(Solved) NURS6521 Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders | Homework Solution

Case Study : 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

Looking into this case study, patient is dealing with a major cardiovascular issue. As a provider caring for this patient, all current medications need to be reviewed and the appropriate changes need to be made. Cardiovascular disease (CVD) is the leading cause of death and a major cause of disability worldwide. In the United States, CVD accounted for 34.4 percent of the 2.4 million deaths in 2003 and remain a major cause of health disparities and rising health care costs. In 2006, health care spending and lost productivity from CVD exceeded $400 billion. (Mesah &Brown, 2007). The main contributing factor to CVD is high blood pressure, overweight/obesity, and diabetes. NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders With the patient recent weight gain of 9 pounds, I will need to determine if the weight gain is within a week or less which could be fluid retention. If the weight gain is longer, that could be a result of patient’s lifestyle and eating habits. The factor I selected for this case study is behavioral factor due to patient history of obesity. Obesity is a complex disease involving an excessive amount of body fat. Obesity isn’t just a cosmetic concern. It is a medical problem that increases risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers (Mayo Clinic, 2019). The effect of obesity on the pharmacokinetics and pharmacodynamics of drugs used for cardiovascular risk reduction (antihypertensive agents, statins, aspirin, antidiabetic agents) (Sankaralingam, Kim & Padwal, 2015). Also obesity can have effect on distribution and dosages of medication. The patient is on 3 types of blood pressure medication with different classification (beta block, vasodilator, and alpha blocker). Patient is also on high – dose of cholesterol lowering statin and selective serotonin reuptake inhibitor (SSRI). Before any changes to the medication, further evaluation need to be done by doing a complete cardiac workup which will include BNP and Echocardiogram to determine patient ejection fraction.  Also, comprehensive blood panel need to be done, all this will help to determine if patient is having congestive heart failure, possible side effect of one of the listed above medication, or if weight gain is as a result of patient poor eating habits.

Changes and improvement in patient’s drug therapy

After reviewing the patient’s ordered lab and Echocardiogram results, alteration may be required. If the result shows CHF, some diuretic such as Lasix may be given. Also add ACE inhibitor which as shown to be more effective as it helps decrease the amount of sodium retained in the kidney and stop production of hormone called angiotensin II (Carter, 2018). Doxazosin may be discontinued due its side effect been weight gain because of fluid retention. I will make changes to the dose of simvastatin to 40 milligrams (mg) which is the maximum dose per day. High dose of simvastatin 80 mg is not recommended as this could cause damage to the muscle as result of myopathy or rhabdomyolysis (Medscape, 2019). On the other side, if the cardiac workup came back to be negative, adjustment to some of the medications still need to be done. As Nurse Practitioner, I will need to discuss with the patient in depth about lifestyle changes such as diet, exercise and important of compliance with prescribed medications. Behavioral modification is another evidence-based approach to improving the patient’s compliance with therapy. Patient education, on the disease as well as pharmacologic (medication) and non-pharmacologic interventions (lifestyle modifications), is a cornerstone of successful treatment (Waldner, 2013). NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders. Recent studies have suggested health coaching because it works as a motivator for patients instead of just reminding them to take their medications. Health coaching has been shown to improve outcomes in cardiovascular risk factors including diabetes and hypertension (Heath, 2016).

References

Cater, A. (2018). ACE Inhibitors for Hypertension. Retrieved from www.healthline.com Heath, S., (2016). Using Health Coaching to Improve Chronic Disease Management. Retrieved from https://healthitanalytics.com/news/using-health-coaching-to-improve-chronic-disease-management Mayo Clinic (2019). Obesity. Retrieved from https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742/Advanced Pharmacology Assignment Medscape (2019).  Simvastatin. Retrieved from www.reference.medscape.com Mensah G.A., & Brown, D.W. An Overview Of Cardiovascular Disease Burden In The United States. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.26.1.38/Advanced Pharmacology Assignment Sankaralingam S., Kim RB, Padwal RS.,(2015).The impact of obesity on the pharmacology of medications used for cardiovascular risk factor control. Rerieved from https://www.ncbi.nlm.nih.gov/pubmed/25661551 Waldner, T.V., (2013). Handling a Silent Killer: Hypertension Management. Retrieved from https://www.rn.com/nursing-news/handling-a-silent-killer-hypertension-management/ NURS 6521: Advanced Pharmacology Assignment: Pharmacotherapy for Cardiovascular Disorders