Wk 2 pharmacology
Assignment: Pharmacotherapy for Cardiovascular
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.
.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.
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.
Sample
Case Study
I chose the first 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 10mg QID
- Sertraline 25g daily
- Simvastatin 80 mg daily
Hyperlipidemia and Hypertension
The American Heart Association (2018) discussed that high blood pressure (HBP) can lead to heart attack, stroke, heart failure, and other serious life threats. Nearly half of U.S. adults have high BP and approximately 45% of people who have HBP do not have it controlled. Hypertension is diagnosed with repeated elevated blood pressure exceeding 140/99 mm Hg (Buzkurt et al., 2016). Age, obesity, and lifestyle are huge factors regarding hypertension. Hypertension increases with age and affects all ethnic groups. Hypertension is classified as primary or essential, secondary or idiopathic (Arcangelo et al., 2017). The goal of treatment of hypertension is to reduce the cardiovascular and renal morbidity and mortality.
Hypertension and Hyperlipidemia go hand and hand because both conditions can be controlled by lifestyle changes and management with medication. Hyperlipidemia is high levels of lipids in the blood and can lead to Coronary Artery Disease. Modifying the patients diet, reducing stress, and encouraging the patient AO to help decrease her blood pressure and the decrease in the number of lipids in her blood. Hypertension and Hyperlipidemia can both be controlled by lifestyle changes including diet changes, stress relief, and daily exercise. If these lifestyle changes are unsuccessful, medication management to reduce HPB and Hyperlipidemia are suggested.
Treatment
Acarangelo et al., (2017) discusses that the first line of treatment of stage 1 hypertention is a thiazide type diuretic. If he desired outcome has not been met with this treatment, a beta blocker, Ace-inhibitor, angiotension receptor II blocker, or a calcium channel blocker. Patient AO is on a beta blocker, Antenolol. Arcangelo et al., (2017) suggests that stage II hypertension should be treated as the same as stage I with the addition of a vasodilator. Patient AO is taking Doxazosin, which treats hypertension but has a bonus effect of relaxing smooth muscles which decreases BP and is associated with a decrease in LDL and cholesterol. Patient AO has recently gained nine pounds, this could be a sign of fluid retention. A diuretic such as Hydrocholorathiazide could be added to the regular regime to help rid the extra fluid. The patient AO should see a reduction in excess fluid with will reduce her weight dramatically. Patient AO is also taking an antidepressant, Sertraline, which will help with stress, which will also help to decrease HBP.
Conclusion
Patient AO is on the right track of medication management of her hypertension, hyperlipidemia, and stress to help reduce both conditions. In my opinion, adding a diuretic will help decrease her sudden weight gain of nine pounds and she will be able to take in consideration lifestyle changes to prolong her life and decrease the chances of her hypertension and hyperlipidemia to cause cardiovascular disease, stroke, or any cause of morbidity related to being obese, hypertensive, and the high content of lipids in her bloodstream.
References
Arcangelo, V. P., Peterson, A M., Wilbur, V., & Reinhold, J. A. (Eds.) (2017) Pharmacotherapeutics for advance practice: A practicle choice (4th ed.)
Amber, PA: Lipincott Williams, & Wilkens, Retrieved from Waldne Univeristy Library Database.
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Bozkurt, B., Aguilar, D., Deswal, A., Dunbar, S. B., Francis, G. S., Horwich, T., … & Rosendorff, C. (2016). Contributory risk and management
of comorbidities of hypertension, obesity, diabetes mellitus, hyperlipidemia, and metabolic syndrome in chronic heart failure: a scientific statement
from the American Heart Association. Circulation, 134(23), e535-e578.
Fulton, B., Wagstaff, A. J., & Sorkin, E. M. (1995). Doxazosin. Drugs, 49(2), 295-320.
Wiysonge, C. S., Bradley, H. A. Volmink, Mayosi B.M& Opie L. H. (207). Beta-blockers were
hypertension (Cochraned databse of sysemtic reviews, (1.) Retrieved form Walden University.
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