Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521

Walden University Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521 assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521                     

Whether one passes or fails an academic assignment such as the Walden University Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521 depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521                     

The introduction for the Walden University Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521 is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521                     

After the introduction, move into the main part of the Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521 assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521                     

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521                     

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

Stuck? Let Us Help You

Completing assignments can sometimes be overwhelming, especially with the multitude of academic and personal responsibilities you may have. If you find yourself stuck or unsure at any point in the process, don’t hesitate to reach out for professional assistance. Our assignment writing services are designed to help you achieve your academic goals with ease. 

Our team of experienced writers is well-versed in academic writing and familiar with the specific requirements of the Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521 assignment. We can provide you with personalized support, ensuring your assignment is well-researched, properly formatted, and thoroughly edited. Get a feel of the quality we guarantee – ORDER NOW. 

A Sample Answer For the Assignment: Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521

Asthma is one of the most common conditions affecting more than 20 million individuals in the United States and over 150 million across the globe. It takes up to $14 billion to treat asthma annually. Particularly hard hit are adolescents and children between the ages of 10 to 18 years. Studies show that up to 14% of children and adolescents in the inner city are diagnosed with asthma. A larger percentage of asthmatic patients in the emergency rooms are children and adolescents.

Consequently, most patients hospitalized as a result of asthma or asthma-related problems are also children. As such, appropriate interventions must be implemented to help in managing asthma among children and adolescents hence reducing their visits to the ER or hospitalization. In the same line, Sentara Home Care Services came up with an innovative program to help in improving asthma management among children and adolescents through home-based strategies such as “Life Coaches” where they are educated on the proper use of medication and lifestyle behaviors for both the patient and their families. This paper reviews different pieces of literature for a better understanding of the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents.

Methods

Quite a significant number of internet sources were available talking about different approaches that can be utilized in managing asthma among children and adolescents. However, only peer-reviewed articles directly relating to the study PICOT questioned were used for this paper. These articles were arrived at by use of several inclusion and exclusion criteria. For instance, the inclusion criteria included studies that had been published within the last 5 years, in English, with participants who are children and adolescents. The studies however could be either experimental or literature review.

Exclusion criteria included articles published more than 5 years, in languages other than English. Consequently, relevant keywords such as asthma,  Sentara’s Asthma Disease Management plan, children and adolescents, and decreased ER/unscheduled PCP visits were utilized. A wide variety of search engines were used for this study, such as Google Scholar, PubMed/MEDLINE, and Cochrane. Generally, only peer-reviewed articles and experimental studies covering the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents, were used for this study.

The patient is dealing with a major cardiovascular issue based on the case study. All the current medication prescribed to the patient needs to be reviewed for appropriate changes. Cardiovascular disease counts as a major cause of disability and leads to a cause of death globally. The statistic indicates that approximately a person dies within approximately 36 seconds in the United States due to cardiovascular disease (Benjamin et al., 2019).

Therefore, cardiovascular disease is the major cause of health disparities and increases the cost of health care. It is vital to consider the patient’s lifestyle, history, and review to manage HH’s illness effectively. This paper Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521 addresses the factors that influence a patient’s pharmacokinetics and pharmacodynamics process and gives changes that impact the recommended drug therapy.

Factor Influencing Pharmacokinetic and Pharmacodynamics Process in the Patient

Based on the case study, I chose age as a factor that can cause drug toxicity and influence the pharmacokinetics of various medications. The altered metabolism and blood concentration of drugs increase with age (Giri et al., 2018). Reduced renal function alters drug pharmacokinetics such as glomerular filtration rate and reduces blood flow. Physiological factors and temperature are two examples of age-related changes in a patient (Giri et al., 2018).

Cognitive function, ventricular aerial stiffness, endothelial function, and electric conduction are all physiological factors (Rosenthal & Burchum, 2021). Because of sympathetic neuronal and baroreceptor responses, most people are sensitive to antihypertensive medication (Giri et al., 2018).

Glipizide is used to treat type 2 diabetes in adults. Because it reduces glucose output from the liver, the drug effectively promotes insulin release from beta cells (Addul-Ghani et al., 2021). For patients with poor metabolic control, the combination of metformin and Glipizide can help them achieve their HbA1c goal in three months (Addul-Ghani et al., 2021).

Glipizide is effective because it has a short half-life and effect duration, reducing the risk of long-term hypoglycemia (Addul-Ghani et al., 2021). Patients who combine Glipizide with thyroid hormone, estrogen-containing contraception, thiazide diuretics, nicotinic acid, or calcium channel blockers are at high risk of hyperglycemia (Rosenthal & Burchum, 2021).

Metformin effectively improves glycemic control without causing hypoglycemia or obesity, and is thus considered a first-line pharmacologic treatment (Shurrab & Arafa, 2020). The drug works in the liver to inhibit gluconeogenesis by blocking the mitochondrial redox shuttle (Shurrab & Arafa, 2020). Metformin has been linked to gastrointestinal side effects such as nausea, diarrhea, and vomiting (Shurrab & Arafa, 2020). When combined with hypoxemia and hypoperfusion, FDA labels warn against prescribing Metformin drug therapy to patients with acute heart failure.

Pharmacotherapy for Cardiovascular Disorders

Patient AO has gained nine pounds of weight and is diagnosed with hyperlipidemia and hypertension. These patients require an effective plan of treatment to help them manage their health. Both hyperlipidemia and hypertension are connected, and one is a risk factor of the other. Using this case, it is evident that the treatment plan is not working out for patient AO. This is because the patient is still having weight gain and is diagnosed with two dangerous cardiovascular conditions.

Approximately seventy million in the United States are diagnosed with hypertension. This translates to about one in every three people, and the statistics are not good (Arcangelo et al., 2017). This paper aims to analyze how old age affects the patient’s pharmacokinetics and pharmacodynamics processes. It also suggests how to improve patient AO treatment plan for cardiovascular condition.

Impact of Age on Pharmacodynamics and Pharmacokinetics

In this scenario, the patient has 3 major medical issues namely high cholesterol level, high blood pressure,

and obesity. As people age and need treatment, there is a need to understand the pharmacodynamics and pharmacokinetics in old age. As one ages, the process of drug absorption, metabolisms, distribution, and excretion are drastically decreased (Thürmann, 2020). Due to the decrease in hepatic flow in older people, the rate of drug metabolism by the hepatic cells is lowered. Therefore, drugs having high extraction ratios will have an increase in bioavailability.

Therefore, to avoid drug toxicity, initial dosages of medicines need to be given to older patients. It is critical to note that aging also affects renal functions by reducing its excretory function. Hence, these factors show how healthcare providers need to know the dosage prescription for older patients (Reeve et al., 2017).

Besides, older people are also marked with decreased gastric emptying, slow peristalsis, and colonic transit. These physiological changes in old age affect the rate of absorption (Arcangelo et al., 2017). It is essential to note that factors such as height, weight, behavioral characteristics, and weight are considered before selecting drugs and other treatment plans.

When the drug reaches its targeted site, the pharmacodynamics processes are triggered. When the drug comes to its targeted site, old age could alter the pharmacodynamics because of the changes in the binding site, differences in the post-receptor effects, and chemical interactions. The magnitude of drug response is dependent on other parameters. They include the receptors’ density, the affinity of the receptors to the drug, and the signal transduction pathways.

How to Improve the Patient’s Drug Therapy Plan

In determining the best treatment plan for the patient, detailed history taking should be conducted, more laboratory tests such as blood chemistry, EKG, liver, and renal function tests need to be undertaken (Kapoor, 2021). It is also noted that patient AO is on several blood pressure drugs. It is challenging to know the types of drugs that are effective.

There is a need to determine the cause to select the right medicine to use in control hypertension. Secondly, drug interaction needs to be investigated since patient AO is put on many medications. It is essential to start the patient on low dosages then increase the amount steadily to avoid toxicity. Additionally, Patient AO’s loss of weight should be part of the plan of treatment.

In older adults, to help ensure the dosages are prescribed as per the age, it will be necessary to conduct renal function tests. This will help determine the drug dosage, optimize the patient’s hydration status, and be aware of the nephrotoxic drugs to be avoided (Peterson et al., 2018). Also, in the elderly, the use of SSRIs has been reported to have an increased risk of GI bleeding due to their antiplatelet properties. Because of this, the Sertraline for patient AO needs to be investigated for any potential risks before continuation (Drenth‐van Maanen, Wilting & Jansen, 2019).

In conclusion, I will recommend the entire medication regimen be stopped. However, I would also suggest more investigations be conducted to find the source of hypertension, obesity, and hyperlipidemia to properly select the drugs in managing the conditions and promote quick healing.

Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521

…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.

Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assignment: Pharmacotherapy for Cardiovascular Disorders NURS 6521  

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 for Assignment Pharmacotherapy for Cardiovascular Disorders NURS 6521

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 of Assignment Pharmacotherapy for Cardiovascular Disorders NURS 6521

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.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Pharmacology for Cardiovascular Disorders

The promotion of safety and quality in the treatment of patients with different conditions is important in nursing practice. Nurses and other healthcare providers utilize their knowledge in pharmacokinetics and pharmacodynamics to select treatments that will optimize outcomes while minimizing the potential of patient harm.

Factors such as age, gender, ethnicity, and genetics among others influence the pharmacokinetics and pharmacodynamics of the medications prescribed to patients. Therefore, this essay examines the influence of age on LM’s pharmacokinetic and pharmacodynamics processes. The essay also discusses the impact of the changes in the patient’s recommended drug therapy and how the treatment can be improved.

Effect of Age on Patient’s Pharmacokinetic and Pharmacodynamics Processes

The selected factor that affects the pharmacokinetic and pharmacodynamics of LM processes is age. Age significantly affects pharmacokinetics of drugs. Aging is associated with decreased small-bowel surface area, reduced gastric emptying, and elevated gastric PH. Changes such as an increase in the gastric PH affects the absorption of drugs such as calcium and enteric coated medications (Koren et al., 2019).

Aging also results in the decrease in the total body water and increase in the total body fat. The increase in body fat volume increases the total volume of distribution of lipophilic drugs and their elimination half-lives. Aging also lowers hepatic metabolism of most drugs. The decrease in cytochrome P-450 lowers the metabolism of drugs in the liver. This also affects first-pass metabolism of drugs before they enter the circulatory system.

Aging is also associated with a decline in renal elimination of medications. The elderly patients have reduced glomerular filtration rate, which affects the elimination of drug metabolites from the body (Drenth-van Maanen et al., 2020; Koren et al., 2019; Peeters et al., 2019). As a result, there is an increased risk of drug toxicity due to the accumulation of the metabolites in the body. These pharmacokinetic changes affect the treatment options and health status of LM.

Aging also affects pharmacodynamics of drugs. Pharmacodynamics refers to the study of the drug effect on the body. Aging is associated with reduced pharmacodynamics processes. One of the mechanisms contributing to the reduced pharmacodynamics is the limited functioning of drug receptor sites. There is also the reduction in the available drug receptors for drug binding. This reduces the effect of the drug on the body while increasing its blood bioavailability (Kratz & Diefenbacher, 2019). An example is seen in patients diagnosed with diabetes. They have low insulin receptors, which result in the elevated blood glucose levels.

The effect of aging on pharmacodynamics can also be seen from the exaggerated response to some drugs among this population. For example, older adults tend to show exaggerated responses to drugs that stimulate the central nervous system. The observation is because of the increased sensitivity to drugs by this population. In addition, aging reduces Gs protein interactions in the elderly patients. The decrease lowers cardiac, pulmonary, and vascular tissue to drugs such as those used in the treatment of hypertension(Stader et al., 2020). Therefore, nurses should consider these changes when prescribing drugs to elderly patients and other vulnerable populations.

Impact of the Changes in Processes on Patient’s Recommended Drug Therapy

The changes in the pharmacokinetic and pharmacodynamics processes affect the patient’s recommended drug therapy. A decline in the drug metabolism in the liver affects the selection of drugs for the patient. Nurses and other healthcare providers should prescribe medications that do not undergo first-pass metabolism to preserve optimum hepatic function. A decline in renal function also affects the client’s recommended drug therapy(Peeters et al., 2019). Nurse practitioners prescribe medications that have other routes of excretion such as feces to promote renal functioning.

There is also the consideration of drug dosages with the changes in the pharmacokinetics and pharmacodynamics. Accordingly, nurse practitioners lower the dosage and frequency of hepatotoxic and renal toxic medications in patients with advanced ages to minimize the risk of harm and drug toxicity (Thürmann, 2020). The reduction in drug absorption due to lowered gastric physiological processes also increases the need for prescribing drugs that are administered through other routes such as intravenously and intramuscularly.

Improving Patient’s Drug Therapy

I will improve the patient’s drug therapy by avoiding polypharmacy. The patient currently uses several drugs that predispose her to harm and medication errors. An effective approach to her treatment would be reducing the number of drugs taken at a time to promote her health, safety, and quality. The other way in which I will improve her drug therapy is by titrating the drug dosage upwards.

Elderly patients should be initiated on low dosage and increased upwards based on tolerance and efficacy (Koren et al., 2019). I will modify the patient’s current treatment. I will lower the dosage of celecoxib to minimize the risk of hepatotoxicity and renal toxicity. I will also stop glyburide and retain metformin. Metformin has the benefit of reducing the risk of cardiovascular mortality in patients with multiple comorbidities that include cardiovascular conditions (Guo et al., 2019).

Conclusion

Aging affects pharmacokinetics and pharmacodynamics processes. Advancing age lowers pharmacokinetic processes such as drug absorption, metabolism, and elimination. It also affects pharmacodynamics processes such as drug binding to their receptor sites. These changes affect the recommended treatment plan for the patient in the case study. Polypharmacy should be avoided in treating LM for safety and quality outcomes.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria

Pharmacotherapy for Cardiovascular Disorders

Patient AO has gained nine pounds of weight and is diagnosed with hyperlipidemia and hypertension. These patients require an effective plan of treatment to help them manage their health. Both hyperlipidemia and hypertension are connected, and one is a risk factor of the other. Using this case, it is evident that the treatment plan is not working out for patient AO.

This is because the patient is still having weight gain and is diagnosed with two dangerous cardiovascular conditions. Approximately seventy million in the United States are diagnosed with hypertension. This translates to about one in every three people, and the statistics are not good (Arcangelo et al., 2017).

Impact of Age on Pharmacodynamics and Pharmacokinetics

In this scenario, the patient is suffering from three problems; high cholesterol level, high blood pressure, and obesity. As people age and need treatment, there is a need to understand the pharmacodynamics and pharmacokinetics in old age (Sera & Uritsky). As one ages, the process of drug absorption, metabolisms, distribution, and excretion are drastically decreased. Due to the decrease in hepatic flow in older people, the rate of drug metabolism by the hepatic cells is lowered.

Therefore, drugs having high extraction ratios will have an increase in bioavailability. Therefore, to avoid drug toxicity, initial dosages of medicines need to be given to older patients. It is critical to note that aging also affects renal functions by reducing its excretory function. Hence, these factors show how healthcare providers need to know the dosage prescription for older patients.

Besides, older people are also marked with decreased gastric emptying, slow peristalsis, and colonic transit. These physiological changes in old age affect the rate of absorption (Arcangelo et al., 2017). It is essential to note that factors such as height, weight, behavioral characteristics, and weight are considered before selecting drugs and other treatment plans.

When the drug reaches its targeted site, the pharmacodynamics processes are triggered (Jaobson, 2013). When the drug comes to its targeted site, old age could alter the pharmacodynamics because of the changes in the binding site, differences in the post-receptor effects, and chemical interactions (Durakovic & Vitezic, n.d). The magnitude of drug response is dependent on other parameters. They include the receptors’ density, the affinity of the receptors to the drug, and the signal transduction pathways.

How to Improve the Patient’s Drug Therapy Plan

In determining the best treatment plan for the patient, detailed history taking should be conducted, more laboratory tests such as blood chemistry, EKG, liver, and renal function tests need to be undertaken. It is also noted that patient AO is on several blood pressure drugs (Topinková et al., 2012). It is challenging to know the types of drugs that are effective.

There is a need to determine the cause to select the right medicine to use in control hypertension. Secondly, drug interaction needs to be investigated since patient AO is put on many medications. It is essential to start the patient on low dosages then increase the amount steadily to avoid toxicity. Additionally, Patient AO’s loss of weight should be part of the plan of treatment.

In older adults, to help ensure the dosages are prescribed as per the age, it will be necessary to conduct renal function tests. This will help determine the drug dosage, optimize the patient’s hydration status, and be aware of the nephrotoxic drugs to be avoided (Jacobson, 2013). Also, in the elderly, the use of SSRIs has been reported to have an increased risk of GI bleeding due to their antiplatelet properties (Carlo & Alpert, 2015). Because of this, the Sertraline for patient AO needs to be investigated for any potential risks before continuation.

In conclusion, I will recommend the entire medication regimen be stopped. However, I would also suggest more investigations be conducted to find the source of hypertension, obesity, and hyperlipidemia to properly select the drugs in managing the conditions and promote quick healing.

References

Arcangelo, V.P., Peterson, A.M., Wilbur, V., & Reinhold, J.A. (2017). Pharmacotherapeutics for Advanced Practice. A Practical Approach. (4th Ed.). Philadelphia, PA: Wolters Kluwer

Carlo, A. D., & Alpert, J. E. (2015). Geriatric Psychopharmacology: Pharmacokinetic and Pharmacodynamic Considerations. Psychiatric Annals, 45(7), 336. Doi: 10.3928/00485713-20150626-04

Durakovic, Z., & Vitezic, D. (n.d). Pharmacodynamics and pharmacokinetics in the elderly. Periodicum Biologorum, 115(4), 517-520.

Jacobson, S. (2013). Effects of pharmacokinetic and pharmacodynamic changes in the elderly. Psychiatric Times, (1),

Sera, L., & Uritsky, T. (2016). Pharmacokinetic and pharmacodynamic changes in older adults and implications for palliative care. Progress in Palliative Care, 24(5), 255-261. doi:10.1080/09699260.2016.1192319

Topinková, E., Baeyens, J.P., Michel, J.P. et al. (2012). Evidence-Based Strategies for the Optimization of Pharmacotherapy in Older People. Drugs Aging 29, 477–494. https://doi.org/10.2165/11632400-000000000-00000

To access your rubric:

Week 2 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 2 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 2

To participate in this Assignment:

Week 2 Assignment

What’s Coming Up in Week 3?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will examine strategies for the treatment and management of respiratory disorders, including asthma. You will analyze asthma and stepwise management and consider the impact of this approach for patient health.

Week 3: Respiratory System

Asthma and chronic obstructive pulmonary disease (COPD) are significant public health burdens. Currently, more than 25 million people in the United States have asthma (HealthyPeople.gov, 2019). As an advanced practice nurse, you will likely encounter patients who will present with respiratory disorders, including asthma or COPD. Understanding specific treatment protocols as well as the types of pharmacotherapeutics used to treat respiratory disorders is important to ensure the effective and safe delivery of advanced nursing practice.

This week, you will evaluate drug therapy plans for patients who present with asthma and analyze the stepwise approach to asthma treatment and management from a patient in your professional practice.

Reference: HealthyPeople.gov. (2019). Respiratory diseases. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/respiratory-diseases

Learning Objectives

Students will:

Evaluate drug therapy plans for asthma
Assess the impact of asthma treatments on patients
Analyze the stepwise approach to asthma treatment and management

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Chapter 62, “Drugs for Asthma and Chronic Obstructive Pulmonary Disease” (pp. 557–579)
Chapter 63, “Drugs for Allergic Rhinitis, Cough, and Colds” (pp. 580–588)

Document: APA Presentation Template

Optional Resources (click to expand/reduce)

National Heart Lung and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

This web resource presents guidelines for diagnosing and managing asthma and outlines treatment recommendations for specific age groups.

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2^nd 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)

Required Media (click to expand/reduce)

Cardiovascular Disorders

Meet Dr. Norbert Myslinski as he discusses ACE inhibitors, angiotensin inhibitors, beta-blockers, calcium channel blockers, and diuretics as different categories of hypertension drugs. What potential drugs might be best recommended for patients suffering from hypertension? (8m)

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

The promotion of safety and quality in the treatment of patients with different conditions is important in nursing practice. Nurses and other healthcare providers utilize their knowledge in pharmacokinetics and pharmacodynamics to select treatments that will optimize outcomes while minimizing the potential of patient harm.

Factors such as age, gender, ethnicity, and genetics among others influence the pharmacokinetics and pharmacodynamics of the medications prescribed to patients. Therefore, this essay examines the influence of age on LM’s pharmacokinetic and pharmacodynamics processes. The essay also discusses the impact of the changes in the patient’s recommended drug therapy and how the treatment can be improved.

Effect of Age on Patient’s Pharmacokinetic and Pharmacodynamics Processes

The selected factor that affects the pharmacokinetic and pharmacodynamics of LM processes is age. Age significantly affects pharmacokinetics of drugs. Aging is associated with decreased small-bowel surface area, reduced gastric emptying, and elevated gastric PH. Changes such as an increase in the gastric PH affects the absorption of drugs such as calcium and enteric coated medications (Koren et al., 2019).

Aging also results in the decrease in the total body water and increase in the total body fat. The increase in body fat volume increases the total volume of distribution of lipophilic drugs and their elimination half-lives. Aging also lowers hepatic metabolism of most drugs. The decrease in cytochrome P-450 lowers the metabolism of drugs in the liver. This also affects first-pass metabolism of drugs before they enter the circulatory system.

Aging is also associated with a decline in renal elimination of medications. The elderly patients have reduced glomerular filtration rate, which affects the elimination of drug metabolites from the body (Drenth-van Maanen et al., 2020; Koren et al., 2019; Peeters et al., 2019). As a result, there is an increased risk of drug toxicity due to the accumulation of the metabolites in the body. These pharmacokinetic changes affect the treatment options and health status of LM.

Aging also affects pharmacodynamics of drugs. Pharmacodynamics refers to the study of the drug effect on the body. Aging is associated with reduced pharmacodynamics processes. One of the mechanisms contributing to the reduced pharmacodynamics is the limited functioning of drug receptor sites.

There is also the reduction in the available drug receptors for drug binding. This reduces the effect of the drug on the body while increasing its blood bioavailability (Kratz & Diefenbacher, 2019). An example is seen in patients diagnosed with diabetes. They have low insulin receptors, which result in the elevated blood glucose levels.

The effect of aging on pharmacodynamics can also be seen from the exaggerated response to some drugs among this population. For example, older adults tend to show exaggerated responses to drugs that stimulate the central nervous system. The observation is because of the increased sensitivity to drugs by this population. In addition, aging reduces Gs protein interactions in the elderly patients.

The decrease lowers cardiac, pulmonary, and vascular tissue to drugs such as those used in the treatment of hypertension(Stader et al., 2020). Therefore, nurses should consider these changes when prescribing drugs to elderly patients and other vulnerable populations.

Impact of the Changes in Processes on Patient’s Recommended Drug Therapy

The changes in the pharmacokinetic and pharmacodynamics processes affect the patient’s recommended drug therapy. A decline in the drug metabolism in the liver affects the selection of drugs for the patient. Nurses and other healthcare providers should prescribe medications that do not undergo first-pass metabolism to preserve optimum hepatic function. A decline in renal function also affects the client’s recommended drug therapy(Peeters et al., 2019). Nurse practitioners prescribe medications that have other routes of excretion such as feces to promote renal functioning.

There is also the consideration of drug dosages with the changes in the pharmacokinetics and pharmacodynamics. Accordingly, nurse practitioners lower the dosage and frequency of hepatotoxic and renal toxic medications in patients with advanced ages to minimize the risk of harm and drug toxicity (Thürmann, 2020). The reduction in drug absorption due to lowered gastric physiological processes also increases the need for prescribing drugs that are administered through other routes such as intravenously and intramuscularly.

Improving Patient’s Drug Therapy

I will improve the patient’s drug therapy by avoiding polypharmacy. The patient currently uses several drugs that predispose her to harm and medication errors. An effective approach to her treatment would be reducing the number of drugs taken at a time to promote her health, safety, and quality. The other way in which I will improve her drug therapy is by titrating the drug dosage upwards.

Elderly patients should be initiated on low dosage and increased upwards based on tolerance and efficacy (Koren et al., 2019). I will modify the patient’s current treatment. I will lower the dosage of celecoxib to minimize the risk of hepatotoxicity and renal toxicity. I will also stop glyburide and retain metformin. Metformin has the benefit of reducing the risk of cardiovascular mortality in patients with multiple comorbidities that include cardiovascular conditions (Guo et al., 2019).

Conclusion

Aging affects pharmacokinetics and pharmacodynamics processes. Advancing age lowers pharmacokinetic processes such as drug absorption, metabolism, and elimination. It also affects pharmacodynamics processes such as drug binding to their receptor sites. These changes affect the recommended treatment plan for the patient in the case study. Polypharmacy should be avoided in treating LM for safety and quality outcomes.

References

Drenth-van Maanen, A. C., Wilting, I., & Jansen, P. A. F. (2020). Prescribing medicines to older people—How to consider the impact of ageing on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921–1930. https://doi.org/10.1111/bcp.14094

Guo, L., Ma, J., Tang, J., Hu, D., Zhang, W., & Zhao, X. (2019). Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis. Journal of Diabetes Research, 2019, 9804708. https://doi.org/10.1155/2019/9804708

Koren, G., Nordon, G., Radinsky, K., & Shalev, V. (2019). Clinical pharmacology of old age. Expert Review of Clinical Pharmacology, 12(8), 749–755. https://doi.org/10.1080/17512433.2019.1632188

Kratz, T., & Diefenbacher, A. (2019). Psychopharmacological Treatment in Older People. Deutsches Ärzteblatt International, 116(29–30), 508–518. https://doi.org/10.3238/arztebl.2019.0508

Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opinion on Drug Metabolism & Toxicology, 15(4), 287–297. https://doi.org/10.1080/17425255.2019.1588249

Stader, F., Kinvig, H., Penny, M. A., Battegay, M., Siccardi, M., & Marzolini, C. (2020). Physiologically Based Pharmacokinetic Modelling to Identify Pharmacokinetic Parameters Driving Drug Exposure Changes in the Elderly. Clinical Pharmacokinetics, 59(3), 383–401. https://doi.org/10.1007/s40262-019-00822-9

Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anesthesiology, 33(1), 109. https://doi.org/10.1097/ACO.0000000000000814

The prevalence and impact of cardiovascular disorders in the U.S. are undeniable, especially in contributing to the nation’s morbidity and mortality rates. Effective pharmacotherapeutic strategies are paramount, and these must be tailored according to individual patient characteristics. The case of LM, an 89-year-old female with a vast array of health complications, serves as a vivid representation of the complexities involved. Central to this discussion is the role of age, a factor with significant implications on both pharmacokinetics (the journey of a drug through the body) and pharmacodynamics (the body’s response to the drug).

Age’s Impact on Pharmacokinetics and Pharmacodynamics

Age plays a pivotal role in determining how drugs interact with the body. Elderly individuals often undergo physiological changes that can drastically alter the absorption, distribution, metabolism, and excretion of drugs. For instance, delayed gastric emptying and reduced gastrointestinal blood flow can result in a slower absorption rate for many medications in older adults.

Similarly, reduced muscle mass and decreased serum albumin can impact how drugs are distributed throughout the body. When it comes to metabolism, the decrease in hepatic blood flow and liver mass commonly seen in elderly patients can reduce the body’s ability to process drugs effectively. Finally, diminished renal function, evident in LM’s eGFR of 45 ml/min, can affect drug excretion, posing potential risks for toxicity (Nightingale et al., 2019).

Moreover, the body’s response to drugs, or pharmacodynamics, undergoes changes with age. Older adults might experience heightened sensitivity to certain medications, leading to unpredictable or altered responses, thus increasing the potential for adverse reactions (McKearney & Coleman, 2020).

Implications for LM’s Drug Therapy

Given LM’s age and observed health metrics, there is a pressing need for keen scrutiny of her medication regimen. Amlodipine, prescribed for her hypertension, may be contributing to her experience (Rafeq & Salzman, 2022). The diuretic, Furosemide, when combined with her diabetes medications, Metformin and Glyburide, poses a potential risk for significant shifts in her electrolyte levels, which could be exacerbating her risk for falls (Ali et al., 2019). Celecoxib, prescribed for osteoarthritis, has known potential to aggravate hypertension and further decline kidney function, especially in the elderly (White et al., 2000).

Recommendations for Drug Therapy Modification

In light of the pharmacokinetic and pharmacodynamic considerations induced by age and LM’s evident health complexities, it is essential to revisit and possibly modify her medication regimen.

A thorough reevaluation of her antihypertensive medications is a priority. Given her recorded supine blood pressure, an adjustment in the dosage or a switch from amlodipine to another antihypertensive class with fewer side effects related to edema might be beneficial.

Regular monitoring of LM’s glucose, potassium, and overall renal function can ensure the safety of her diabetes medications combined with the diuretic (Davies et al., 2022). Additionally, her pain management strategy needs to be readdressed. It might be more advantageous to explore non-drug interventions or consider switching from celecoxib to acetaminophen, a medication with a better safety profile for the elderly (Alorfi, 2023).

Conclusion

The case of LM underscores the importance of meticulous pharmacotherapeutic planning, especially in elderly patients with multiple health challenges. Age-induced changes in pharmacokinetics and pharmacodynamics necessitate a tailored approach, ensuring not just effective treatment but also the well-being and safety of the patient. Collaborative and informed medical decisions remain the linchpin in achieving optimal therapeutic outcomes.

Introduction

The processes that a medicine goes through in the body after administration are referred to as pharmacokinetics. Absorption, distribution, metabolism, and excretion are all included in this. Pharmacodynamics, on the other hand, deals with the effects that drugs have on the body, such as adverse effects.

Variables like a patient’s genetics, gender, ethnicity, age, behavioral factors, medical history, and concurrent drugs all have an impact on pharmacokinetics and pharmacodynamics. According to the case study, these variables especially age do indeed change the drugs pharmacokinetics and pharmacodynamics (Rosenthal. & Burchum, 2018).

Age influencing pharmacodynamics and pharmacokinetics

The patient is of advanced age whereby it has been stated that they are 74 years old this is indeed can affect the pharmacodynamics and pharmacokinetics related to the drug. In advanced age you find the boy’s physiology has changed thus affecting the pharmacokinetics and elements such as absorption, distribution, metabolism and excretion. One of the most significant impacts in old age is whereby you’ll have a decreased glomeruli filtration rate which determines the level of drug elimination. Since it is decreased it could lead to the drug being retained in the system and leading to toxicity (Sieder et al., 2016).

In old age there is also decreased gastrointestinal motility thus leading to delayed absorption rate. This leads to delayed onset of pharmacological effects of drugs thus making them less effective. The peak drug concentrations are also affected hence the drug doesn’t reach its maximum capacity for effect (Mangoni & Jarmuzewska, 2019).

Age also increases the body fat which could lead to increase the volume of distribution increases. Therefore if the drug has to be distributed to a wider area than affection it will affect its expected performance thus not delivering the desired therapeutic effect. Due to the increased body fat there is also decreased body water levels thus leading to the drug’s elimination half-lives also getting increased (Sieder et al., 2016).

Having an advanced age also affects metabolism which mostly occurs in the liver. This occurs in due to the decreased required enzymes that may no longer be available due to the physiological changes that occur because of age. This also leads to decreased clearance hence the already metabolised drug aren’t cleared from the system (Mangoni & Jarmuzewska, 2019).

Age impacting pharmacodynamics occurs through decrease in effect for beta-adrenergic agents. This is due to decrease in response in the vascular, cardiac, and pulmonary tissues due to a decline in some required proteins. There is also reduced sensitivity to drugs due to the body’s receptors undergoing physiological changes.

Therefore if the response and sensitivity is inhibited the desired therapeutic effect isn’t achieved. Homeostatic mechanisms are also seen to influence the pharmacodynamics in that in advanced age it is reduced. The mechanisms are seen to reduce in old age. Therefore in the case the drugs lead to adverse effects the body takes a longer period of time to return to the initial state (Sieder et al., 2016).

Changes in the Process that Impact the Patient’s Recommended Drug Therapy

Due to the old age the pharmacodynamics and pharmacokinetics has been impacted. The absorption has been delayed due to decreased gastric motility, on the distribution end the volume of distribution has increased due to the increased body fat and the metabolism due to decreased enzymes has also decreased. The physiological changes in the glomeruli has decreased the glomeruli filtration rate hence decreasing excretion and could lead to toxicity. The pharmacodynamics due to decrease in sensitivity, decrease in response and reduced homeostatic mechanisms negatively affect it (Mancia et al., 2014).

Therefore encompassing all this there is a definite change in the recommended drug therapy in order to benefit the patient. The changes are in medication such as atenolol will be used in place of the beta-blocker metoprolol, starting at 25 to 200 mg per day. However, fast response is attainable with longer release modules and can be delivered thrice daily, thus it’s advised to begin new medication, notably such as beta-blockers, with prolonged release formulae. Instead of ibuprofen that is contraindicated with warfarin patients should be prescribed acetaminophen orally 500mg thrice daily to manage the pain. I would also advise using lipid-lowering drugs other than statins to lower the low-density lipoprotein cholesterol levels (Mangoni & Jarmuzewska, 2019).

How to Improve the Drug Therapy Plan

Patients with a high risk of cardiovascular disease, a heart attack, or is known diabetic, such as this patient, are advised to begin taking a moderate-intensity statin with the aim of reducing LDL-C levels by 30% or more. For this patient, it is advised to utilize Ezetimibe, administered orally at a dose of 10 mg each day. Cardiovascular diseases, diabetes mellitus, left ventricular dysfunction and diabetic neuropathy can receive treatment by use of angiotensin converting enzyme inhibitors.

They can also be used to prevent strokes. Starting doses of ramipril range from 1.25 mg to 2.5 mg orally every day. This medication is also recognized to lessen myocardial infarctions, strokes, and fatalities. Moreover aside from changes in medications can make other alterations such as diet change, smoking cessation, weight loss, provision of health education from medical professionals and physical activity is required (Mayor, 2017).

Conclusion

The majority of deaths globally are currently caused by cardiovascular disorders, and diabetes is frequently found in these people. It is thought that people with type diabetes are more likely than non-diabetics to die from cardiovascular illnesses. In order to get the best results in the management of cardiovascular diseases which aims to maximize the benefits of available treatments while minimizing patient harm clinicians must possess basic knowledge of pharmacokinetics and pharmacodynamics (Rosenthal. & Burchum, 2018).

References

Hoover, L. E. (2019). Cholesterol management: ACC/AHA Updates guideline. Https://eds-a-       ebscohost-com-ezp.waldenulibrary.org/eds/pdfviwer/

Mayor, S. (2017). Pharmacokinetics: Optimizing safe and effective prescribing.             Https://onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1551

Rosenthal, L.D. & Burchum. J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice    providers. St. Louis, MO: Elsevier.

Sieder, S. T., Kalus, J. & Lanfear, D. E. (2016). Cardiovascular pharmacokinetics,            Pharmacodynamics and Pharmacogenomics for the clinical practitioner. Https://eds-a-  ebscohost-com.ezp.waldenulibrary.org/eds/delivery/

Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., & Galderisi, M.       (2014). 2013 ESH/ESC Practice guidelines for the management of arterial hypertension:            ESH-ESC: The Task Force for the management of arterial hypertension of the European           Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood          Pressure, 23(1), 3-16.

Mangoni, A. A., & Jarmuzewska, E. A. (2019). The influence of heart failure on the         pharmacokinetics of cardiovascular and non‐cardiovascular drugs: A critical appraisal of           the evidence. British Journal of Clinical Pharmacology, 85(1), 20-36.