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
Write a 2- to 3-page paper that addresses the following:
- Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
- Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. Stick to ONE factor! Describe the effect of the factor on PK/PD in general
- Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. Describe the pharmacokinetics/pharmacodynamics of EACH drug in the patient’s list. Research the effect of the factor you selected on EACH drug in the drug list provided as part of the patient case. You can use primary research articles and a drug reference for information
- Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Use bullet points for your recommendations. Include one bullet point for each drug. Be specific. For example:
- decrease atenonol to 50mg daily because bioavailibilty…
- stop metformin. Start….at XXmg because bioavailibilty…
While grading, I noticed some common mistakes from the work you submitted in Week 1.
- Read the question carefully. Some of you provided great information in the discussion posts, but you did not answer the question. Use the guidance provided in the announcement on Monday of each week
- This is a pharmacology class. When discussing a patient case, focus on the drugs. Use a drug reference and primary research articles (randomized controlled trials and systematic reviews are preferred) evaluating effects and side effects of the drugs
- Use generic names for drugs. If you want to you can add the brand name in parenthesis – e.g. furosemide (Lasix®)
- References should fit the patient e.g.
- an article on metformin use in oncology patients can only be cited if your patient is taking metformin and has cancer. In addition, the type of cancer and cancer treatments used in the research and in your patient should match
- an article on pharmacokinetics in a diabetic patient taking metformin can only be used if your patient has diabetes and is on metformin
- APA style – review the basic checklist and be sure to look at examples on citations and references
Required Readings
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)
Expert Answer and Explanation
Pharmacotherapy for Cardiovascular Disorders
How Alcoholic Behavior Might Influence Pharmacokinetic and Pharmacodynamic Processes
Pharmacokinetics (PK) is the movement of medication inside one’s body. On the other hand, pharmacodynamics (PD) is the biological response of one’s body to medications. According to Luepke et al. (2017), advanced practice nurses should have knowledge and understanding of the exposure-response relationship (PK-PD) for them to prescribe quality and safe medications to respective patients. Knowledge about KK and PD also helps reduce incidences of prescription error. Various factors can impact the exposure-response of one to certain medications. The factor that has been selected for this assignment is patient behavior, such as alcohol use. Alcohol can highly impact how one reacts to medications.
For instance, Murphy, Xu, Kochanek, and Arias (2018) report that alcohol can impact the PK of medications by altering liver metabolism or gastric emptying. Alcohol may alter liver metabolism by inducing cytochrome P450 2EI. In other words, when one consumes alcohol together with medications, it can increase drug absorption by increasing gastrointestinal blood flow. The reaction between alcohol and medications can lead to tachycardia, sedation, and body intoxicated (Martin, Feig, Maksoudian, Wysong & Faasse, 2018). As a result, advanced practice nurses should understand the medical history of patients before prescribing medications.
The Impact of Changes in the Patient’s Recommended Drug Therapy
The changes in the PK and PD processes might impact Patient HM’s current drug therapy. According to Dumond et al. (2017), both blood thinners, such as warfarin and alcohol, thin one’s blood. Therefore, taking the two substances concurrently may trigger the development of anticoagulant effect, increasing Patient HM’s chances of suffering bleeding. To prevent Patient HM’s risk of suffering bleeding, the nurse should consider changing the warfarin to another alternative (Rosenthal & Burchum, 2021). A therapy that can be prescribed in place of warfarin to help patients with atrial fibrillation is WATCHMAN. WATCHMAN is an implant that can prevent patients with atrial fibrillation from suffering stroke (Rosenthal & Burchum, 2021). Excessive consumption of alcohol can also lower the patient’s metabolic rate, hence reducing the rate at which the medications can be absorbed into the bloodstream and excreted (Moj et al., 2017). As a result, the patient will not experience the drug’s full effects on his body and thus reduce his chances of getting better.
How to Improve the Patient’s Drug Therapy Plan?
I can improve the patient’s drug therapy plan through the following ways. First, I can recommend that the patient change from warfarin to WATCHMAN implant. The FDA approved the WATCHMAN implant as an alternative therapy that can be used to treat people with atrial fibrillation, such as Patient HM. The therapy can be used to reduce Patient HM’s risk of suffering stroke. The second improvement is patient education. Patient education can help patients understand the functions of the medications and how to take them. Through patient education, I can educate the patient about the negative effects of using alcohol in his current condition and when taking prescribed medications. Through patient education, I can urge the patient to avoid alcohol for the time being or take it in small amounts. Lastly, I can improve the patient’s therapy plan by recommending that he be introduced to remote patient monitoring. The device can help me monitor the patient’s vitals even when he is not close to the care facility.
References
Dumond, J. B., Collins, J. W., Cottrell, M. L., Trezza, C. R., Prince, H. M. A., Sykes, C., … & Patterson, K. B. (2017). P16ink4a, A Senescence Marker, Influences Tenofovir/Emtricitabine Metabolite Disposition In HIV‐Infected Subjects. CPT: Pharmacometrics & Systems Pharmacology, 6(2), 120-127. Https://Ascpt.Onlinelibrary.Wiley.Com/Doi/Pdf/10.1002/Psp4.
Luepke, K. H., Suda, K. J., Boucher, H., Russo, R. L., Bonney, M. W., Hunt, T. D., & Mohr III, J. F. (2017). Past, Present, And Future Of Antibacterial Economics: Increasing Bacterial Resistance, Limited Antibiotic Pipeline, And Societal Implications. Pharmacotherapy: The Journal Of Human Pharmacology And Drug Therapy, 37(1), 71-84. Https://Doi.Org/10.1002/Phar.1868
Martin, L. R., Feig, C., Maksoudian, C. R., Wysong, K., & Faasse, K. (2018). A Perspective On Nonadherence To Drug Therapy: Psychological Barriers And Strategies To Overcome Nonadherence. Patient Preference And Adherence, 12, 1527. Doi: 10.2147/PPA.S155971
Moj, D., Britz, H., Burhenne, J., Stewart, C. F., Egerer, G., Haefeli, W. E., & Lehr, T. (2017). A Physiologically Based Pharmacokinetic And Pharmacodynamic (PBPK/PD) Model Of The Histone Deacetylase (HDAC) Inhibitor Vorinostat For Pediatric And Adult Patients And Its Application For Dose Specification. Cancer Chemotherapy And Pharmacology, 80(5), 1013-1026. Https://Link.Springer.Com/Article/10.1007/S00280-017-3447-X
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
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics For Advanced Practice Nurses And Physician Assistants (2nd Ed.) St. Louis, MO: Elsevier.
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