Case Study: 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.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 lbs Ht 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.
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.
- 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.
- 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.
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.
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)
