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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.

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.

Case scenario:

            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) 

Family History: 

None reported 

Vitals:                                     Labs: 

Wt 113 lbsHt 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. 

  • 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.
  • The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references

Learning resources

  • 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)
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