Pharmacotherapeutics For Cardiovascular Disorders essay paper
Pharmacotherapeutics For Cardiovascular Disorders essay paper
Case Overview
L.M is an 86 years old female admitted with delirium at the emergency department. She has AFib, hypertension, CKD, osteoarthritis, and GERD. She is currently on digoxin, metoprolol, warfarin, APAP, omeprazole, and multivitamin. She has no known food and drug allergy. On examination, she has altered consciousness. However, she does not have signs of bruising, bleeding, or other injuries. Her blood pressure is 101/58, heart rate 52, co2 CL-99, BUN-33, CR-1.2, glucose-109, INR-3.3, and dig-2.4. Pharmacotherapeutics For Cardiovascular Disorders essay paper
Introduction
Delirium is a reversible cause of mental dysfunction and manifests clinically with a wide range of neuropsychiatry manifestations. It is common in elderly patients who previously had compromised mental status. The patient takes multiple drugs due to multiple diagnoses. aging is a driving factor for multiple diseases that involve the musculoskeletal system, cardiovascular, immune system, and cancers. Causes of age-related disease are physiological changes, cognitive changes, environmental, and psychological changes. Dementia, osteoporosis, and cardiovascular conditions are the most common at the age of 85 years. Therefore, polypharmacy is common to treat all the symptoms. However, age, gender, genetics, ethnicity, and behavior affect the pharmacokinetics and pharmacodynamics of drug therapy.
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Explain How The Factor You Selected Might Influence The Pharmacokinetics And Pharmacodynamic Processes
Age plays is an important factor when considering the phenotypic changes in health and medicine. Age affects the disease progress as well as the mode of action of drugs. Age determines the choice of drug for a patient because of the pharmacokinetics and pharmacodynamics. In addition, contraindication of some drugs in old age due to severe side effects is common. Age is the main factor affecting the pharmacodynamics and pharmacokinetics of this patient due to cardiac structure and function changes, renal system changes, gastrointestinal changes, body composition, and neuroendocrine responses. Age reduces cardiac muscle elasticity thus increasing high blood pressure. There is a decrease in myocardial relaxation and intrinsic heart rate. There is an increase in sino-atrial node conduction time. Gastrointestinal changes include hydrochloric acid secretion, reduced absorption, and alteration of hepatic enzymes (Wilms, et al, 2018). The renal system changes result in decreased glomerular filtration rate and loss of acid-base balance.
Age is associated with a decrease in absorption, first-pass metabolism, and an increase in bio-availability of some drugs due to fat accumulation, increase in total body fluid and decrease in lean body mass (Landry, et al, 2021). For example, water-soluble drugs such as digoxin tend to have a smaller volume of distribution resulting in higher serum levels. Such drugs require dose adjustment in old age to avoid toxicity. There is a reduced absorption rate due to reduced age-related gastric acid secretion and gastric emptying. Old age is associated with the decline of renal function related to cardiovascular disease as established in this patient. Pharmacotherapeutics For Cardiovascular Disorders essay paper
There is a greater trend of pharmacodynamics sensitivity among the elderly in response to cardiovascular drugs. The decrease in response of beta-blockers is due to a decrease in Gs protein interactions hence, the decrease in heart rate and PR interval prolongation (Landry, et al, 2021). However, angiotensin-converting enzyme inhibitors ACE’s has an increase in effect for older adults. Protein binding is old may trigger drug interaction and hence, severe side effects. According to Malik, et al, (2019) there is a greater inhibition of anti-coagulants such as warfarin and vitamin K in old age.
Describe How Changes In The Processes Might Impact The Patient’s Recommended Drug Therapy. Be Specific And Provide Examples.
A patient with cardiovascular disease should be on the follow-up to monitor the progress of the patient as well de-prescribe medication. This patient with diabetes mellitus due to the elevated blood glucose (109), hypertension, and cardiovascular disease needs medicine that controls all the three parameters without increasing the risk of toxicity and excessive interactions. Drugs I would recommend the patient are Sitagliptin 50mg PO once daily for type two diabetes mellitus, Losartan 50mg PO once daily for hypertension, digoxin 0.25 mg for atrial fibrillation and heart rate control, and aspirin 81mg PO once daily for arthritic pain and antiplatelet prophylaxis.
Changing the patient’s prescription reduced a load of drugs making it easier to comply with the medication. In addition, the patient achieves the maximum desired therapeutic effects with fewer side effects. Metoprolol is a Beta-blocker whose effect reduces with old age. Therefore, I will consider changing to a calcium channel blocker such as Amlodipine 5mg whose effect is not affected by old age. I would remove warfarin and replace with aspirin because warfarin has slow absorption rate, distribution, and increased bioavailability in old age thus increasing the risk of toxicity (Malik, et al, 2019). I will consider removing Omeprazole and replace it with antacid because it increases the risk of osteoporosis in old age
Explain How You Might Improve The Patient’s Drug Therapy Plan And Explain Why You Would Make These Recommended Improvements.
According to Watanabe, et al, (2018), the purpose of improving a patient’s drug therapy is to achieve therapeutic effects with no side effects, reduced medical cost, and minimal drug interactions. Therefore, the care provider should understand the patient’s medication-taking behavior, talk about the side effects, assess health literacy, and reduce complexity. The care provider should list the desired objectives before prescribing medicine to the patient. Other factors to consider when changing the therapy plan are the physiological changes that come with age and the adverse effects of drugs. The reason I would make these improvements on this patient is to control blood pressure, blood glucose and improve bradycardia. The cause of bradycardia in the patient is due to metoprolol. I will replace warfarin with aspirin to prevent toxicity. I would replace metoprolol with amlodipine to improve the blood pressure and prevent bradycardia. Pharmacotherapeutics For Cardiovascular Disorders essay paper
Conclusion
Elderly patients’ prescriptions should be written by authorized healthcare providers to avoid medication errors. However, in patients with cardiovascular diseases, the choice of drugs should suit the therapeutic needs. The care provider should also check the drug-drug interactions as well as long-term effects of a drug.
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. 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 pharmacokinetic and pharmacodynamic 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. Pharmacotherapeutics For Cardiovascular Disorders essay paper
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Hello Class, Welcome to week 2. Below is this week’s case study LM is an 86-year-old female admitted to the emergency department with delirium. Her spouse is with her and verifies that LM adheres to the medications she is currently prescribed. She does not self-monitor her BP or heart rate at home. PMH: A Fib diagnosed 1 month ago HTN x 10 years CKD x 5 years Osteoarthritis x 7 years GERD x 20 years Medications: Digoxin 0.25 mg QD Metoprolol XL 25mg QD Warfarin 3 mg QD APAP 650 mg TID Omeprazole 20mg QD Multivitamin QD Allergies: NKDA Social History: Married to husband for 57 years No smoking, alcohol, limited daily exercise (short walks each morning) Family History: None reported Vitals: Labs: Wt 113 lbs Ht 5’4” Na+ 138 K+ 4.0 BP 101/58, HR 52 Cl- 99 CO2 27 BUN 33 Cr 1.2 Gluc 109 INR 3.8 Dig 2.4 PE: Elderly female with altered level of consciousness, no signs of bruising, bleeding, or other injury. 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 pharmacokinetic and pharmacodynamic 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. Pharmacotherapeutics For Cardiovascular Disorders essay paper
