N521-Module Four: Pharmacotherapy of Respiratory & Cardiovascular Disorders

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Module 4 Overview

Introduction

This week we will focus on the pharmacotherapeutics of respiratory and cardiovascular disorders, including commonly occurring conditions and their commonly prescribed medications.

Learning Objectives

After completing this module, you will be able to:

  • Utilize advanced nursing and pharmacological interventions in treatment of respiratory and cardiovascular disorders to resolve complex and biological, psychological, physiological and pathophysiologic conditions.
  • Discuss evidence-based informatics resources for the prescriber
  • Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products in respiratory and cardiovascular disorders.

Reading & Resources

  • Read Chapters 19-23 & 25-26 in Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins
  • Online, open access readings
  • Hypertension guideline retrieved from http://www.nmhs.net/documents/27JNC8HTNGuidelinesBookBooklet.pdf
  • PulmCCM (2018). New 2017 guidelines for COPD released.  Retrieved from https://pulmccm.org/copd-review/new-2017-gold-guidelines-copd-released/
  • Qaseem, A., Wilt, T. J., Rich, R., Humphrey, L. L., Frost, J., & Forciea, M. A. (2017). Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 166(6), 430. doi:10.7326/m16-1785
  • White, J., Paton, J. Y., Niven, R., & Pinnock, H. (2018). Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. Thorax, 73(3), 293–297. doi:10.1136/thoraxjnl-2017-211189
  • Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., … Westlake, C. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of Cardiac Failure, 23(8), 628–651. doi:10.1016/j.cardfail.2017.04.014

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Learning Activities

  • Discussion: Participate in Discussion 4.
  • Assignment: Complete & Submit Assignment 2. Click on the Assignment 2 link for more details.

Discussion 4

R. S., a 65-year-old African-American man, was referred to the CNP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55, Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages; Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day

Diagnosis: Stage 1 Hypertension

In this discussion forum:

  1. Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol
  2. Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.
  3. Discuss the parameters for monitoring the success of the therapy.
  4. Discuss health promotion recommendations you would consider for R. S.
  5. Does the presence of Diabetes Mellitus impact your treatment selection?

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.