Pharmacotherapy for Cardiovascular Disorders – As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This is the result of the extensive treatment and care that is often required for patients with these disorders. While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011). Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors. 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.
Consider the following case studies:
NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders 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
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily

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NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders Case Study 2:
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

NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders Case Study 3:
Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:

Glipizide 10 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily

To prepare:

Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.
Select one of the three case studies, as well as 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.

Post a 1 page paper APA format

an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected.
Then, describe how changes in the processes might impact the patient’s recommended drug therapy.
Finally, explain how you might improve the patient’s drug therapy plan.

NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders Readings

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

o   Chapter 19, “Hypertension” (pp. 230–246) . This chapter examines the relationships between the cardiovascular, nervous, and renal systems. It then describes diagnostic criteria for hypertension patients, drugs used to treat hypertension and possible adverse reactions, monitoring patient response, and patient education.
o   Chapter 20, “Hyperlipidemia” (pp. 247–262). This chapter explores causes of hyperlipidemia, treatments for hyperlipidemia patients, and methods for monitoring patient response. It also reviews strategies for risk assessment and patient education.
o   Chapter 21, “Chronic Stable Angina” (pp. 263–277) . This chapter begins by exploring factors that contribute to chronic stable angina, types of drugs used in treatment, and diagnostic criteria for initiating drug therapy. It also examines methods for monitoring patient response to treatment and educating patients on self-care.
o   Chapter 22, “Heart Failure” (pp. 278–297) . This chapter examines the process of prescribing drugs to treat heart failure and explores effects of prescribed drugs, proper dosages, and possible adverse reactions.
o   Chapter 49, “Anticoagulation Disturbances” (pp. 764–803) . This chapter covers drug therapy options for three disorders requiring anticoagulants: venous thromboembolism, atrial fibrillation, and ischemic stroke. It also explains the process of initiating and managing drug therapy for patients with these disorders.

Drugs.com. (2012). Retrieved from http://www.drugs.com/. This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

NURS 6521 Pharm Week 3 Discussion: Pharmacotherapy for Cardiovascular Disorders Media

Laureate Education, Inc. (Executive Producer). (2012). Hypertension and hyperlipidemia. Baltimore, MD: Author. This media presentation outlines hypertension and hyperlipidemia including contributing factors, evaluation, treatment, and implications.Note: The approximate length of this media piece is 10 minutes.

NURS 6521 Pharm Week 10 Discussion Hormone Replacement Therapy
In recent years, hormone replacement therapy has become a controversial issue. When prescribing therapies, advanced practice nurses must weigh the strengths and limitations of the prescribed supplemental hormones. If advanced practice nurses determine that the limitations outweigh the strengths, then they might suggest alternative treatment options such as herbs or other natural remedies, changes in diet, and increase in exercise.
Consider the following scenario:
As an advanced practice nurse at a community health clinic, you often treat female (and sometimes male patients) with hormone deficiencies. One of your patients requests that you prescribe supplemental hormones. This poses the questions: How will you determine what kind of treatment to suggest? What patient factors should you consider? Are supplemental hormones the best option for the patient, or would they benefit from alternative treatments?
To prepare:

Review Chapter 56 of the Arcangelo and Peterson text, as well as the Holloway and Makinen and Huhtaniemi articles in the Learning Resources.
Review the provided scenario and reflect on whether or not you would support hormone replacement therapy.
Locate and review additional articles about research on hormone replacement therapy for women and/or men. Consider the strengths and limitations of hormone replacement therapy.
Based on your research of the strengths and limitations, again reflect on whether or not you would support hormone replacement therapy.
Consider whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies.

Post A 1 page paper APA format ( no title page)

a description of the strengths and limitations of hormone replacement therapy.
Based on these strengths and limitations, explain why you would or why you would not support hormone replacement therapy.
Explain whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies and why.

Resources

Holloway, D. (2010). Clinical update on hormone replacement therapy. British Journal of Nursing, 19(8), 496–504.Retrieved from the Walden Library databases.This article examines the purpose, components, and administration of hormone replacement therapy (HRT). It also presents benefits, risks, potential side effects, and alternative treatment options of HRT.
Mäkinen, J. I., & Huhtaniemi, I. (2011). Androgen replacement therapy in late-onset hypogonadism: Current concepts and controversies—A mini-review. Gerontology, 57(3), 193–202.Retrieved from the Walden Library databases.This article examines the role of testosterone levels in the development of hypogonadism. It also explores health issues that are impacted by testosterone levels and the role of testosterone replacement therapy.

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

Chapter 56, “Menopause and Menopausal Hormone Therapy” (pp. 884–895)This chapter presents various options for menopausal hormone therapy and examines the strengths and limitations of each form of therapy.

SAMPLE APPROACH
Case Study 2
Patient HM has an extensive cardiovascular history.  There is a history of atrial fibrillation, ischemic attack (TIA), type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease.  The patient is prescribed a list of medications that include:

Warfarin 5 mg daily po MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81mg daily po
Metformin 1000 mg PO
Glyburide 10 mg PO BID
Atenolol 100 mg PO daily
Motrin 200 mg 1-3 tablets every 6 hours as needed for pain

Cardiovascular disease affects many people worldwide annually.  Kendir et al. 2018 state that cardiovascular diseases are the most common cause of death from non-communicable diseases (p.46).  Cardiovascular disease can refer to many diseases that affect the heart, and it’s vessels.  Our patient HM had many diagnosed cardiovascular disorders.  Atrial fibrillation which is an arrhythmia the heart due to loss of coordination of electrical and mechanical activity in the atria (Arcangelo,
NURS 6521 Pharm Week 3 Discussion Pharmacotherapy for Cardiovascular Disorders
Petterson, Wilbur, & Reinhold, 2017, p.864).  Clots or thrombi can develop from atrial fibrillation causing strokes or ischemic attacks.  Unfortunately, HM had a history of ischemic attacks (TIA).  According to Arcangelo et al. 2017, an ischemic stroke is described as a sudden or progressive onset of focal neurologic sign due to the inadequate blood supply to the brain (p.868).  Having hyperlipidemia which is a high blood level of cholesterol further makes heart disease worse because the cholesterol builds up in vessels affecting blood flow.  Hypertension heightens the potential of developing cardiovascular disease and chronic kidney disease.  Hypertension can go for a long period of time going undetected because it can be asymptomatic.  Finally, HM was diagnosed with type II diabetes, which is caused when adipose and muscle cells become less sensitive to the actions of insulin or the pancreas produces less insulin than the body needs (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.785).
Patient Factor
The disorders that HM has been diagnosed with can happen at any age, however, in elderly patients, they may have a poorer prognosis because medications are not always processed by the body as well or as intended.  The development and worsening of cardiovascular disease are associated with many factors such as genetics, lifestyle choices/behaviors, ethnicity, and age.  With so many other factors as a person ages, it is worsening the disease because that is a factor that cannot be changed.  With the patient HM’s medical history as a provider, you have to be cautious when prescribing because medications are absorption may be affected because of age.
Drug Therapy Plan
The patient’s medical history puts him at higher risk of having a heart attack or stroke from complications of cardiovascular disease.  With this patient, we want to control his diabetes, hypertension, hyperlipidemia, and atrial fibrillation keeping levels within normal limits without over prescribing to this patient.  The first thing that was noticed when looking at the patient’s medication list is that he is talking two medications with anticoagulant effects.  Warfin which is a strong anticoagulant and aspirin.  When taking Warfin routine lab work is needed to check the PT, INR, and aPTT levels in the blood to determine if the medication dose needs to be adjusted.  Added aspirin in could cause increased bleeding, the elderly population with underlying malignancy and those taking interacting drugs that increase warfarins effect are at high risk for bleeding and should receive lower initial doses (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.874).
HM has type two diabetes and is taking Atenolol 100mg daily which is a beta-blocker.  Arcangelo et al. 2017 stated, in diabetic patients, beta-blockers can mask all symptom of hypoglycemia except sweating (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.266).  Being on this medication, the patient would have to consistent with monitoring his glucose levels and educated well on signs and symptoms of hypoglycemia.  This patient may benefit better from an Angiotensin II Receptor Blocker such as losartan.  For diabetics, losartan is a better choice because it is more effective than atenolol in lower cardiovascular morbidity and mortality in diabetic patients with hypertension and left ventricular hypertrophy (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.267).  Being that HM is elderly, his initial dose should be losartan 50 mg Po daily.  Starting at 50 mg daily leaves enough room to adjust up if needed depending on the patient’s blood pressure (Kizior,2018).
Reference:
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins
Kendir, C., van den Akker, M., Vos, R., & Metsemakers, J. (2018). Cardiovascular disease
patients have increased risk for comorbidity: A cross-sectional study in the Netherlands. The European Journal Of General Practice, 24(1), 45–50. https://doi-org.ezp.waldenulibrary.org/10.1080/13814788.2017.1398318
Kizior, R. (2018). Saunders Nursing Drug Handbook 2019. Elsevier – Health Sciences Division.

Rubric Detail NURS 6521 Pharm Week 3 Discussion Pharmacotherapy for Cardiovascular Disorders

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Content

Name: NURS_6521_Week3_Discussion_Rubric

Outstanding Performance
Excellent Performance
Competent Performance
Proficient Performance
Room for Improvement

Main Posting:
Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

Points Range: 44 (44%) – 44 (44%)

Thoroughly responds to the discussion question(s)
is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
supported by at least 3 current, credible sources

Points Range: 40 (40%) – 43 (43%)

Responds to the discussion question(s)
is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
75% of post has exceptional depth and breadth
supported by at least 3 credible references

Points Range: 35 (35%) – 39 (39%)

Responds to most of the discussion question(s)
is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
50% of post has exceptional depth and breadth
supported by at least 3 credible references

Points Range: 31 (31%) – 34 (34%)

Responds to some of the discussion question(s)
one to two criteria are not addressed or are superficially addressed
is somewhat lacking reflection and critical analysis and synthesis
somewhat represents knowledge gained from the course readings for the module.
post is cited with fewer than 2 credible references

Points Range: 0 (0%) – 30 (30%)

Does not respond to the discussion question(s)
lacks depth or superficially addresses criteria
lacks reflection and critical analysis and synthesis
does not represent knowledge gained from the course readings for the module.
contains only 1 or no credible references

Main Posting:
Writing

Points Range: 6 (6%) – 6 (6%)

Written clearly and concisely
Contains no grammatical or spelling errors
Fully adheres to current APA manual writing rules and style

Points Range: 5.5 (5.5%) – 5.5 (5.5%)

Written clearly and concisely
May contain one or no grammatical or spelling error
Adheres to current APA manual writing rules and style

Points Range: 5 (5%) – 5 (5%)

Written concisely
May contain one to two grammatical or spelling error
Adheres to current APA manual writing rules and style

Points Range: 4.5 (4.5%) – 4.5 (4.5%)

Written somewhat concisely
May contain more than two spelling or grammatical errors
Contains some APA formatting errors

Points Range: 0 (0%) – 4 (4%)

Not written clearly or concisely
Contains more than two spelling or grammatical errors
Does not adhere to current APA manual writing rules and style

Main Posting:
Timely and full participation

Points Range: 10 (10%) – 10 (10%)

Meets requirements for timely and full participation
posts main discussion by due date

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

Does not meet requirement for full participation

First Response:
Post to colleague’s main post that is reflective and justified with credible sources.

Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings
responds to questions posed by faculty
the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives

Points Range: 8.5 (8.5%) – 8.5 (8.5%)

Response exhibits critical thinking and application to practice settings

Points Range: 7.5 (7.5%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting

Points Range: 6.5 (6.5%) – 7 (7%)

Response is on topic, may have some depth

Points Range: 0 (0%) – 6 (6%)

Response may not be on topic, lacks depth

First Response:
Writing

Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues
Response to faculty questions are fully answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English

Points Range: 5.5 (5.5%) – 5.5 (5.5%)

Communication is professional and respectful to colleagues
Response to faculty questions are answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English

Points Range: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues
Response to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible sources
Response is written in Standard Edited English

Points Range: 4.5 (4.5%) – 4.5 (4.5%)

Responses posted in the discussion may lack effective professional communication
Response to faculty questions are somewhat answered if posed
Few or no credible sources are cited

Points Range: 0 (0%) – 4 (4%)

Responses posted in the discussion lack effective
Response to faculty questions are missing
No credible sources are cited

First Response:
Timely and full participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely and full participation
posts by due date

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

Does not meet requirement for full participation

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.

Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings * responds to questions posed by faculty
the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives

Points Range: 8.5 (8.5%) – 8.5 (8.5%)

Response exhibits critical thinking and application to practice settings

Points Range: 7.5 (7.5%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting

Points Range: 6.5 (6.5%) – 7 (7%)

Response is on topic, may have some depth

Points Range: 0 (0%) – 6 (6%)

Response may not be on topic, lacks depth

Second Response:
Writing

Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues
Response to faculty questions are fully answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English

Points Range: 5.5 (5.5%) – 5.5 (5.5%)

Communication is professional and respectful to colleagues
Response to faculty questions are answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English

Points Range: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues
Response to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible sources
Response is written in Standard Edited English

Points Range: 4.5 (4.5%) – 4.5 (4.5%)

Responses posted in the discussion may lack effective professional communication
Response to faculty questions are somewhat answered if posed
Few or no credible sources are cited

Points Range: 0 (0%) – 4 (4%)

Responses posted in the discussion lack effective
Response to faculty questions are missing
No credible sources are cited

Second Response:
Timely and full participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely and full participation
Posts by due date

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

NA

Points Range: 0 (0%) – 0 (0%)

Does not meet requirement for full participation

Total Points: 100

Name: NURS_6521_Week3_Discussion_Rubric

 

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