Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders

LM, an 89-year-old resident in a long-term care facility, presents a complex case involving cardiovascular disorders, falls, and pain management. Exploring the impact of age on pharmacokinetic and pharmacodynamic processes, this analysis aims to enhance drug therapy plans for elderly individuals with cardiovascular disorders, specifically addressing LM’s case. The selected factor, age, is pivotal in shaping how medications are absorbed, metabolized, and responded to in the elderly population. As the leading risk factor for heart disease is prevalent among older adults, understanding how age influences drug processes is crucial for advanced practice nurses. The subsequent discussion delves into the intricate relationship between age-related changes and the patient’s pharmacotherapy, aiming to provide insights into optimizing drug therapy plans for elderly individuals with cardiovascular disorders.

Influence of Age on Pharmacokinetic and Pharmacodynamic Processes

Pharmacokinetics is affected by age-related alterations in drug absorption, distribution, metabolism, and excretion (Katzung et al., 2021; Stauffer et al., 2020). Reduced renal function in elderly patients can impact drug clearance. In LM’s case, the increased creatinine level and reduced eGFR indicate weakened kidney functions affecting drug excretion. Regarding pharmacodynamics, aging could alter the sensitivities and responses to drugs and their receptors (Katzung et al., 2021). Decreased cognition in LM (MMSE score of 18 over a total score of 30) or altered pain perception could potentially reduce the effectiveness of drugs taken. For instance, altered central nervous system function may impact the analgesic response.

Impact on Drug Therapy

Pharmacokinetic Changes

It is significant to make necessary changes in LM medication dose, and drugs with primary renal excretion should be given special consideration, including amlodipine and glyburide (Katzung et al., 2021; Whalen, 2018). Drug clearance could be affected by renal impairment; thus, it can result in the accumulation of drugs, which would raise toxicity levels. Rigorous clinical monitoring should be undertaken due to reduced clearance, limiting effective treatment, and preventing dangerous side effects. Therefore, clinicians are advised to consider each drug’s importance against the therapeutics’ goal versus eliminating the adverse effects of kidney failure.

Pharmacodynamic Changes

Given LM’s pain assessment and cognitive decline, prudent gradual administration of analgesics is warranted for maintaining a fine balance between pain reduction and preserving the cognitive performance of the patient (Katzung et al., 2021; Whalen, 2018). Physical therapy, heat therapy, and massage are non-pharmacological modes of managing pain that should be employed together with pharmacotherapy. That is a comprehensive approach directed towards optimal pain management and preventing cognitive decline, which complies with the principles of geriatric-centered care. Thus, integrating these strategies enables a more integrated and individualized approach to pain management within dementia.

Improving Drug Therapy Plan

Dose Adjustment

Considering that LM has some impaired renal function, her dose of amlodipine and glyburide needs careful re-titration because these drugs may accumulate in the body, leading to toxication. Closely monitoring for any indications of undesirable and insufficient responses will help adjust the dose to achieve optimal therapy outcomes (Rosenthal & Burchum, 2021). Moreover, frequent renal function tests would help adjust the medication doses according to the changing renal function of LM. Drugs having minimal cognitive consequences are essential for pain management. Such a plan would take a holistic approach that is aligned with the multi-faceted nature of LM’s health needs.

Polypharmacy Review

A comprehensive review of LM’s extensive medication list is imperative to mitigate the risks associated with polypharmacy. Given the patient’s old age, complex nature, and severity of multiple comorbidities, the patient needs to choose only essential drugs. Reducing unnecessary drugs and minimizing exposure to adverse effects and drug interaction facilitates an improved safety profile and maximized effectiveness for pharmacotherapy (Rosenthal & Burchum, 2021). This is the essence of deprescribing, considering what medicines LM needs concerning her current health condition and aspirations.

Collaborative Approach

Addressing LM’s problems of both cardiovascular and pain-related nature calls for involving a multidisciplinary team. Physical therapists play crucial roles in targeted pain management plans, which help ensure proper functioning and mobility (Rosenthal & Burchum, 2021). Pain specialists’ collaboration promotes subtle strategies for managing pain depending on a patient’s degree of comprehension. Medication management relies on pharmacists’ knowledge of drug interactions and optimization. Using the participative decision-making system will ensure that LM will benefit from a holistic healthcare delivery process, hence improving quality healthcare. This involves the synergistic efforts of the healthcare team to develop a more focused management approach designed for LM’s particular condition. Top of Form

Conclusion

In conclusion, it is important to comprehend the effects of age on pharmacokinetic and pharmacodynamic processes while treating cardiovascular diseases in LM. The changes in these parameters require modification of drug therapy, such as dose adjustments, polypharmacy reviews, and collaborative interventions, towards safer and more effective patient care. Besides, continuous monitoring and alteration dependent on a patient’s response are still crucial parts of effective pharmacotherapy care aimed at cardiovascular diseases among elders.

References

Katzung, B. G., Kruidering-Hall, M., Tuan, R. L., Vanderah, T. W., & Trevor, A. J. (2021). Katzung & Trevor’s pharmacology examination and board review (13th ed). McGraw Hill Professional.

Rosenthal, L.D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses (2nd ed.). Elsevier.

Stauffer, V. L., Turner, I., Kemmer, P., Kielbasa, W., Day, K., Port, M., Quinlan, T., & Camporeale, A. (2020). Effect of age on pharmacokinetics, efficacy, and safety of galcanezumab treatment in adult patients with migraine: Results from six phase 2 and phase 3 randomized clinical trials. The Journal of Headache and Pain, 21(1). https://doi.org/10.1186/s10194-020-01148-9

Whalen, K. (2018). Lippincott illustrated reviews: Pharmacology. LWW.

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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 of the following factors: genetics, gender, ethnicity, age, or behavior factors.

Pharmacotherapy for Cardiovascular Disorders

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.
BY DAY 7 OF WEEK 2
Write a 2- to 3-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.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632Links to an external site.). All papers submitted must use this formatting.