NURS 6521 Week 2 Assignment - Pharmacotherapy for Cardiovascular Disorders

Introduction In this case study I will be focusing on pharmacotherapy on Cardiovascular system. I will be analyzing patient LM which is a 86 year old female that presented to the emergency department with delirium. Patients medical history concludes A Fib that was diagnosed a month ago, hypertension (HTN) of 10 years, CKD of 5 years, Osteoarthritis of 7 years and GERD for 20 years. It is evident by her husband’s words that the patient is not self-monitoring her blood pressure (BP) or heart rate at home but does comply with her medication regimen. Pt is currently taking Digoxin, metoprolol XL, Warfarin, APAP, Omeprazole and multivitamins. It is important for any patient with such poor health history to stay medication compliant and monitor symptoms daily. In this case analysis it is apparent that patient needs adjustment with medication regiment, especially focusing on patients age. The influence of the Age in the Pharmacokinetic and Pharmacodynamic Processes It is very important to keep in mind the age of a patient when prescribing any medication regimen. Age of a patient plays a vital role on pharmacodynamics and pharmacokinetics, therefore the medication needs to be adjusted from time to time in order to decrease the adverse side effects and provide best therapeutic effect for treatment provided. It is stated by the National Institute of Aging, that cardiovascular incidence such as heart attacks and strokes affect mostly people in the age group of 65 years old and older (NIH, 2018). In this age group it is vital to provide patient centered care by understanding the changes of physiology and pharmacology of a patient in order to achieve best health outcomes and prevent any chronic diseases and decrease the risk of them. By personalizing each patients medicine, a provider not only increases the quality and life span of the patient, but also it plays a role on reducing the financial part of healthcare cost (Mathur & Sutton, 2017). Each patients case treatment regimen needs to be individualized. The patient is prescribed anticoagulants and antihypertensive medications which both require close monitoring in order to prevent bleeding, hypotension and bradycardia, especially with patients age. How changes in the processes might impact the patient’s recommended drug therapy Due to the patients age and current medical history it is important to keep in mind that a systemic approach needs to be taken into consideration when planning a change in treatment in order to avoid exacerbation of any other illness, while targeting current symptoms. It is known that metoprolol is metabolized by the CYP2D6 in the liver approximately 70 % to 80 % (Zisaki et al., 2015). With age the liver undergoes many physiological changes which will affect the hepatic clearance of the medication, therefore the metoprolol which is a beta blocker needs to be properly adjusted by keeping in mind patients age in order to decrease the possible adverse side effects. As it is noted that the patient also has a history of CKD of 5 years which affects the renal function and plays major role in the clearance of the medications. Warfarin that a patient is prescribed is an anticoagulant and is excreted by the kidneys, if not monitored closely it can be fatal. Normal International normalized ratio (INR) is between 2-3 and it needs to be close monitored when patient is on warfarin anticoagulation therapy due to increased risk for bleeding in patients older then 70 years old and who have renal failure and hypertension (Blackshear et al, 1996). The patient current level of INR is 3.8 which presents with a risk for bleeding and warfarin anticoagulant dosage needs to be adjusted. Improving the patient's drug therapy plan It is important to make adjustments to patients current medication regimen of anticoagulant in order to avoid risk of stroke that is present in patients with atrial fibrillation. Since patients INR level is slightly elevated a change in warfarin dosage can be decreased and adding on aspirin to the treatment regimen to prevent stroke or bleeding. Turan et al ( 2015) stated that the treatment in patients with AF with warfarin and aspirin combination has been overused among providers in order to prevent any potential cardiovascular accidents such as strokes or myocardial infarctions. The patients current blood pressure is controlled with metoprolol which is a beta blocker and it appears to drop patients hear rate significantly, therefore it can be replaced by an angiotensin-converting enzyme (ACE) inhibitor in order to keep better control of the hypertension and not drop the heart rate. In patients with health history of hypertension and other comorbidities such as diabetes and heart failure, it is evident in the studies that certain antihypertensive medications can increase longevity and reduce morbidity (Turan et al., 2015). Conclusion When analyzing this case it is apparent that patient centered care should be one of the important focuses. When the health care is specifically patient centered it fosters better health outcomes and decreases the adverse side effects of any treatment prescribed. It is very important to have adjustment in medication regimen when following with the patient at follow up appointments. It is vital to keep in mind pharmacodynamics and pharmacokinetics when adjusting patients medications due to comorbidities, medications taken and the physiology of each patient. References: Blackshear JL, Baker VS, Rubino F, Safford R, Lane G, Flipse T, et al. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke prevention in atrial fibrillation III randomised clinical trial. Lancet. 1996;348(9028):633–8.