Pharmacotherapy for Cardiovascular Disorders Paper
Pharmacotherapy for Cardiovascular Disorders Paper
Various factors affect the pharmacotherapeutics for cardiovascular disorders. These factors include age, gender, genetics, ethnicity, and behavior (Peeters et al., 2019). The identified patient factors may impact the pharmacokinetics and pharmacodynamic processes of the drugs used to treat and manage cardiovascular disorders. This essay focuses on the effect of age on a patient’s pharmacokinetic and pharmacodynamic processes, how the processes might impact the patient’s drug therapy, and the improvements that should be made in the drug therapy plan.
The case study involves L.M., an 89-year-old female resident of a long-term care facility who has been experiencing falls, and her ambulation status has declined to wheelchair level. Her past medical history includes hypertension, hypothyroidism, Alzheimer’s disease, osteoarthritis, and diabetes.
The selected patient factor is age. The age of a patient significantly impacts the pharmacokinetic and pharmacodynamic processes. Pharmacokinetics involves the movement of a drug in the body and how it affects it, while pharmacodynamics involves the body’s biological response to the drug. The pharmacokinetic processes involve the absorption, distribution across body parts, metabolism, and excretion of a drug. With the increase in age, the absorption of drugs decreases following decreased bowel surface area, increased gastric PH, and slower gastric emptying (Polaka et al., 2022). The distribution of drugs is also slowed by the increase in body fat and the decrease in body water as a patient ages. Due to low renal elimination, the metabolism and excretion of drugs also reduce with age. The pharmacodynamic processes in older adults also change due to the pathologic changes in organs. Polaka et al.(2022) note that pathologic changes in organs or older adults affect drug-receptor interactions, post-receptor events, and adaptive homeostatic responses.
Furthermore, the pharmacokinetic and pharmacodynamic changes significantly impact the patient’s drug therapy. The current and previous medications included in the patient’s therapy plan are 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. Decreased bowel surface area, increased body fat, and low renal elimination impact these drugs’ absorption, distribution, metabolism, and excretion. Pathologic changes in vital organs that help with pharmacokinetics, such as the intestines, liver, and kidney, affect the absorption and excretion of drugs. For instance, the reduced renal clearance affects the excretion of Gluburide, thus increasing the risk of hyperglycemia. Renal impairment may also affect the excretion of metformin, which is excreted by the kidneys, thus increasing the risk of Lactic acidosis (Schilling, Dingemanse & Ufer,2020).
Improving drug therapy plans for patients whose pharmacodynamic and pharmacokinetic processes have changed is essential in improving the drug’s pharmacological effects and patient outcomes and preventing adverse effects. The patient’s drug therapy plan can be improved by adjusting the doses by titration, discontinuing unnecessary drugs, and avoiding drug-drug/drug-disease interactions. These changes are recommended to improve patient outcomes and prevent adverse effects. According to Bulsara and Cassagnol (2022), Amlodipin in hypertensive geriatric patients should be reduced to 2.5mg QD since it is a low-absorption drug, and lower dosages increase clinical effectiveness in geriatric hypertensive patients. Additionally, a medication such as donepezil may be unnecessary in this case since the patient has a high risk of falls, and one of the medication’s side effects is muscle weakness. However, the medication can be replaced with Rivastigmine, which is equally effective.
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Individual patient factors affecting pharmacodynamics and pharmacokinetics, such as age, should be considered while developing a drug therapy plan. Adjustments should also be made to enhance patient outcomes and clinical effectiveness and prevent adverse reactions. The recommended therapy changes for the patient in this case study are discontinuation of donepezil and titration of Amlodipine.
References
Bulsara K.G. & Cassagnol, M. (2022). Amlodipine. [Updated 2022 Nov 23]. In: StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK519508/
Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opinion on Drug Metabolism & Toxicology, 15(4), 287-297. https://doi.org/10.1080/17425255.2019.1588249
Polaka, S., Tella, J. D., Tekade, M., Sharma, M. C., & Tekade, R. K. (2022). Impact of ageing on the pharmacokinetics and pharmacodynamics of the drugs. In Pharmacokinetics and Toxicokinetic Considerations (pp. 241-261). Academic Press. https://doi.org/10.1016/B978-0-323-98367-9.00008-1
Schilling, U., Dingemanse, J., & Ufer, M. (2020). Pharmacokinetics and pharmacodynamics of approved and investigational P2Y12 receptor antagonists. Clinical Pharmacokinetics, 59(5), 545-566. https://doi.org/10.1007/s40262-020-00864-4
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This week our focus will be on Cardiovascular Disorders, the treatments for them, and how patient factors may influence the pharmacokinetic and pharmacodynamic processes of the drugs that are used to treat these disorders.
Week 2 Assignment – Utilize the following Case Study:
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
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
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NURS_6521_Week2_Assignment_Rubric
| NURS_6521_Week2_Assignment_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning OutcomeExplain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. |
|
25 pts | ||||
| This criterion is linked to a Learning OutcomeDescribe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. |
|
30 pts | ||||
| This criterion is linked to a Learning OutcomeExplain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements. |
|
30 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||
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