Pharmacotherapy for Cardiovascular Disorders assignment

Pharmacotherapy for Cardiovascular Disorders assignment

Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy plays a significant role in the management of cardiovascular disorders, especially for the management of the otherwise debilitating symptoms across the whole disease spectrum. In fact, pharmacotherapy presents life-prolonging and life-saving interventions as well as enhancing the quality of life. In essence, pharmacological agents have beneficial effects in managing cardiac disorders. Although the pharmacological agents are welcome, they present a challenge because of the patient’s age. In prescribing and delivering pharmacotherapy, medical personnel must be conversant with the influence of age on pharmacotherapy action to include indications, contraindications, appropriate dosages, and adverse effects (Kaski & Kjeldsen, 2019). Pharmacotherapy for Cardiovascular Disorders assignment

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Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.

The case is of an 86-year-old female who is admitted into the emergency department with delirium. She has been married for 57 years, takes prescribed medications for different conditions, and does not self-monitor her blood pressure or heart rate at home.

The patient is elderly. Age is identified as a factor that influences the pharmacokinetic and pharmacodynamic processes in the patient. Ageing is the progressive accumulation of random changes that lowers an individual’s ability to cope with external stress and limits the average life expectancy to approximately 85 years. It is the sum of cumulative local effects at the tissue, cellular and molecular levels, all structures capable of performing specific physiological activities that characterize the organs. Of particular concern when considering age is consistent time-related loss of functional units. This patient is elderly, and the ageing process produces cardiovascular changes key of which is reduced elasticity and compliance of blood vessels leading out of and into the heart (Farinde & Hebdon, 2019).

Age has an influence on pharmacokinetics. First, it reduces drug absorption from the reduced absorptive capacity of the small intestines, splanchnic blood flow, gastric emptying, and gastric acid secretion. There are age related differences in the absorption rates of different drugs with the absorption of calcium, iron and vitamin B12 being reduced as they go through active transport mechanisms, while the levodopa absorption is increased. Second, it reduces first-pass metabolism and bioavailability. This is due to reduced blood flow and liver mass. Third, it affects drug distribution with polar drugs (water soluble) having higher serum levels in elderly persons, such as cimetidine, theophylline, ethanol, digoxin and gentamiciren. This implies that loading doses of polar drugs must be reduced to accommodate the changes. In contrast, nonpolar drugs (lipid soluble) have lower serum levels in elderly persons, such as chlormethiazole, lignocaine, thiopentone and diazepam. This implies that loading doses of non-polar drugs must be increased. Fourth, it affects drug clearance as elderly persons have reduced organ functions so that the kidney and liver systems clear drugs at a slower rate (Michel et al., 2018).

Age has an influence on pharmacodynamics. In fact, the effect of age on drug sensitivities varies. It makes individuals less sensitive to cardiovascular and respiratory drugs. This is explained by decreased baroreceptor sensitivity, and increased sensitivity to negative inotropic and vasodilator effects. Also, there is reduced β-adrenoceptor function among elderly persons due to reduced influence of reflex cardiovascular effects on healtrt rate rather than reduced β-adrenoceptor sensitivity. Besides that, there is reduced responses for β-adrenoceptor antagonist and β2-adrenoceptor agonist with increase in age among elderly persons (Michel et al., 2018).

Describe how changes in the processes might impact the patient’s recommended drug therapy.

It is clear that advancing age among elderly persons has an influence on drug sensitivity and activity. Ageing is associated with reduced small-bowel surface area, increased gastric pH and slowed gastric emptying, all factors that reduced drug absorption. For drugs absorbed in the small intestines, there is a need to introduced pharmaceutical agents that slow gastrointestinal motility to delay the absorption and onset of actions while reducing pharmacological effects and peak drug concentration. In addition, ageing reduced total body water and increases body fat, thereby increasing the volume of distribution for lipophilic drugs while increasing their elimination half-lives. Besides that, ageing causes decreased renal elimination of drugs. This implies that daily doses of drugs that rely on renal elimination should be reduced or dosing frequency decreased to accommodate the decreased renal elimination (Michel et al., 2018). Pharmacotherapy for Cardiovascular Disorders assignment

Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.                     

The patient is elderly with her age affecting the drug therapy plan. This requires that a stepwise approach be applied to improve the patient’s drug therapy plan. First, the current drug therapy should review to identify and discontinue therapies for indications that no longer exist, add new medication, change drug doses, and substitute drugs with potentially safer agents. The medication review considers whether an age-based change in the status of the patient (such as liver or renal functions) necessitates dosing adjustment, whether the regimen can be simplified, and whether the symptoms reported reflect drug side effects. Second, discontinue unnecessary therapy as determined by care goals for the patient and risk of adverse effects. Third, consider adverse drug events for any new symptoms that the patient presents (Akhtar & Rosenbaum, 2018). Pharmacotherapy for Cardiovascular Disorders assignment

Fourth, consider non-pharmacological interventions. A lifestyle modification may produce results that are comparable to pharmacotherapy, such as reduced sodium intake and weight loss could allow a patient to discontinue taking antihypertensive medication. Fifth, check the use of drugs for toxicity, especially for common drugs, such as prolonged nonsteroidal anti-inflammatory drug (NSAID) use in elderly patients is associated with heart failure, renal impairment and gastrointestinal bleeding. Sixth, reduce drug dosages where possible and only use the minimal dose required to obtain clinical benefit. Seventh, simplify the dosing schedule as greater complexity in the regimen and multiple medication would increase probability of confusion or poor compliance with dosing. Finally, only prescribe beneficial therapy (Akhtar & Rosenbaum, 2018).

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Write a 2- to 3-page paper that addresses the following: Select one the following factors: genetics, gender, ethnicity, age, or behavior factors. 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. Pharmacotherapy for Cardiovascular Disorders assignment

References

Akhtar, S., & Rosenbaum, S. (Eds.) (2018). Principles of Geriatric Critical Care. Cambridge University Press.

Farinde, A., & Hebdon, M. (2019). Pharmacological Considerations in Gerontology: A Patient-Centered Guide for Advanced Practice Registered Nurses and Related Health Professions. Springer Publishing Company.

Kaski, J. C., Kjeldsen, K. P. (2019). Cardiovascular pharmacotherapy: a new ESC Handbook comprehensively addresses pharmacological treatment issues for patients with cardiovascular disease. European Heart Journal – Cardiovascular Pharmacotherapy, 5(4), 185-186. https://doi.org/10.1093/ehjcvp/pvz019

Michel, J-P., Beattie, B. L., Martin, F. C., Walston, J. D. (eds.) (2018). Oxford Textbook of Geriatric Medicine (3rd ed.). Oxford University Press. Pharmacotherapy for Cardiovascular Disorders assignment

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