Walden – NURS 6521 Pharmacotherapy for Cardiovascular Disorders

Module 2: Cardiovascular and Respiratory Systems

What’s Happening In This Module?

Module 2: Cardiovascular and Respiratory Systems is a 2-week module, Weeks 2 and 3 of the course. In this module, you will examine how patient factors may influence pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics used in the treatment of cardiovascular and respiratory disorders. You will also explore and suggest drug therapy plans for asthma and analyze the stepwise approach for asthma treatment and management.

Go to the Week’s Content

Week 2: Cardiovascular System

Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. In clinical settings, patients often present with symptoms of several cardiovascular disorders, making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options.

This week, you examine the impact of patient factors that may lead to changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.

Learning Objectives

Students will:

Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes

Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies

Evaluate drug therapy plans for cardiovascular disorders

Learning Resources

Required Readings

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2^nd) 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

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)

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.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
• Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 2 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submitbutton to complete your submission.

 Submit Your Assignment by Day 7 of Week 2

Sample Paper Week 2 Assignment

Walden NURS 6521 Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders

Student’s Name:

Institutional Affiliation:

Explain How the Factor You Selected Might Influence the Pharmacokinetic and Pharmacodynamic Processes

The patient factor I selected is age. It is assumed that the patient is aged because he presents with old age-associated comorbidities like obesity, overweight, hypertension, and hyperlipidemia. The patient is also on five prescription drugs. Research shows that most Americans aged individuals take at least three prescription drugs daily due to multiple age-related comorbidities .the state has significant implications in patient’s pharmacokinetic and pharmacodynamic processes in regards to drug interaction and adverse drug reactions (Van den Anker, Reed, Allegaert & Kearns, 2018).

Aging is accompanied by progressive random changes in the body that influence the pharmacokinetics and pharmacodynamics process. Cardiovascular conditions in elderly individuals cause decreased renal functioning, reduced hepatic blood flow, increased body fat, and reduced muscle mass and total body water, thus affecting distribution, metabolism, and elimination of cardiovascular drugs (Cossart, Cottrell, Campbell, Isbel & Staatz, 2019).

These changes in the elderly include reduced elasticity and a reduction in the intrinsic heart rate, and renal impairment that impairs effective blood flow, thus hindering drug distribution in the body to the target tissues. The gastrointestinal system also changes with age.  Absorption of several substances decreases with age. Decreased organ functionality impairs the secretion of digestive enzymes that facilitate the absorption of drugs in the small intestine. Impaired muscle movement and renal impairment also cause uncontrolled fast movement of food along the duodenum, thus impairing maximum drug absorption.

Advancing age is associated with a progressive reduction in liver volume and liver blood flow. It is also associated with decreased organ functioning like liver and kidney functioning thus impairing drug clearance and facilitating high drug concentration and toxicity.

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

The patient’s current prescription drugs are daily doses of Atenolol, Doxazosin, Hydralazine, Sertraline, and Simvastatin. The patient’s age is a factor in the absorption, distribution, metabolism, and excretion of these drugs.  The patient is on atenolol, a beta-blocker prescribed for r hypertension. The sensitivity to beta-blockers is higher increases with age, leading to increased risk of drug side effects. Therefore, a much lower dose should be used for older adults. The increased sensitivity results in increased absorption, thus increased plasma concentration and leading to increased risk of stroke and heart failure, the significant side effects. The high concentration results in increased kidney functioning to excrete the drug through urine, thus resulting in frequent urination and thirst. The drug, therefore, covers up diabetic symptoms in elderly individuals, which may lead to a late diabetes diagnosis. For this reason, the drug is discouraged in older adults (Wang, Xiang, Chen & Ji, 2019).

The second drug is doxazosin, an alpha-blocker prescribed for hypertension. Older adults are more sensitive to alpha-blockers, leading to increased absorption and high plasma concentration, therefore consequent severe side effects. The concentration is increased by impaired kidney functioning due to old age, which results in decreased drug excretion. The side effects include fainting, dizziness, and kidney failure (Abdi & Campbell, 2018). Co-administration of beta-blockers and alpha-blockers leads to extremely low blood pressure, which caused malfunctioning of blood vessels, due to muscle weakness associated with old age. It consequently impairs drug distribution via blood circulation. This is because they both act as muscle relaxers.

The third prescription is sertraline, prescribed for hyperlipidemia.it side effects include gastrointestinal complications like diarrhea, stomach upset, and intestinal bleeding. Due to the decrease in mucous lining along the digestive system associated with old age, these symptoms are severe in older adults. This consequently results in fast movement of food and impaired absorption of drugs, thus decreasing plasma concentration and drug effectiveness. Co-administration with beta and alpha-blockers increases the bleeding due to consequent muscle relaxation. This hinders transportation of drug to target tissues for metabolism (Chen et al., 2016).

The other prescription is simvastatin, a statin prescribed for high cholesterol levels. It impairs the processing of cholesterol by the liver, thus reducing general liver functioning. Old age is associated with muscle wear out hence consequent organ failure. Therefore, the drug causes faster liver failure in older individuals, leading to the permanent synthesis of body cholesterol. One of its side effects among the elderly is muscle problems. Therefore, if administered with beta and alpha-blockers, it alters the action of muscle relaxation, thus hindering drug distribution through blood circulation (Rosenthal & Burchum, 2018).

Explain How You Might Improve the Patient’s Drug Therapy Plan

First, since co-administration of beta-blockers and alpha-blockers causes’ excessive low blood pressure, and the two types of drugs lead to risk of cardiovascular complications like stroke, the AHA, only recommends prescription of Thiazide Diuretics as a first-line therapy in the treatment of hypertension in the elderly population. This is   because they have been established prevent other cardiovascular conditions like stroke, coronary artery disease and chronic heart failure. I would, therefore, discontinue Atenolol and Doxazosin, and prescribe Thiazide Diuretics; a dose of 12.5 mg of hydrochlorothiazide instead. The low dose helps prevent toxicity caused by high plasma concentration due to old age associated renal function impairment. It is supplemented by non-pharmacological approaches. Hydralazine should also be terminated as well since it should ideally be given with a beta-blocker. Simvastatin dose should be continued as it is the AHA prescribed the first-line drug for hyperlipidemia. However, the dose should be lowered to 40 g to decrease the risk of diabetes, which is one of the side effects of the drug. The reason is that although the patient does not have diabetes, his age puts him at risk of diabetes. Bariatric surgery such as gastric bypass and laparoscopic adjustable gastric banding will be prescribed for treatment, rather than obesity drugs, to prevent drug interaction.

I will also recommend Non- pharmacologic Treatment. AHA recommends that hypertension treatment in the elderly should entail both pharmacological and non-pharmacological approaches to avoid drug interaction, associated with the use of multiple drugs. It involves Lifestyle modification like exercise, Weight control, and Dietary Approaches like consumption of low sodium, sugar, and fat diet.

References

Abdi, E., & Campbell, A. (2018). Urological symptoms and side effects of treatment. In The MASCC Textbook of Cancer Supportive Care and Survivorship (pp. 469-503). Springer, Cham.

Chen, S. T., Narvaez, T. A., Harwood, D. G., Leskin, L. P., Brommelhoff, J. A., Bussel, N., & Sultzer, D. L. (2016). Sertraline for the treatment of depression in vascular cognitive impairment. The American Journal of Geriatric Psychiatry, 24(3), S171-S172.

Cossart, A. R., Cottrell, W. N., Campbell, S. B., Isbel, N. M., & Staatz, C. E. (2019). Characterizing the pharmacokinetics and pharmacodynamics of immunosuppressant medicines and patient outcomes in elderly renal transplant patients. Translational andrology and urology, 8(Suppl 2), S198.

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

Van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58, S10-S25.

Wang, Q., Xiang, B., Chen, S., &Ji, Y. (2019). Efficacy and safety of oral atenolol for the treatment of infantile haemangioma: A systematic review. Australasian Journal of Dermatology, 60(3), 181-185.

What’s Coming Up in Week 3?

Next week, you will examine strategies for the treatment and management of respiratory disorders, including asthma. You will analyze asthma and stepwise management and consider the impact of this approach for patient health.

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