Cardiovascular disorders are a leading cause of death in the United States for both men and women and account for more than 7 million hospitalizations annually. The mode of treatment and care for the patient diagnosed with the disorders is extensive hence requiring hospitalizations (Arcangelo & Peterson, 2006). According to the Centers for Disease Control and Prevention (2011), the mortality rates of cardiovascular disorders are on a decline. It is due to improved treatment options and increased knowledge about the patient risk factors. Advanced practice nurses have a mandate of recommending the appropriate treatment options and also ensure safety and drug effectiveness. The Essay provides a discussion of the factors that influence the pharmacokinetic and pharmacodynamic processes to the patients and how changes in processes affect the patients under treatment.
The selected case study for the discussion is:
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 (beta blocker)
Doxazosin 8 mg daily (for hypertension)
Hydralazine 10 mg QID (Apresoline)
Sertraline 25 mg daily (SSRIs)
Simvastatin 80 mg daily (Statins for lowering cholesterol)
From the case study selected, the factor to dwell on in the discussion is age. Ageing is a progressive accumulation of some random changes in the body. Aging limits the average life expectancy and also reduces the ability to cope with external stress. The physiological responses also vary with age since it is a cumulative effect of the molecular, cellular, and tissue levels. The aging process is characterized by the effect on the function of the regulatory processes that allow functional integration between the cells and the organs. Some important pharmacokinetic and pharmacodynamic changes arise with advancing age, hence necessary to consider them in giving the treatment options hospitalizations (Arcangelo & Peterson, 2006). The pharmacokinetic changes include a reduction in the renal and hepatic clearance and elevated volume if distribution of the lipid soluble drugs. On the other hand, the pharmacodynamic changes involve alterations to the sensitivity of certain classes of drugs like anticoagulants, cardiovascular, and psychotropic drugs (Corsonello, Pedone & Incalzi, 2010).
For the drugs prescribed to the patient, age is a significant factor in their absorption, distribution, metabolism, and excretion. As one advances in age, the drugs have slightly decreased absorption. Distribution effects vary with the type of the drug and aging can cause increased volume of distribution, increased plasma concentration, and increased free fraction of the highly protein-bound acidic drugs. For metabolism, the drugs become less effective with age. Also observed is the impaired renal elimination of the water-soluble drugs (Wooten, 2012). The Calcium Channel Blockers have a reduced mode of action with age, and the Beta blockers have reduced effect due to the alterations of signal transduction pathway hospitalizations (Arcangelo & Peterson, 2006). The changes in the pharmacokinetic and pharmacodynamic processes affect the patient’s recommended drug therapy since the effectiveness is limited as one advance in age. Thus, the patient may fail to benefit as required by the use of the drugs in treating hypertension and hyperlipidemia disorders.
The age related changes in pharmacokinetics and pharmacodynamics contribute to the increased incidences of adverse drug reactions with age. Thus, it would be appropriate to check the therapeutic effect and the potential adverse drug reactions with age on a regular basis. I might improve the patient drug therapy by having a regular assessment of the effects of the drugs on the patient and recommending changes as appropriate. It would also be necessary to modify the drug treatment options with other drugs that reduce the adverse effects. Non-therapeutic treatment options for hypertension and hyperlipidemia would also be appropriate. They include a lifestyle change in diet and developing a culture of performing physical exercises.
Arcangelo V.G. & Peterson A.M (2006) Pharmacotherapeutics for Advanced Practice: A Practical Approach, Volume 536, Lippincott Williams & Wilkins Publishers, ISBN 0781757843, 9780781757843, Chapters 19 and 20
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