Pharmacotherapy for Cardiovascular Disorders
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.
————————————————————————————————————————————————-
Write a 2 to 3-page paper that addresses the following: (There will be a penalty for extra-long papers)
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.
BUY A PLAGIARISM-FREE PAPER HERE
Assignment: Pharmacotherapy for Cardiovascular Disorders
Delirium is a transient, rapid, and varied impairment of psychological functioning. It is characterized by trouble paying attention, disorientation, inability to think clearly, and fluctuations in consciousness (Kirpinar et al., 2018). Delirium is typically influenced by a mixture of unchangeable variables such as baseline dementia, advanced age (>65), and accelerating factors such as sedative medicines, emotional distress, infections, metabolic dysregulation, and surgery. Delirium is frequently linked to dementia in the elderly.
Delirium is sometimes not transitory and reversible as it might result in long-term cognitive impairment. However, if diagnosed early, it is treatable. This paper is based on a case study of LM, an 86-year-old female admitted to the emergency room with delirium. It investigates how age and other characteristics influence the pharmacokinetic and pharmacodynamics processes and how changes in the process may affect patient-recommended pharmaceutical therapy. The paper also considers ways of improving the patient’s pharmaceutical therapy plan.
Impact of age on Pharmacokinetic and pharmacodynamics
The age of the patient may affect her pharmacokinetic and pharmacodynamic processes. Because aging is associated with an increase in body fat and a decrease in total body water, medications whose distribution relies heavily on these changes would necessitate dosage or dose interval reductions (Peeters et al., 2019). Serum albumin levels decline with aging. This decrease may affect the concentration of extensively bound medicines, such as warfarin, necessitating a dosage reduction. Elderly adults also have reduced renal function, which may translate into the poorer clearance of drugs excreted primarily by filtration at the kidney, such as digoxin, and those created directly by the renal tubule.
The dose of drugs taken may need to be modified to ensure that they are removed from the body at a pace that does not cause harmful effects. Furthermore, older individuals are more prone to encounter unpleasant effects from drugs since their systems do not metabolize and eliminate them as fast as younger ones. Furthermore, the adverse consequence might result from the malfunctioning of the homeostatic process.
The presence of concomitant illness influences pharmacokinetics, pharmacodynamics, and medication sensitivity. Kidney failure is a prevalent disease among the elderly. Renal dysfunction, in particular, lowers medication secretion, removed mainly by the kidney. Renal failure can also increase meningeal permeability, making an elder patient more sensitive to certain medicines. As a result, the patient’s age should be considered while prescribing and giving drugs.
How changes in process impact patient’s recommended therapy
Changes in the patient’s processes, such as kidney function, can impact the prescribed therapies in various ways. It may be necessary to change the dosage of warfarin in patients with CKD because; impaired renal function alters the dose-effect relationship of warfarin. According to studies, it suppresses the metabolism of (S)-warfarin and (R, S)-warfarin, raising its level, which can be harmful (Lutz et al., 2020). Therefore, the dosage has to be lowered. The kidneys eliminate digoxin, and sustained toxicity may ensue from dehydration due to its effect on fluid retention. Thus does, decrement would be necessary if the patient gets dehydrated. Similarly, in cases of hypokalemia, the digoxin dosage must be adjusted.
In the context of delirium, the patient is unlikely to adhere to her medication schedule. Besides, the patient may have adverse medication responses. Digoxin intoxication, for instance, may be worsened by the patient’s bewilderment. Her unstable psychological state may aggravate warfarin-induced hemorrhage. Changes in the patient’s process may also affect her susceptibility to drugs. This may alter recommended therapy. Correcting an electrolyte imbalance, for example, may minimize her sensitivity to her current therapy, such as her sensitivity to digoxin.
Improving Patient Drug Therapy
According to the case study, the client adheres to medications she is currently prescribed, but she does not self-monitor her blood pressure or heart rate at home. This might compound the patient’s condition by developing high blood pressure or tachycardia. The patient must be encouraged to keep her blood pressure and Heart rate under continual monitoring. In addition, her prescription must be adjusted as appropriate. To optimize heart rate and blood pressure regulation, the patient’s digoxin should be substituted with a beta-blocker. Besides, warfarin and omeprazole dosages must be reduced as appropriate to manage patient symptoms better. To address nutritional and electrolyte deficiencies linked with delirium (Rahman et al., 2018), the patient should begin taking a multivitamin.
Conclusion
The case included an older woman suffering from delirium. With limited past medical history and screening tests, it was determined that specific changes to her medicine regimen were required to regulate her condition better. This is due to her age, which affects medication pharmacokinetics and pharmacodynamics.
References
Kirpinar, I. (2018). Delirium: Clinical features, diagnosis, and differential diagnosis. Delirium in elderly patients, 19-37. https://link.springer.com/chapter/10.1007/978-3-319-65239-9_3
Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert opinion on drug metabolism & toxicology, 15(4), 287-297. https://doi.org/10.21037%2Ftau.2018.10.16
Lutz, J. (2020, June). Platelets in advanced chronic kidney disease: two sides of the coin. In Seminars in thrombosis and hemostasis (Vol. 41, No. 03, pp. 342-356). Thieme Medical Publishers. DOI: 10.1055/s-0040-1708841
Rahman, A., & Paul, M. (2018). Delirium tremens (DT). https://europepmc.org/article/med/29489272
| Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. | 23 (23%) – 25 (25%)
The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. |
20 (20%) – 22 (22%)
The response provides a basic explanation of how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. |
18 (18%) – 19 (19%)
The response inaccurately or vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient. |
0 (0%) – 17 (17%)
The response inaccurately and vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient, or is missing. |
||
| Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. | 27 (27%) – 30 (30%)
The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy. Accurate, complete, and aligned examples are provided to support the response. |
24 (24%) – 26 (26%)
The response accurately describes how changes in the processes might impact the patient’s recommended drug therapy. Accurate examples may be provided to support the response. |
21 (21%) – 23 (23%)
The response inaccurately or vaguely describes how changes in the processes might impact the patient’s recommended drug therapy. Inaccurate or vague examples are provided to support the response. |
0 (0%) – 20 (20%)
The response inaccurately and vaguely describes how changes in the processes might impact the patient’s recommended drug therapy, or is missing. Inaccurate and vague examples may be provided to support the response, or is missing. |
||
| Explain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements. | 27 (27%) – 30 (30%)
The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan. The response includes an accurate and detailed explanation to support the recommended improvements. |
24 (24%) – 26 (26%)
The response accurately explains how to improve the patient’s drug therapy plan. The response may include an accurate explanation to support the recommended improvements. |
21 (21%) – 23 (23%)
The response inaccurately or vaguely explains how to improve the patient’s drug therapy plan. The response may include an inaccurate, vague, or misaligned explanation to support the recommended improvements. |
0 (0%) – 20 (20%)
The response inaccurately and vaguely explains how to improve the patient’s drug therapy plan, or is missing. The response may include an inaccurate and vague explanation to support the recommended improvements, or is missing. |
||
| Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. |
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. |
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. |
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. |
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. |
||
| Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors |
4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors |
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors |
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding |
||
| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. | 5 (5%) – 5 (5%)
Uses correct APA format with no errors |
4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors |
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors |
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors |
||
| Total Points: 100 | ||||||