NSG 6005 Advanced Pharmacology FL02 Week 5 Discussion 1 Completed A

NSG 6005 Advanced Pharmacology FL02 Week 5 Discussion 1 For Mr. EBR's current treatment plan, I would add Nitro-glycerine. A common symptom of CAD is chest pain. Nitroglycerin, which is a type of nitrate, dilates blood vessels and allows the heart to pump blood with less effort. These actions help relieve chest pain. I would not discontinue any of Mr. EBR's medication. I would continue metformin since it's both effective is CAD and Diabetes. Since Mr. EBR has diabetes, his medications should be thoroughly screened. The prevalence of type 2 diabetes has been increasing rapidly throughout the world during the past decades. Since cardiovascular disease is the major complication of type 2 diabetes and cardiovascular mortality accounts for the majority of diabetic patient deaths, there should be strategies for blood glucose control in type 2 diabetic patients to reduce cardiovascular risk and mortality. Therefore treatment with metformin will substantially reduce major cardiovascular events. Results indicated that a potential benefit of metformin therapy on cardiovascular outcomes in high-risk patients (Woo, 2015). Stage 3 chronic kidney disease coupled with the other diagnoses that Mr. EBR should be taken into consideration. As an NP, I would want to ensure that these drugs ease the secretion of insulin and are related to increased risk of hypoglycaemia, which is a major issue for CAD patients (Woo, 2015). Combination therapy of hypertension with separate agents or a fixed-dose combination pill offers the potential to lower blood pressure more quickly, obtain target blood pressure, and decrease adverse effects. Antihypertensive agents from different classes may offset adverse reactions from each other, such as a diuretic decreasing edema occurring secondary to treatment with a calcium channel blocker. Most patients with hypertension require more than a single antihypertensive agent, particularly if they have comorbid conditions (Woo, 2015). It is beneficial to prescribe aspirin therapy in this patient. Since Everyone's blood has a tendency to form clots, the aspirin would be needed to stop the blood clots bleeding that may start, such as from a cut or a stomach ulcer. On the other hand, if clots form too easily, they can plug up an artery, causing a heart attack or the most common kind of stroke. Aspirin works to lower the risk of heart attack and stroke because it reduces the tendency of blood to clot (Woo, 2015). Reference Woo, T. M. (08/2015). Pharmacotherapeutics for Advanced Practice Nurse Prescribers with Davis Plus Resources, 4th Edition. [South University]. Retrieved from Discussion 2 The three classes of drugs affecting the Hematopoietic System are: Heparin, Warfarin, and Rivaroxaban. Administered heparin binds reversibly to ATIII and leads to almost instantaneous inactivation of factors IIa and Xa The heparin-ATIII complex can also inactivate factors IX, XI, XII, and plasmin. The mechanism of action of heparin is ATIII-dependent. It acts mainly by accelerating the rate of the neutralization of certain activated coagulation factors by antithrombin, but other mechanisms may also be involved. The antithrombotic effect of heparin is well correlated to the inhibition of factor Xa. Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics (Woo, 2015). Warfarin inhibits vitamin K reductase, resulting in depletion of the reduced form of vitamin K (vitamin KH2). As vitamin K is a cofactor for the carboxylation of glutamate residues on the N-terminal regions of vitamin K-dependent proteins, this limits the gamma-carboxylation and subsequent activation of the vitamin K-dependent coagulant proteins. The synthesis of vitamin K-dependent coagulation factors II, VII, IX, and X, and anticoagulant proteins C and S is inhibited. Depression of three of the four vitamin K-dependent coagulation factors II, VII, and X results in decreased prothrombin levels and a decrease in the amount of thrombin generated and bound to fibrin. This reduces the thrombogenicity of clots (Woo, 2015). Rivaroxaban competitively inhibits free and clot-bound factor Xa. Factor Xa is needed to activate prothrombin factor II to thrombin factor IIa. Thrombin is a serine protease that is required to activate fibrinogen to fibrin, which is the loose meshwork that completes the clotting process. Since one molecule of factor Xa can generate more than 1000 molecules of thrombin, selective inhibitors of factor Xa are profoundly useful in terminating the amplification of thrombin generation. The action of rivaroxaban is irreversible (Woo, 2015). Warfarin is used in treating patients with deep vein thrombosis (DVT) to prevent extension of the clot, and to reduce the risk of pulmonary embolism. Patients with pulmonary embolism are treated with warfarin to prevent further emboli. Additionally, warfarin also is used in patients with atrial fibrillation or artificial heart valves to reduce the risk of strokes, and after a heart attack (Woo, 2015). Warfarin may be taken with or without food. Since warfarin is metabolized (inactivated) by the liver and then excreted by the kidneys, dosages need to be lowered in patients with liver and kidney dysfunction. Frequent blood tests (INR test) are performed to measure the effect of warfarin and to adjust dosing. Consequently, treatment usually is started at 2 to 5 mg once daily and the dose is adjusted based on INR tests and patients typically require 2 to 10 mg of warfarin daily (Woo, 2015). Reference Woo, T. M. (08/2015). Pharmacotherapeutics for Advanced Practice Nurse Prescribers with DavisPlus Resources, 4th Edition. [South University]. Retrieved from