NURS 6521 Week 2 Assignment - Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders 2 The pharmacokinetics and pharmacodynamics of medications are influenced by heredity, gender, ethnicity, age, and behavioral factors. Advanced practice registered nurses (APRNs) must consider all these elements that could influence a patient's response to therapy, and treatment should be personalized to the individual's needs. Pharmacotherapy becomes even more difficult for patients with co- morbidities and taking many medications. Before prescribing prescription, primary care physicians (PCPs) and advanced practice registered nurses (APRNs) must assess and consider various contraindications of drugs for patients with multiple conditions such as cardiovascular disorders. In this case study, I'll examine how various patient characteristics influence pharmacokinetics and pharmacodynamics. I'll investigate how the patient's medical history, other medicines, and physiological changes affect their total treatment for cardiovascular problems. Factors such as genetics, gender, ethnicity, age, or behavior can influence the patient's pharmacokinetic and pharmacodynamic processes in the scenario. LM is a long-term care home resident who is 89 years old. She had fallen several times, which might have been caused by a loss of strength, cognitive ability, or physiological processes. Increased oxidative stress, 3 increased lipid peroxidation, telomere shortening, changed gene expression, and activation of apoptosis are all linked to alterations in human organ and body functions, resulting in mitochondrial and nuclear DNA damage (Drenth-van Maanen, Wilting, & Jansen, 2020). The pharmacokinetics and pharmacodynamics of the medications consumed can be affected by all these typical biological changes associated with aging. Patient LM has other associated medical conditions such as hypertension, Alzheimer's disease, hypothyroidism, osteoarthritis, and diabetes. As the patient ages, her body becomes less efficient at metabolizing and excreting medications from her body. The effect of the medicines stays longer in the patient's system, making her at risk for serious side effects. Describe how changes in the processes might impact the patient's recommended drug therapy. Be specific and provide examples. Given the patient's diagnosis of hypertension (HTN), Alzheimer's disease (AD), hypothyroidism, osteoarthritis, and diabetes, it's critical to know all the drugs the patient is taking to avoid any potential drug interactions. The patient has a history of multiple falls, a low GFR, which could indicate kidney disease, and bilateral lower extremity edema with 4 pain, secondary to osteoarthritis, or the swelling, which could be a potential kidney disease or heart failure. This new probable diagnosis should be investigated further to improve treatment and consider current pharmacological therapy when writing future prescriptions. Age-related biological changes may affect a person's sensitivity to pharmaceutical adverse effects. The rate of drug metabolism and excretion slows down. The patient was diagnosed with HTN and prescribed antihypertensive drugs such as amlodipine and furosemide, which put her at risk for low blood pressure and, if not closely managed, could lead to falls due to dizziness and low blood pressure. Because she needs to get up from her bed, wheelchair, and the toilet, furosemide increases her chance of falling if she can get up. Due to the enhanced action of the furosemide and the patient's incontinence, the patient runs the risk of developing a decubitus ulcer. Certain medicines, such as diuretics and thyroid hormones, can reduce the effectiveness of insulin and other antidiabetic treatments. Because these medicines can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and worsening of preexisting diabetes, they may interfere with blood glucose management (Canadian Agency for Drugs and Technologies in Health, 2015). 5 In the study by Akimoto, Oshima, Wakiyama, Okita, Horii, Inoue, Ohshima, and Kobayashi (2020), the authors cited that glyburide was associated with a higher risk of AD. Multiple reports included in the study have shown that the use of sulfonylureas which provides less favorable glycemic control than other antidiabetic drugs like metformin. The Beers Criteria of the American Geriatrics Society recommends that glyburide be avoided in the elderly because of the potential dangers, including hypoglycemia consequences such as altered mental status, seizures, coma, and death (Canadian Agency for Drugs and Technologies in Health, 2015). Patients with Alzheimer's disease have been discovered to have increased insulin resistance in numerous areas of the brain, including the cerebellar cortex and hippocampus, regardless of whether they have diabetes. Explain how you might improve the patient's drug therapy plan and why you would make these recommended improvements. The first line of defense against high blood pressure has always been lifestyle changes such as exercise and diet. This is not the case with frail old folks. The patient in this case study has hypertension as well as diabetes, osteoarthritis, Alzheimer's disease, and hypothyroidism. The goal for this patient is to reduce the medication burden by gradually 6 reducing the number of medications prescribed, coordinating the treatment plan with other physicians and healthcare providers involved in the patient's care, and researching the advantages and risks of polypharmacy. Patients with diabetes mellitus, a high risk of coronary artery disease, and those with salt-sensitive hypertension, such as blacks and the elderly, all benefit from calcium channel blockers (Dickerson, Pharm, Gibson, 2005). Moreover, when a patient is on diuretics, they should be closely watched for hypotension, electrolyte imbalances, and renal abnormalities. When on this therapy, the risk of falling should be recognized. Metformin may be a preferable alternative for the patient, which does not produce low blood sugar levels. The dosage of levothyroxine could be increased. The patient takes 0.88 mg of levothyroxine per day, which may be insufficient to maintain normal thyroid hormone levels. The patient's energy levels, and overall health could be improved by increasing the daily dosage to 1.12 mg. Elderly people, especially those with dementia, tend to forget about taking their medications. Family members should be involved in goal setting, and therapy plans should include cultural beliefs and previous experiences (Dickerson, Pharm, Gibson, 2005).