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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 pharmacodynamics 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

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.

Write a 3-page paper that addresses the following:

· Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamics 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.  

Case study assigned:

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

· atenolol 12.5 mg daily

· doxazosin 8 mg daily

· hydralazine 10 mg qid

· sertraline 25 mg daily

· simvastatin 80 mg daily

Pharmacotherapy for Cardiovascular Disorders | Case Study 1

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

Atenolol 12.5 mg daily

Doxazosin 8 mg daily

Hydralazine 10 mg qid

Sertraline 25 mg daily

Simvastatin 80 mg daily

explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected.

Patient Factor

The patient factor I selected is behavior factors which focuses on the AO’s obesity. Obesity is a risk factor for hypertension and hyperlipidemia, as well as other conditions such as diabetes that have the potential to complicate treatment for cardiovascular disorders (Arcangelo & Peterson, 2013). Two factors affecting the pharmacokinetics for this patient include poor nutrition and reduced circulation (Arcangelo & Peterson). It is assumed that this patient’s nutrition is poor, as this usually accompanies obesity. Reduced circulation can be affected by limited physical activity, vasoconstriction that accompanies hypertension, and the potential for plaque build-up in hyperlipidemia. Understanding these risk factors as well as the potential effects they may have on the patient’s ability to respond appropriately to a medication regimen and receive therapeutic treatment, the patient should be encouraged to modify his or her diet and exercise habits as well, particularly through recommendation of the DASH diet (Arcangelo & Peterson).

Improving the Drug Therapy Plan

There are several areas for improvement in AO’s drug plan. First, beta-blockers are known to contribute to hyperlipidemia (Arcangelo & Peterson, 2013). Also, beta-blockers are not commonly used as a first-line treatment for hypertension (Arcangelo & Peterson). Understanding this, the atenolol should be discontinued. Because the atenolol is being discontinued, hydralazine should also be discontinued, as it should ideally be given with a beta-blocker and a diuretic (Arcangelo & Peterson). Because the recommended first line of treatment for hypertension is diuretics (Arcangelo & Peterson), a dose of 12.5 mg of hydrochlorothiazide should be initiated daily. This drug was selected because thiazide diuretics are considered safe in diabetics, with a reduction in mortality from heart disease and stroke (Arcangelo & Peterson). The dose was selected because, though they are considered safe and beneficial, diabetics should be administered thiazide diuretics at the lowest possible dose (Arcangelo & Peterson). Though the patient is not a known diabetic, he or she does possess many risk factors for the disease, and it should be considered a very real possibility that the patient either already has or will soon develop diabetes. Simvastatin is an appropriate choice for hyperlipidemia, as the statin drug class is the recommended first-line treatment and individual drug choice is dictated by the cholesterol levels (Arcangelo & Peterson), which I was not provided with.

References

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.