NURS 6521: Advanced Pharmacology
Week 2: 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.
Learning Objectives
Students will:
Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes
Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies
Evaluate drug therapy plans for cardiovascular disorders
Learning Resources
Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
Assignment: Pharmacotherapy for Cardiovascular Disorders
…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…
—Murphy et al., 2018
Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.
Photo Credit: Getty Images/Science Photo Library RF
As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.
Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm
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.
Pharmacokinetic and Pharmacodynamic
Name
Academic Institution
Pharmacokinetic and Pharmacodynamics
The selected patient factor is aging which has a major effect on the pharmacokinetics and pharmacodynamics process of drugs. Pharmacokinetic what the body does to the drugs including excretion, absorption, metabolism, and distribution (Bell, 2019). Aging affects metabolism and excretion of some drugs thus requiring clinicians to decrease the dosage. If the dosage is not decreased poor metabolism and excretion cause toxicity in the body which can complicate the health condition of a patient. Renal elimination also decreases with age making it crucial for clinicians to consider the drugs they prescribe to aging patients (Bell, 2019). Additionally, cardiovascular response sensitivity of carotid sinus baroreceptors is decreased in aging patients (Peltoniemi, Hagelberg, Olkkola & Saari, 2016). On the other hand, pharmacodynamics is the effect of a drug on the body. Aging affects physiological functions of the body thus affecting the effect of the drug. It is thus necessary to avoid specific drugs since they can have severe effects on elderly patients. Clinicians should take a comprehensive assessment of a patient before prescribing any drug.
The changes in pharmacodynamics and pharmacokinetics have a major impact on the recommended drugs. The reason is that the aging patient is required to take medication that will not cause complications that may increase the risk of death in a patient (Peltoniemi, Hagelberg, Olkkola & Saari, 2016). For example, clinicians have identified Herceptin as one of the drugs that can cause toxicity if used in elderly patients to treat cardiac problems. The drugs are known to increase risk of breast cancer. Another example is anticholinergic which increases the risk of dementia in elderly patients. It is thus necessary for clinicians to carry out a comprehensive assessment of a patient before prescribing drugs (Peltoniemi, Hagelberg, Olkkola & Saari, 2016). The reason is that drug interactions with the body may cause toxicity and increase the risk of death. Clinicians should also consider some mild side effects of cardiovascular drugs such as excessive bleeding, nausea, ingestion, stomach pain, headache and diarrhea (Graham et al., 2017). The considerations will ensure the recommended drugs are effective in the treatment of cardiovascular conditions among patients. Renal elimination decreases with age, so clinicians must take into account the drugs they prescribe to aging patients (Bell, 2019). Furthermore, the cardiovascular response sensitivity of carotid sinus baroreceptors decreases with age (Peltoniemi, Hagelberg, Olkkola & Saari, 2016). Pharmacodynamics, on the other hand, is the effect of a drug on the body. Aging affects physiological functions of the body, which affects the drug’s effect. As a result, specific drugs must be avoided because they can have serious consequences for elderly patients. Before prescribing any medication, clinicians should conduct a thorough Assessment of the patient.
The drug therapy of an elderly patient should be improved to avoid toxicity. One of the changes that should be made to the drug prescription is to reduce the dosage to avoid the accumulation of the drug due to poor distribution, renal elimination and excretion (Graham et al., 2017). On the other hand, it is important to consider drug interactions and the condition of the body. If the patient is suffering from other cardiovascular-related problems such as high blood pressure it is important to consider the interaction can have negative effects (Lainscak et al., 2016). For example, warfarin is one of the drugs that is associated with hospitalization of elderly patients due to the side effects.
The recommended improvements will be made since the elderly patient has weak organs that are critical in distribution, absorption of drugs. For example, the critical organs that experience reduced functionality with aging are kidney and liver (Lainscak et al., 2016). The two are critical in pharmacodynamics and pharmacokinetics of drugs. Therefore, elderly patients who are suffering from cardiovascular diseases should be careful about the medication to take (Graham et al., 2017). Clinicians should make appropriate assessments to avoid toxicity in a patient. Patients should also reveal the other drugs they have been taking in the past to avoid any drug toxicity.
References
Bell, W. R. (2019). Therapeutic agents—pharmacokinetics and pharmacodynamics. Reviews in Cardiovascular Medicine, 3(S2), 34-44.
Graham, M. J., Lee, R. G., Brandt, T. A., Tai, L. J., Fu, W., Peralta, R., … & Baker, B. F. (2017). Cardiovascular and metabolic effects of ANGPTL3 antisense oligonucleotides. New England Journal of Medicine, 377(3), 222-232.
Lainscak, M., Vitale, C., Seferovic, P., Spoletini, I., Trobec, K. C., & Rosano, G. M. (2016). Pharmacokinetics and pharmacodynamics of cardiovascular drugs in chronic heart failure. International Journal of Cardiology, 224, 191-198.
Peltoniemi, M. A., Hagelberg, N. M., Olkkola, K. T., & Saari, T. I. (2016). Ketamine: a review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy. Clinical Pharmacokinetics, 55(9), 1059-1077.
