: 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., 2018Despite 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 RFAs 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.htmTo PrepareReview 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.BELOW IS THE QUESTION———Write a 2 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.BELOW IS THE 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)BELOW IS THE SCENARIO————-LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.PMH:HTNAlzheimer’s diseaseHypothyroidismOsteoarthritisDiabetesMEDICATIONS:Amlodipine 10 mg QDDonepezil 10 mg QHSLevothyroxine 0.88 mg QAMCelecoxib 200 mg QDFurosemide 40 mg QAMMetformin 500mg, 1 BIDGlyburide 5mg, 1 BIDALLERGIES: NKASOCIAL HISTORY:Widowed with 2 adult children living in town, retired photographer and owner of an art supply storeVITALS: LABS:Weight: 129 lbs TSH 2.45 Free T4 0.98Height: 64 inches Na 135, K+ 3.8, Cl 99, CO2 25,BP: Supine = 177/82 Glucose 101, SCr 0.9, BUN 42HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1Plt 255Cr: 1.6 UA: CleareGFR: 45 ml/minPE:HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranesCV: RRRRespiratory: Clear to auscultation bilaterallyAbdomen: Soft, non-tender, no masses or guardingG/U: Skin intact, assisted with toileting and personal hygiene by staffExtremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearmNeuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months.PAIN ASSESSMENT:Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severeplease make sure to use APA format 7th edition and add 5 references not more than 5 years old and make sure to go through the rubic. Please this paper must include title page, introduction, summary and refe CORE SKILL: cardiovascular drug selection is DIAGNOSIS-DEPENDENT and COMORBIDITY-DEPENDENT. The graded reasoning is why THIS drug for THIS patient.
HYPERTENSION — know the guideline framework (ACC/AHA: normal <120/80; elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90) and the FIRST-LINE CLASSES: thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers. Note what is NOT first-line: beta-blockers, unless there is a compelling indication (post-MI, heart failure with reduced EF, atrial fibrillation rate control). Students reflexively reach for beta-blockers; the guidelines do not.
COMPELLING INDICATIONS — this is the actual clinical logic, and it's what earns marks:
— DIABETES or CHRONIC KIDNEY DISEASE with albuminuria → ACE INHIBITOR or ARB (renoprotective via efferent arteriolar dilation, reducing intraglomerular pressure — state the MECHANISM, not just the recommendation).
— HEART FAILURE WITH REDUCED EF → the four pillars: ARNI (sacubitril/valsartan) or ACEi/ARB; EVIDENCE-BASED beta-blocker (only carvedilol, metoprolol SUCCINATE, or bisoprolol — metoprolol TARTRATE is NOT one of them, a distinction that matters and is frequently missed); mineralocorticoid receptor antagonist (spironolactone/eplerenone); and SGLT2 INHIBITOR (now indicated regardless of diabetes status — a major recent change worth citing).
— BLACK PATIENTS without CKD or HF → thiazide or CCB are preferred as initial monotherapy (ACEi/ARB show lesser BP response and higher angioedema risk in this population). Note the important caveat that "race" here is a crude proxy for underlying physiology and its use in guidelines is actively debated — acknowledging that debate is a mark of sophistication.
— PREGNANCY → ACEi/ARBs are CONTRAINDICATED (fetal renal injury, oligohydramnios). Use labetalol, nifedipine, or methyldopa.
KEY MECHANISMS AND ADVERSE EFFECTS: ACE inhibitors cause a DRY COUGH (bradykinin accumulation — which is why switching to an ARB resolves it, since ARBs don't affect bradykinin) and ANGIOEDEMA (rare, potentially fatal, higher risk in Black patients); both ACEi and ARBs cause HYPERKALEMIA and are contraindicated in bilateral renal artery stenosis. Thiazides: hypokalemia, hyponatremia, hyperuricemia (can precipitate gout), hyperglycemia. Dihydropyridine CCBs (amlodipine): peripheral edema. Non-dihydropyridines (verapamil, diltiazem): negative inotropy — AVOID in HFrEF.
LIPIDS: statins (HMG-CoA reductase inhibition); myalgia and rare rhabdomyolysis; interaction with CYP3A4 inhibitors and grapefruit; know high- vs. moderate-intensity dosing and the four statin benefit groups. Ezetimibe, PCSK9 inhibitors.
ANTICOAGULATION: warfarin (vitamin K antagonist; INR monitoring; enormous interaction list; reversed with vitamin K/PCC) vs. DOACs (apixaban, rivaroxaban — no routine monitoring, fewer interactions, but avoid in mechanical valves and severe renal impairment). CHA2DS2-VASc for stroke risk in AF; HAS-BLED for bleeding risk.
PATIENT FACTORS the assignment demands: age, renal and hepatic function, pregnancy, race/ethnicity, comorbidities, polypharmacy, cost and adherence.
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