explanation to support the recommended improvements. 21 (21%) – 23 (23%)
The response inaccurately or vaguely explains how to improve the patient’s drug therapy plan.

The response may include an inaccurate, vague, or misaligned explanation to support the recommended improvements. 0 (0%) – 20 (20%)
The response inaccurately and vaguely explains how to improve the patient’s drug therapy plan, or is missing.

The response may include an inaccurate and vague explanation to support the recommended improvements, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors 4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors 4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors
Total Points: 100
Name: NURS_6521_Week2_Assignment_Rubric