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Posted: July 16th, 2023
This week we will reflect on pharmacodynamic and pharmacokinetic principles we discussed in week one, allowing us to see how patient-specific variances can impact the treatment we choose and how efficacious it will be for the patient. We will read about hypertension, hyperlipidemia, chronic stable angina, heart failure, and anticoagulation disturbances. There is a lot of content to cover this week, so use your time wisely! Even though there are no discussions this week, there is a lot to read and learn!
There are several prominent classes of medications that are commonly used to treat each of these disorders, so I would advise you to focus on the pharmacokinetic and pharmacodynamic factors that separate each class from others. When you approach your paper for this week, focus on patient-specific factors that will impact the response and potential change in therapy.
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I would also suggest that you read up on the treatment guidelines for some of the cardiovascular issues that we are discussing this week. These treatment guidelines are critical. As APNs, you will be expected to know this information! The disorders that we are talking about this week are ubiquitous, and many of you will be dealing with patients with these issues regularly.
For example, beta blockers were once widely used to treat hypertension, but as new APNs, you must recognize that the data on beta blockers in treating hypertension is reserved for select patients, and that typically they are not recommended as a first-line treatment unless the patient has a history of MI, HF, etc.
The following guidelines will be helpful for this week:
JNC 8 Guidelines for the treatment of hypertension in adults
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ACC/AHA national cholesterol treatment guidelines
ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for Diagnosis and Management of Patients with Stable Ischemic Heart Disease, and
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the ACCF/AHA Guideline for the Management of Heart Failure
These disorders are ubiquitous and the pharmacological principles that direct their treatment can be extremely valuable in any capacity as an APN.
The Case Study for this week is the following:
Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:
Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily
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Patient-specific factors that will impact the response and potential change in therapy:
Obesity: Obesity is a risk factor for hypertension and hyperlipidemia. It can also affect the way the body metabolizes medications. For example, obese patients may be more likely to experience side effects from certain medications, such as atenolol.
Recent weight gain: Recent weight gain can be a sign of fluid retention, which can increase blood pressure. It is important to monitor the patient's weight and blood pressure closely. If the patient's weight continues to increase or their blood pressure is not controlled with their current medications, the doctor may need to make changes to their treatment plan.
JNC 8 Guidelines for the treatment of hypertension in adults:
The JNC 8 Guidelines recommend that adults with hypertension have a systolic blood pressure (SBP) of less than 140 mmHg and a diastolic blood pressure (DBP) of less than 90 mmHg. The guidelines also recommend that lifestyle changes, such as weight loss, exercise, and a healthy diet, be made before starting medication. If lifestyle changes are not enough to control blood pressure, medication may be needed.
ACC/AHA national cholesterol treatment guidelines:
The ACC/AHA national cholesterol treatment guidelines recommend that adults with high cholesterol have a low-density lipoprotein (LDL) cholesterol level of less than 70 mg/dL. If LDL cholesterol cannot be controlled with lifestyle changes, medication may be needed.
ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for Diagnosis and Management of Patients with Stable Ischemic Heart Disease:
The ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for Diagnosis and Management of Patients with Stable Ischemic Heart Disease recommends that patients with stable ischemic heart disease have a SBP of less than 140 mmHg and a DBP of less than 90 mmHg. The guidelines also recommend that lifestyle changes, such as weight loss, exercise, and a healthy diet, be made before starting medication. If lifestyle changes are not enough to control blood pressure, medication may be needed.
ACCF/AHA Guideline for the Management of Heart Failure:
The ACCF/AHA Guideline for the Management of Heart Failure recommends that patients with heart failure have a SBP of less than 140 mmHg and a DBP of less than 90 mmHg. The guidelines also recommend that lifestyle changes, such as weight loss, exercise, and a healthy diet, be made before starting medication. If lifestyle changes are not enough to control blood pressure, medication may be needed.
Based on the information provided, the following changes to the patient's medication regimen may be needed:
Atenolol: Atenolol is a beta-blocker that is commonly used to treat hypertension. However, beta-blockers can increase the risk of weight gain, which is a concern for this patient. The doctor may consider switching the patient to a different type of medication, such as an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB).
Doxazosin: Doxazosin is an alpha-blocker that is commonly used to treat hypertension. However, alpha-blockers can cause fluid retention, which can increase blood pressure. The doctor may consider switching the patient to a different type of medication, such as an ACE inhibitor or an ARB.
Hydralazine: Hydralazine is a vasodilator that is commonly used to treat hypertension. However, hydralazine can cause side effects, such as headaches, dizziness, and flushing. The doctor may consider switching the patient to a different type of medication, such as an ACE inhibitor or an ARB.
Sertraline: Sertraline is an antidepressant that is commonly used to treat depression. However, sertraline can cause side effects, such as nausea, vomiting, and diarrhea. The doctor may consider switching the patient to a different type of antidepressant, such as fluoxetine or citalopram.
Simvastatin: Simvastatin is a statin that is commonly used to treat hyperlipidemia. However, statins can cause side effects, such as muscle pain and liver damage. The doctor may consider switching the patient to a different type of statin, such as atorvastatin or rosuvastatin.
It is important to note that these are just suggestions and the doctor may make different recommendations based on the patient's individual circumstances.
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