Question
Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders: Due Day 7 Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). In addition, 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 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 of 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 patient’s pharmacokinetics and pharmacodynamic processes 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. 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) Excellent Good Fair Poor Explain how the factor you selected might influence the patient’s pharmacokinetics and pharmacodynamic processes from the case study you were assigned. 23 (23%) – 25 (25%) The response accurately and completely explains 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 patient’s pharmacokinetics and pharmacodynamic processes. 18 (18%) – 19 (19%) The response inaccurately or vaguely explains how the factor selected might influence the patient’s pharmacokinetics and pharmacodynamic processes. 0 (0%) – 17 (17%) The response inaccurately and vaguely explains how the factor selected might influence the patient’s pharmacokinetics and pharmacodynamic processes 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 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 are 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 the 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 the 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
Answer
Pharmacology Introduction
The rising number of patients diagnosed with multiple chronic illnesses is continuously becoming a major health and medical challenge in the world. There are several combined factors that such as age, genetic predisposition, ethnicity, comorbidities, and other corresponding factors. These conditions are known to last for a year or more and require advanced medical attention such as the multidisciplinary approach to ascertain an effective approach to achieving optimal health (Thürmann, P. A. (2020). Patients with multiple chronic illnesses require active participation in treatment, prevention, and promotional health activities to reduce the risk of severe health outcomes.
Case scenario
This paper presents the case of an HM who has been diagnosed with hypertension, type 2 diabetes mellitus, hyperlipidemia, and ischemic heart disease. The patient has a history of atrial fibrillation, and a transient ischemic attack (TIA). HM was prescribed 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, and Motrin 200 mg 1–3 tablets every 6 hours.
Pharmacology Effects of age on patient pharmacokinetic and pharmacodynamics
Pharmacokinetic
Advancing age affects pharmacokinetics and pharmacodynamics in several ways. Patients with advanced age have changes in the renal, hepatic, respiratory, and gastrointestinal systems. There is a significant reduction in lean body mass and total body water with the corresponding increase in body fat. The process of drug absorption, first-pass metabolism and bioavailability, drug distribution, and drug clearance are affected in different ways. For instance, older patients are likely to have a slower absorption similar to the liver that has a reduced first-pass mechanism caused by decreasing blood vessels and lower mass (Rosenthal & Burchum 2021). The use of calcium and vitamin B12 and iron is likely to experience a reduced absorption rate in the body. The use of labetalol and propranolol is likely to increase in circulation due to increased release into the circulatory system.
Renal and hepatic systems perform a significant role in drug clearance. In advancing age, glomerular filtration rates reduce hence reducing the clearance of the drug. Hepatic capacity continually reduces hence reducing drug clearance from the body. The use of lithium, NSAIDS, glyceryl nitrate, lignocaine, pethidine, and propranolol, aminoglycosides, morphine, warfarin, and phenytoin are likely to take longer in the body in older adults (Rosenthal & Burchum 2021). HM is on warfarin and is at risk of prolonged half-life hence predisposing the patient to excessive bleeding from trauma, open wound, and or surgical wounds.
Pharmacodynamics
The pharmacodynamics of drugs in older patients usually depends on drug properties such as concentration. It then becomes hard to make generalizations about general songs. Patients will experience different sets of bodily responses to each drug. For instance, patients on diazepam, diltiazem, morphine, temazepam, and verapamil have a higher sensitivity to these drugs. Therefore, older patients initiated on these medications are likely to have prolonged therapeutic effects on the body. For instance, HM is on warfarin which is likely to stimulate sensitivity in the body due to advancing age. therefore, the body will respond by greatly inhibiting the synthesis of vitamin K-dependent clotting with plasma concentration similar to younger patients (Peeters, et al, 2019). As such the prescriber may consider an averagely low dose of warfarin or prescribing an alternative drug that does not excite similar sensitivity to the body.
References
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.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anesthesiology, 33(1), 109-113.