Pharmacotherapeutics For Cardiovascular Disorders essay

Pharmacotherapeutics For Cardiovascular Disorders essay

Pharmacotherapeutics For Cardiovascular Disorders

L.M is an 89-years old female complaining of pain in her leg after walking a short distance across the nursing unit. She is in a long-term care facility and has been experiencing multiple falls resulting in injuries and bruising. The patient has hypertension, Alzheimer’s disease, Hypothyroidism, Osteoarthritis, and Diabetes mellitus. She is currently taking Amlodipine 10 mg QD, Donepezil 10 mg QHS, Levothyroxine 0.88 mg QAM, Celecoxib 200 mg QD, Furosemide 40 mg QAM, Metformin 500mg, 1 BID, and Glyburide 5mg, 1 BID. She has bilateral pitting edema, skin dryness, dark bruising, and skin tear on her right elbow and forearm. She is alert and oriented to person only, the MMSE is 18/30. Her blood pressure is elevated and has a chronic kidney injury because her glomerular filtration rate is 45g/dl, creatinine 1.6, and urea at 42. Pharmacotherapeutics For Cardiovascular Disorders essay

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Pharmacodynamics And Pharmacokinetics

Pharmacodynamics is the physiologic effects of drugs and their mechanism of action in the body consisting of receptor binding, chemical interactions, and post-receptor effects (van den Anker, et al, 2018). Factors affecting pharmacodynamic processes in the body are the body’s physiologic changes like aging, diseases, and drug co-administration. Physiological changes in the body change the receptor binding and decrease the sensitivity of the receptors. Aging alters receptor binding or receptor sensitivity in some drugs, thus, affecting a drug’s efficacy and target occupancy. Pharmacokinetics is the physiologic activity of the drug in the body through absorption, metabolism, distribution, bioavailability, and excretion. Age, gender, diet, environment, body weight, genetics, and drug-to-drug interactions affect these processes.

How Age Affects The Pharmacokinetics And Pharmacodynamics Of A Drug

Aging causes physiological changes in the body that affects drug absorption, metabolism, distribution, and drug bioavailability. Aging reduces the amount of dopa decarboxylase in the gastric, reduces liver mass index, reduces fast pass metabolism, increases water accumulation, increases fact accumulation, and decreases lean tissue. Advancing age reduces the absorption of some drugs and increases some due to reduced gastric secretion and the effects of diseases (Stader, et al, 2021). Metabolism is the process of biochemical transformation of a drug for easier absorption, distribution, and elimination. Aging reduces metabolism due to decreased liver blood flow and mass. Drug distribution depends on body composition. In old age, the patient has a higher water accumulation rate, thus some drug has a smaller volume of distribution. Such drugs are given at lower doses to avoid toxicity.  Age reduces receptor sensitivity and protein binding, this affecting concentration, bioavailability, and plasma half-life. Pharmacodynamic changes are increased or decreased sensitivity of receptors for example in cardiovascular diseases, verapamil has increased sensitivity to thus the negative ionotropic and vasodilator effect. Pharmacotherapeutics For Cardiovascular Disorders essay

Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.

Physiological changes in the body affect drug absorption, metabolism, distribution, and bioavailability. The patient is 89 years and has undergone physiologic body change, has pre-existing medical illnesses, and uses other drugs. The patient is using levothyroxine which is linked with dementia, chronic kidney disease, and congestive heart failure. Advancing age reduces the secretion of gastric juices that prevent gastric corrosion (Dharmarajan, T.S. 2021). Drug interactions may inhibit or improve the action of a drug. According to Sutthapitaksakul, et al, (2021), interaction of donepezil, amlodipine, and celecoxib increases the risk of heart failure and intestinal bleeding.

Explain How You Might Improve The Patient’s Drug Therapy Plan And Explain Why You Would Make These Recommended Improvements.

Change from Levothyroxine to liothyronine to prevent complications. Celecoxib is a non-steroidal anti-inflammatory drug associated with acute kidney injury, electrolyte derangement, and worsening of hypertension and heart failure. I would change to Tylenol, which does not affect the kidney. Amlodipine is a calcium channel blocker whose effect is lower limb swelling. I would change to losartan 50mg to prevent lower limb edema. The patient has moderate to severe dementia due to the MMSE score of 18/30. I will increase the donepezil dosage from 10mg to 23mg.

LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.

PMH:

HTN
Alzheimer’s disease
Hypothyroidism
Osteoarthritis
Diabetes
MEDICATIONS:

Amlodipine 10 mg QD
Donepezil 10 mg QHS
Levothyroxine 0.88 mg QAM
Celecoxib 200 mg QD
Furosemide 40 mg QAM
Metformin 500mg, 1 BID
Glyburide 5mg, 1 BID
ALLERGIES: NKA

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SOCIAL HISTORY:

Widowed with 2 adult children living in town, retired photographer and owner of an art supply store

VITALS: LABS:

Weight: 129 lbs TSH 2.45 Free T4 0.98

Height: 64 inches Na 135, K+ 3.8, Cl 99, CO2 25,

BP: Supine = 177/82 Glucose 101, SCr 0.9, BUN 42

HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1

Plt 255

Cr: 1.6 UA: Clear

eGFR: 45 ml/min

PE:

HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes
CV: RRR
Respiratory: Clear to auscultation bilaterally
Abdomen: Soft, non-tender, no masses or guarding
G/U: Skin intact, assisted with toileting and personal hygiene by staff
Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
Neuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months.
PAIN ASSESSMENT:

Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severe

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. Pharmacotherapeutics For Cardiovascular Disorders essay
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.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting. Pharmacotherapeutics For Cardiovascular Disorders essay.