Patient HM has a History of Atrial Fibrillation and a Transient Ischemic Attack

Pharmacotherapy for Cardiovascular Disorders

As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This is the result of the extensive treatment and care that is often required for patients with these disorders. While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011).

Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors. 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.

Consider the following:

Case Study 1:

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

Case Study 2:

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:

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

Case Study 3:

Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:

Glipizide 10 mg po daily

HCTZ 25 mg daily

Atenolol 25 mg po daily

Hydralazine 25 mg qid

Simvastatin 80 mg daily

Verapamil 180 mg CD daily

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To prepare:

Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.

Select one of the three case studies, as well as 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.

With these thoughts in mind:

By Day 3

Post an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected. Then, describe how changes in the processes might impact the patient’s recommended drug therapy. Finally, explain how you might improve the patient’s drug therapy plan.

By Day 6

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different case study than you did, in one or more of the following ways:

Provide alternative recommendations for drug treatments.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.