NURS 6521 Week 2 EmmaGarcia Pharmacotherapy For Cardiovascular Disorders Example
Pharmacotherapy For Cardiovascular Disorders Sample 1
Pharmacokinetic and Pharmacodynamic Processes
The selected factor, genetics, can significantly influence the pharmacokinetic and pharmacodynamic processes in the patient from the provided case study. Starting with pharmacokinetics, genetic variations can impact drug metabolism, absorption, distribution, and elimination. For instance, in this case, the patient’s genetic variations in the CYP2C9 gene can influence the metabolism of warfarin. Reduced enzymatic activity due to specific genetic variants can lead to slower warfarin metabolism, resulting in higher blood levels of the drug. This can increase the risk of bleeding and necessitate lower initial doses of warfarin. Genetics also influence drug transporters (Rosenthal & Burchum, 2021).
The patient’s genetic variations in the ABCB1 gene, encoding P-glycoprotein, can affect the function of this transporter. Reduced P-glycoprotein activity due to genetic variants can lead to higher concentrations of digoxin, a medication transported by P-gp, in the body. This elevated concentration increases the risk of digoxin toxicity and may require lower initial doses of digoxin in patients with such genetic variations (Wojtyniak et al., 2021).
In terms of pharmacodynamics, genetic variants might affect the targets and receptors of drugs. In this case, the patient’s genetic polymorphisms in the ADRB1 gene, coding for beta-1 adrenergic receptors, may impact the sensitivity of these receptors to metoprolol, a beta-blocker (Rosenthal & Burchum, 2021). Specific genetic variants can alter the response to metoprolol, potentially requiring different doses or alternative medications to achieve the desired heart rate control in atrial fibrillation.
Changes
Changes in the pharmacokinetics and pharmacodynamics processes can profoundly impact the recommended drug therapy for the patient described in the case study. One notable area where these changes can influence treatment is drug metabolism. For instance, the patient is prescribed warfarin, an anticoagulant primarily metabolized by the cytochrome P450 enzyme CYP2C9. However, genetic variations in the CYP2C9 gene can alter warfarin’s metabolism rates (Rosenthal & Burchum, 2021).
Patients with specific genetic variants, such as CYP2C92 or CYP2C93, may exhibit reduced enzymatic activity, leading to slower metabolism of warfarin. As a result, their blood levels of warfarin may increase, putting them at a higher risk of bleeding. In such cases, the recommended drug therapy may involve starting with lower initial doses of warfarin and closely monitoring the patient’s International Normalized Ratio (INR) to ensure appropriate anticoagulation.
Additionally, changes in drug transporters can affect drug absorption and distribution. The patient is taking digoxin, a medication transported by the P-glycoprotein (P-gp) transporter. Genetic variations in the ABCB1 gene, which encodes P-gp, can impact its function. Some individuals may have genetic variants that result in reduced P-gp activity, leading to higher concentrations of digoxin in the body. This increased concentration raises the risk of digoxin toxicity. To address this, the recommended drug therapy for patients with such genetic variations may involve starting with lower initial doses of digoxin and monitoring serum digoxin levels to avoid adverse effects.
Furthermore, genetic variations in drug targets can impact drug response. The patient has atrial fibrillation (A.F.) and is prescribed metoprolol, a beta-blocker, to manage her heart rate. However, genetic polymorphisms in the ADRB1 gene, which codes for beta-1 adrenergic receptors, can affect the sensitivity of these receptors to medications like metoprolol (Hirota et al., 2020). Individuals with specific ADRB1 variants may require different doses or alternative medications to achieve the desired heart rate control in A.F.
Improving the Patient’s Drug Therapy Plan
Based on the provided case study, several recommended improvements can be made to improve the patient’s drug therapy plan. Firstly, conducting a comprehensive medication review would be beneficial considering the patient’s age, the potential for polypharmacy, and the presence of delirium. This review would assess the appropriateness of each medication, evaluate potential drug interactions, and identify any medications that may contribute to or exacerbate the patient’s delirium (Wojtyniak et al., 2021). Considering the patient’s altered level of consciousness, an alternative oral anticoagulant, such as a direct oral anticoagulant (DOAC), could be considered instead of warfarin. DOACs have a more predictable pharmacokinetic profile, fewer interactions, require less monitoring, and have a lower risk of major bleeding.
Adjusting the dose or considering an alternative medication with a more favorable cardiovascular profile may be necessary to manage the patient’s low blood pressure and heart rate while still effectively controlling her heart rate. Lastly, dosage adjustments for medications undergoing renal elimination, such as digoxin, should be considered due to the patient’s chronic kidney disease (CKD).
Close monitoring of renal function and drug levels can help ensure appropriate dosing to minimize the risk of drug toxicity (Wojtyniak et al., 2021). These recommended improvements aim to enhance safety, effectiveness, and patient outcomes. Conducting a medication review, considering alternative anticoagulants, adjusting cardiovascular medications, and accounting for CKD-related dosage adjustments can optimize the medication regimen to better suit the patient’s needs, minimize adverse effects, and improve overall therapeutic outcomes.
Conclusion
Improving the patient’s drug therapy plan based on the case study involves conducting a medication review, considering alternative anticoagulants, adjusting cardiovascular medications, and accounting for CKD-related dosage adjustments. These recommendations are crucial to enhance safety, effectiveness, and overall patient outcomes. Conducting a comprehensive medication review ensures the appropriateness of each medication and minimizes the risk of adverse effects.
Considering alternative anticoagulants like DOACs can provide a more predictable pharmacokinetic profile and lower bleeding risk. Adjusting cardiovascular medications helps manage the patient’s low blood pressure and heart rate more effectively. Dosage adjustments for drugs undergoing renal elimination account for the patient’s CKD, minimizing the risk of drug toxicity. By implementing these improvements, healthcare providers can optimize the patient’s drug therapy plan, tailor it to her specific needs, and improve her treatment’s overall quality and safety.
References
Hirota, T., Fujita, Y., & Ieiri, I. (2020). An updated review of pharmacokinetic drug interactions and pharmacogenetics of statins. Expert Opinion on Drug Metabolism & Toxicology, 16(9), 809-822. https://doi.org/10.1080/17425255.2020.1801634
Rosenthal, L., & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). S.L.: Saunders.
Wojtyniak, J. G., Selzer, D., Schwab, M., & Lehr, T. (2021). Physiologically based precision dosing approach for drug‐drug‐gene interactions: A simvastatin network analysis. Clinical Pharmacology & Therapeutics, 109(1), 201-211. https://doi.org/10.1002/cpt.2111
Module 2: Cardiovascular and Respiratory Systems
MODULE 2: AT A GLANCE
CARDIOVASCULAR AND RESPIRATORY SYSTEMS
WEEK 2
WEEK 3
WHAT’S HAPPENING 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.
INTRODUCTION
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
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
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
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-20293632Links to an external site.). All papers submitted must use this formatting.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK2Assgn_LastName_Firstinitial
- Then, click on Start Assignmentnear the top of the page.
- Next, click on Upload Fileand select Submit Assignment for review.
NURS_6521_Week2_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeExplain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
25 to >22.5 pts
Excellent
The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.
22.5 to >19.75 pts
Good
The response provides a basic explanation of how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.
19.75 to >17.25 pts
Fair
The response inaccurately or vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.
17.25 to >0 pts
Poor
The response inaccurately and vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient, or is missing.
25 pts
This criterion is linked to a Learning OutcomeDescribe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
30 to >26.7 pts
Excellent
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.
26.7 to >23.7 pts
Good
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.
23.7 to >20.7 pts
Fair
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.
20.7 to >0 pts
Poor
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.
30 pts
This criterion is linked to a Learning OutcomeExplain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements.
30 to >26.7 pts
Excellent
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.
26.7 to >23.7 pts
Good
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.
23.7 to >20.7 pts
Fair
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.
20.7 to >0 pts
Poor
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.
30 pts
This criterion is linked to a Learning OutcomeWritten 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 to >4.45 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4.45 to >3.95 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.95 to >3.45 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
3.45 to >0 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.45 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors
4.45 to >3.95 pts
Good
Contains a few (1–2) grammar, spelling, and punctuation errors
3.95 to >3.45 pts
Fair
Contains several (3–4) grammar, spelling, and punctuation errors
3.45 to >0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
This criterion is linked to a Learning OutcomeWritten 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 to >4.45 pts
Excellent
Uses correct APA format with no errors
4.45 to >3.95 pts
Good
Contains a few (1–2) APA format errors
3.95 to >3.45 pts
Fair
Contains several (3–4) APA format errors
3.45 to >0 pts
Poor
Contains many (≥ 5) APA format errors
5 pts
Total Points: 100
LEARNING RESOURCES
- 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)
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)
- Walden University. (n.d.). Instructor feedbackLinks to an external site.. https://cdn-media.waldenu.edu/2dett4d/Walden/WWOW/1001/pulse_check/instructor_feedback/index.html#/
[Music] One of the missions
of this course is to straddle the basic sciences
and the clinical sciences. Many years ago,
Sir William Osler said, “One cannot become
a competent clinician “without the full knowledge
of human physiology “and pathology. “Without it,
one flounders along “in an aimless fashion,
never able to gain “an accurate conception
of disease, “practicing a sort
of popgun pharmacy, “hitting now the malady
and again the patient, he himself
not knowing which.” This week,
Dr. Norbert Myslinski examines how categories of drugs
working through different mechanisms can provide
a synergistic effect creating more treatment options. So often in hospitals
and the doctors’ offices and also in medical schools
and nursing schools and dental schools,
there is this dichotomy between the two. I mean, you first learn
the basic sciences, then you forget about those
and you go to the clinics, I think you learn
the real stuff, but we want to do
with this course is to produce a bridge between the two. And make the understanding
of the clinical portions more relevant by knowing
the basic science– knowing the basic science
that we have. Another way in which groups
are important is synergism. In pharmacology,
we have a concept where the effect
of two different drugs is greater than the sum
of the individual drugs and which is very important
when you combine different drugs and especially when you have
groups of drugs or categories that work via
different mechanisms of action. You may have a same end result
of different categories of drugs, but they work
via different mechanisms. And if you do that,
you’re more likely to get a synergistic effect
than if they all worked via the same mechanism. Some drugs work
via same mechanism no matter what
their effects are, okay? For instance, aspirin. Aspirin has many effects,
all right? Aspirin is an analgesic
that alleviates pain. Aspirin is anti-inflammatory,
alleviates inflammation. Aspirin is an anticoagulant
for the blood. Aspirin also is antipyretic. It decreases
body temperature, okay? But how does it do it? It has many effects. By the way, all drugs
have multiple effects. No drug only has one effect. All drugs have
more than one effect. But how does aspirin do
all these different effects? Via the same mechanism. And that’s
through the inhibition of a certain compound
in the body called prostaglandins. So inhibition of the synthesis
of prostaglandins produces all of them. Okay? There are many different types
of prostaglandins and therefore we have
different effects in there, Okay? So if we have
two different drugs, they work via the inhibition
of prostaglandins. Say, aspirin and Tylenol, right? They’re not going to have
a synergistic effect. They’ll have an additive effect,
right? But if you have, for instance,
a narcotic like morphine, okay? And then you also have Tylenol,
you can have a synergistic effect
with those two. Although with Tylenol
and aspirin, there is a ceiling. You can take
two or three tablets and that’s the maximum
pain relief you’re going to get. No matter if you take five
or 10 after that, you may have gastric distress,
but it’s more of an effect, it’s a ceiling. With morphine though
there is no ceiling. You just keep going,
going, going, you get more
and more pain relief, you know, until your respiration
shuts down and you die. So if we look at hypertension,
that silent killer. That’s one disorder
that we have a wealth of groups and categories of drugs working
via many different mechanisms. So we can have
a very nice synergistic effect. We can tailor-make
their pharmacotherapy, you know, so they can control
their blood pressure with the least amount
of side effects and they can function
in society. For example, you have
your ACE inhibitors, you have
your angiotensin inhibitors, you have your beta-blockers,
you have your calcium-channel blockers,
you have your diuretics, all of them can
reduce blood pressure, all of them work
via different mechanisms. There are two types
of blood vessels that go up, which is the carotids
and the vertebrals and then they go into
a little area here and distributed throughout
the brain and one of the most
common causes of disability that we have is stroke. Now, stroke is when you have
a deprivation of oxygen going to a part of the brain. And that’s usually
due to one of three things. Either there is a buildup
of a clot in that blood vessel, a primary site,
so the blood stops going to that area
or you have a clot that breaks off
from a different part of your body, more likely
from the left side of heart because you may have
atherosclerosis, build up of fatty tissues
and clots there and if one breaks off,
it can go into your brain and to clog a blood vessel,
that will be quick or you can have
a weak blood vessel wall so that it blows up
like a balloon, a balloon is aneurysm
and eventually it bursts and when it bursts
then you have a stroke in that part
of the area of brain. Now, the symptoms of a stroke
on many patients that nurses treat
for chronic time periods, the symptoms of a stroke
can be quite varied. You know, as many functions
that are functions of the brain depending upon
where the stroke is, depending upon
where the stroke is, okay? For instance, if it happens here
at the back of the brain, you’ll have a lot
of visual symptoms because this is where
the brain processes visual information,
occipital lobes. If you have one over here
in the temporal lobes, that process is hearing, okay? So you’d have
hearing problems, okay? If you have a stroke
that affects this part over here,
this is somatosensory cortex, you may have a problem
with the feeling, touch, and pressure
in different parts of your body. Over here is the motor cortex
and that has to do with movement. So you may have problems
with movement of your body. Okay, so it all depends upon
where that injury is and it’s very interesting
because when there is a stroke, the main part dies and then
the other parts around it shut down and unless
treatment is given quickly and drugs can be given that can
dissolve a clot real quickly, okay, the part
that sort of are not dead yet, but they are affected
around there if not treated quickly
then that part may also die. And so when you first
have a stroke your symptoms involve
not only the dead part, but also the part back here
sort of shut down, all right? If you’re treated quickly,
if you have the signs of a stroke you have
what we call a brain attack then you get right there
to the emergency center, you can dissolve the clot,
and then you can have reversal of some of the symptoms. Like dysfunction of all
these ones around, the dysfunctional ones can come
back and we can have reversal of the symptoms, but if you
don’t get the treatment, these will eventually die too
and the others– those symptoms will stay around
for a very long time. And so it all depends upon
where the dysfunction is and that determines
what kind of symptoms we have. Captioning performed by
Aegis Communications