NURS 6521 Week2 Assignment PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). Thepatient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:
â€¢ Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
â€¢ Aspirin 81 mg daily
â€¢ Metformin 1000 mg po bid
â€¢ Glyburide 10 mg bid
â€¢ Atenolol 100 mg po daily
â€¢ Motrin 200 mg 1â€“3 tablets every 6 hours as needed for pain
2- to 3-page , APA

NURS 6521

Week2 Assignment

PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Case assigned

Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81 mg daily
Metformin 1000 mg po bid
Glyburide 10 mg bid
Atenolol 100 mg po daily
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

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.

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.

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Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts

Required Reading

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants(2nd ed.) St. Louis, MO: Elsevier.
- Chapter 33, “Review of Hemodynamics” (pp. 285–289)
- Chapter 37, “Diuretics” (pp. 290–296)
- Chapter 38, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 297–307)
- Chapter 39, “Calcium Channel Blockers” (pp. 308–312)
- Chapter 40, “Vasodilators” (pp. 313–317)
- Chapter 41, “Drugs for Hypertension” (pp. 316–324)
- Chapter 42, “Drugs for Heart Failure” (pp. 325–336)
- Chapter 43, “Antidysrhythmic Drugs” (pp. 337–348)
- Chapter 44, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 349–363)
- Chapter 45, “Drugs for Angina Pectoris” (pp. 364–371)
- Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)

NURS_6521_Week2_Assignment_Rubric

Criteria	Ratings
Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.	25 to >22.5 pts Excellent The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.
Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.	30 to >26.7 pts Excellent The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy. … Accurate, complete, and aligned examples are provided to support the response.
Explain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements.	30 to >26.7 pts Excellent The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan. … The response includes an accurate and detailed explanation to support the recommended improvements.
Written 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 to >4.45 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.45 pts Excellent Uses correct grammar, spelling, and punctuation with no errors
Written 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 to >4.45 pts Excellent Uses correct APA format with no errors

Title of the Paper in Full

Student Name

Program Name or Degree Name (e.g., Master of Science in Nursing), Walden University

COURSE XX: Title of Course

Instructor Name

Month XX, 202X

Title of the Paper in Full

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References

(Note that the following references are intended as examples only.)

American Counseling Association. (n.d.). About us. https://www.counseling.org/about-us/about-aca

Anderson, M. (2018). Getting consistent with consequences. Educational Leadership, 76(1), 26-33.

Bach, D., & Blake, D. J. (2016). Frame or get framed: The critical role of issue framing in nonmarket management. California Management Review, 58(3), 66-87. https://doi.org/10.1525/cmr.2016.58.3.66

Burgess, R. (2019). Rethinking global health: Frameworks of Power. Routledge.

Herbst-Damm, K. L., & Kulik, J. A. (2005). Volunteer support, marital status, and the survival times of terminally ill patients. Health Psychology, 24(2), 225–229. https://doi.org/10.1037/0278-6133.24.2.225

Johnson, P. (2003). Art: A new history. HarperCollins. https://doi.org/10.1037.0000136-000

Lindley, L. C., & Slayter, E. M. (2018). Prior trauma exposure and serious illness at end of life: A national study of children in the U.S. foster care system from 2005 to 2015. Journal of Pain and Symptom Management, 56(3), 309–317. https://doi.org/10.1016/j.jpainsymman.2018.06.001

Osman, M. A. (2016, December 15). 5 do’s and don’ts for staying motivated. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/5-dos-and-donts-for-staying-motivated/art-20270835

Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice (7th ed.). Wiley.

Walden University Library. (n.d.). Anatomy of a research article [Video]. https://academicguides.waldenu.edu/library/instructionalmedia/tutorials#s-lg-box-7955524

Walden University Writing Center. (n.d.). Writing literature reviews in your graduate coursework [Webinar]. https://academicguides.waldenu.edu/writingcenter/webinars/graduate#s-lg-box-18447417

World Health Organization. (2018, March). Questions and answers on immunization and vaccine safety. https://www.who.int/features/qa/84/en/

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Pharmacotherapy for cardiovascular disorders

Age and Pharmacokinetic and Pharmacodynamics Processes

My factor of choice in this case scenario is age. Advancing age has been found to be positively correlating with atrial fibrillation according to research (Adderley et al., 2018). Furthermore, research has shown that the median age of about 2million people globally who live with atrial fibrillation is 75years (Sagris et al., 2021). As such, about 79% of people living with atrial fibrillation is between the ages of 65 to 85years. According to a study by (Wasmer et al., 2017), among 834 patients with atrial fibrillation were composed of those who had transient ischemic attack and those who had ischemic stroke or both. The use of warfarin was found to be more effective than the use of aspirin to those patients with ischemic stroke.

As a result of weak immune system associated with older adults, development of changes in renal and hepatic clearance may occur followed by elevated volume of distribution for some lipid soluble drugs in the pharmacokinetic processes (Sagris et al., 2021). Furthermore, various experienced changes such as adjusted sensitivity to some classes of medications such as anticoagulants, psychotropic and cardiovascular drugs do occur.

Improvements on the Patient’s Drug Therapy Plan

The various exposures that the patient is experiencing such as atrial fibrillation, type II diabetes, ischemic heart disease and high blood pressure puts him at a health risk of developing congestive heart failure. Having this information, I would consider maintaining atenolol medication but with an addition of loop diuretic. The medication to be recommended in that case is hydrochlorothiazide, 25mg PO daily. Considering that the patient also experiences high blood pressure and type II diabetes, Lisinopril 2.5mg PO daily and an ACE inhibitor are also essential medications for the patient (Rosenthal & Burchum, 2020). The use of these medications would not only act as hypertension control for the patient, but also offer kidney protection for the patient.

Patient HM has also been found to be suffering from hyperlipidemia buts not under any medication such as statin responsible for controlling the condition. Since the patient has been found to be experiencing ischemic heart disease, they should be taking ARB or an ACE inhibitor, statin medication, an aspirin and a beta blocker (Adderley et al., 2018). The Lisinopril is essential in providing ACE inhibitor to the patient. To provide the patient with the required statin for the management of hyperlipidemia, simvastatin 10mg PO daily is essential. I would also consider removing Motrin from HM’s medication list to ensure that their kidneys are not stressed, a factor that might also impact thinning of blood (Rosenthal & Burchum, 2020). For pain management of the patient aspirin and warfarin are not the appropriate choice since they already exist in his list of medications. I would therefore consider making a change through introduction of acetaminophen 325mg PO to be taken 2 or 3 tabs after every 6 to 8hours. Therefore, the new list of medication for patient HM would therefore be;

81mg Aspirin orally per day
Acetaminophen for pain management, 325mg oral, 2 tabs after every 7 hours

Glyburide 10 mg orally and twice daily

Hydrochlorothiazide 25mg PO daily
Lisinopril 2.5mg PO daily
Metformin 1000 mg PO bid

Simvastatin 10mg PO daily
Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun PO daily.

References

Adderley, N. J., Nirantharakumar, K., & Marshall, T. (2018). Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies. bmj, 361. https://doi.org/10.1136/bmj.k1717

Wasmer, K., Eckardt, L., & Breithardt, G. (2017). Predisposing factors for atrial fibrillation in the elderly. Journal of geriatric cardiology: JGC, 14(3), 179. doi: 10.11909/j.issn.1671-5411.2017.03.010

Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants-E-Book. Elsevier Health Sciences. 2nd Edition

Sagris, M., Vardas, E. P., Theofilis, P., Antonopoulos, A. S., Oikonomou, E., & Tousoulis, D. (2021). Atrial fibrillation: pathogenesis, predisposing factors, and genetics. International journal of molecular sciences, 23(1), 6. https://doi.org/10.3390/ijms23010006