Cardiovascular System
Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. In clinical settings, patients often present with symptoms of several cardiovascular disorders, making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options.
This week, you examine the impact of patient factors that may lead to changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.
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.
ASSIGNMENT
Write a 2- to 3-page paper that addresses the following:
- Explain how the factor you selected (AGE) 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.
Case Study 1
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)
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.
Expert Solution Preview
Introduction:
This paper discusses how age can affect pharmacokinetic and pharmacodynamic processes in patients with cardiovascular disorders such as LM, an 86-year-old female diagnosed with atrial fibrillation, hypertension, chronic kidney disease, osteoarthritis, and gastroesophageal reflux disease, who was admitted to the emergency department with delirium. The paper also describes how changes in these processes may impact the recommended drug therapy and suggests how the patient’s drug therapy plan can be improved based on the pharmacokinetic and pharmacodynamic changes.
1. How Age Might Influence Pharmacokinetic and Pharmacodynamic Processes in LM
Age can influence pharmacokinetic and pharmacodynamic processes in LM, leading to changes in drug metabolism, absorption, distribution, and elimination. Older adults like LM have a reduced hepatic blood flow and metabolic activity, leading to a decreased clearance rate of drugs. Similarly, they have a decreased glomerular filtration rate and renal blood flow, which reduces drug elimination rates. Age-related changes can also affect drug absorption and distribution by reducing gastrointestinal motility, leading to decreased drug absorption rates. Age also affects receptor sensitivity and drug response, leading to altered pharmacodynamic processes.
2. How Changes in Pharmacokinetic and Pharmacodynamic Processes Might Impact the Patient’s Recommended Drug Therapy
Changes in pharmacokinetic and pharmacodynamic processes can impact LM’s recommended drug therapy by altering drug efficacy, safety, and toxicity. The reduced clearance rate of drugs due to decreased metabolic activity and glomerular filtration rate increases drug exposure, leading to increased risk of adverse effects, such as bleeding in LM’s case. Similarly, changes in receptor sensitivity and drug response can lead to altered drug efficacy or even drug resistance, requiring dose adjustments or alternative drug therapy.
3. How to Improve the Patient’s Drug Therapy Plan and Why
Improving the patient’s drug therapy plan requires a comprehensive review of the patient’s medical history, comorbidities, pharmacokinetic and pharmacodynamic changes, and drug interactions. In LM’s case, improving drug therapy would involve discontinuing or adjusting the dose of warfarin, which has a narrow therapeutic range and is associated with increased risk of bleeding in older adults. Instead, LM could receive newer anticoagulants such as dabigatran or apixaban that are safer and are not affected by age-related changes in pharmacokinetics. Additionally, adjusting the dose of digoxin based on LM’s renal function could reduce the risk of toxicity. Ensuring adequate monitoring of LM’s blood pressure and heart rate and educating her on the importance of self-monitoring can prevent further complications. In summary, improving drug therapy in older adults with cardiovascular disorders requires understanding how age influences pharmacokinetic and pharmacodynamic processes and individualizing treatment plans accordingly to improve efficacy, safety, and tolerability.
