Pharmacotherapy for Cardiovascular Disorders Essay

Cardiovascular diseases cause significant morbidity and mortality globally and in the US. Besides, their prevalence in the US is increasing gradually thus, they pose potential threats and challenges to the American healthcare system. Despite the advancement in treatment, patients with cardiovascular diseases do not receive optimal care. This is attributed to their complex nature, which requires a good understanding of their risk factors and pathophysiology and how these factors influence pharmacodynamics and pharmacokinetic processes. Pharmacotherapy for Cardiovascular Disorders Essay.

Case Overview

The selected case study for this assignment involves a patient named AO who was obese and has subsequently gained 9 pounds. AO has a diagnosis of hyperlipidemia and hypertension with the following prescribed medications: Sertraline 25 mg, doxazosin 8 mg, atenolol 12.5 mg and Simvastatin 80 mg daily, with hydralazine 10 mg qid.

Patient Factors

The selected patient factor is behavior concerning AOs obesity. This means that AO’s lifestyle has a high-calorie intake and decreased physical activity. As explained by Shattat (2015), the pathophysiology of obesity-related hypertension is attributed to the accumulation of fat in the intravascular space and intra-abdominal muscles, it activates the renin-angiotensin system and leads to retention of sodium hence increased renal absorption.

Obesity and hyperlipidemia complicate the management of cardiovascular disorders. Therefore, poor circulation and poor nutrition affect the pharmacokinetics and pharmacodynamics of this patient. It is inarguable that AO has poor nutrition and reduced circulation, which is influenced by obesity and limited physical activity respectively. The two factors lead to vasoconstriction that accompanies hypertension and the build-up of plaque as observed in hyperlipidemia. As emphasized by Arcangelo & Peterson (2013), it is necessary to understand how these risk factors affect the management of cardiovascular disorders and their side effects on the patient’s ability to respond to drug therapy to achieve desired therapeutic outcomes. This understanding will also influence clinical decision making on appropriate dietary and therapeutic modifications to attain specific treatment goals. AO should consider making modifications to his diet and have a regular physical exercise to improve his cardiovascular health and efficacy of the recommended treatment plan. Pharmacotherapy for Cardiovascular Disorders Essay

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Pharmacodynamics & Pharmacokinetics

It is not clear if AO adheres to prescribed medications since he has several pills to take daily. Based on the recommendations provided by the AHA (American Heart Association), patients with hypertension should be given combined therapy to reduce the risks of side effects and non-compliance. AO is at a high risk of hydralazine associated SLE. Besides, the combination of doxazosin and atenolol produces synergistic effects such that, the latter blocks alpha 1 receptors resulting in the dilation of blood vessels reducing the peripheral resistance (Pokrovsky, Polishchuk & Polischuk, 2017).  However, atenolol is cardio-selective thus blocks beta 1 receptors even at the lowest doses.

Improving the Drug Therapy Plan

AO’s drug plan has numerous areas that need improvement. First, AO’s prescription has atenolol, which is a beta-blocker. Beta-blockers act by blocking the effects of adrenaline to influence vasodilation, improve the flow of blood and lower blood pressure. Beta-blockers are major contributors to hyperlipidemia according to currently existing research (Carey & Wheaton, 2018).  Besides, according to the recommendations provided by the FDA, it is not the 1^st line dug of choice in hypertension management. Based on these reasons, atenolol must be discontinued in this patient’s drug therapy. Discontinuation of atenolol should also prompt the discontinuation of hydralazine since the latter is administered alongside a diuretic and a beta-blocker. Pharmacotherapy for Cardiovascular Disorders Essay.

The FDA recommends diuretics for hypertension 1^st line managements. For this patient, a daily dose of 12.5mg hydrochlorothiazide (HCTZ) is the most appropriate. As a thiazide diuretic, HCTZ acts on the renal system by decreasing the reabsorption of sodium in the distal convoluted tubule (Roush & Sica, 2016). It is also worth mentioning that thiazides are not only beneficial but also safe in patients with diabetes and reduce the risk of high mortalities from stroke and heart disease. However, it should be administered in the lowest dose possible. AO is not a known diabetic. However, she has several risk factors for diabetes, which should prompt the need to determine whether she has diabetes.

Simvastatin, a statin, is appropriate for managing this patient’s hyperlipidemia. Simvastatin acts by decreasing cholesterol production in the liver by blocking the HMG CoA enzyme (Arcangelo & Peterson, 2013). Besides, it is the FDA‘s recommended drug for the 1^st line management of hyperlipidemia based on a patient’s blood cholesterol levels. Therefore, to determine if simvastatin is still effective, I would order for a blood cholesterol test. On the other hand, I would recommend that AO take doxazosin at night since it causes orthostatic hypotension as a major side effect. Pharmacotherapy for Cardiovascular Disorders Essay.

 References

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

Carey, R. M., & Wheaton, P. K. (2018). Prevention, detection, evaluation, and management of high blood pressure in adults: Synopsis of the 2017 American College of Cardiology/American Heart Association hypertensive guideline. Annals of Internal Medicine, 168(5), 351-358.

Pokrovsky, V., Polishchuk, L., & Polischuk, S. (2017). The methodology for assessing the effectiveness of the therapy. Research Results in Pharmacology, 3, 91.

Roush, G. C., & Sica, D. A. (2016). Diuretics for hypertension: a review and update. American journal of hypertension, 29(10), 1130-1137. Pharmacotherapy for Cardiovascular Disorders Essay

Shattat, G. F. (2015). A review article on hyperlipidemia: types, treatments and new drug targets. Biomedical and Pharmacology Journal, 7(1), 399-409.

Paper details

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.  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.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

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 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. Pharmacotherapy for Cardiovascular Disorders Essay

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.
• Scenario: 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
• Sertaline 25 mg daily
• Pharmacotherapy for Cardiovascular Disorders Essay

Essay on state of adult obesity in Texas

Respond to the following essay on state of adult obesity in Texas

Texas County has a 33% of adults who reported a BMI of 30 or more. The top performer in this category has 26% with the state of Missouri recording 31% in the category. I feel like this is an area that needs improvement especially considering the dire health outcomes of obesity which include prevalence of acute and chronic conditions like hypertension (Brennan et al., 2014). Texas county and by extension the entire state of Missouri need to address the problems of adult obesity as the numbers do not make for good reading. Clearly, improvements need to be made to at least get to the level of the leading state at 26%. Essay on state of adult obesity in Texas

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Health resources available

With statistics showing that one in every three adults in the state of Missouri are obese, the state of through the Missouri Department of Health and Senior Services (DHSS) has partnered with Centers for Disease Control and Prevention (CDC) for The Missouri Disability and Health Collaborative (Dietz, 2015). This is meant to get the necessary funds to support people who are intellectually challenged ad help them access an array of evidenced based physical activity. This collaborative move seeks to ensure individuals with intellectual disabilities can access Missouri’s public health facilities in terms of adapting evidenced based physical activity and nutrition to improve their health (Dietz, 2015). Essay on state of adult obesity in Texas

Health policy

Preventing obesity at childhood is the best possible way if reducing the rates of obesity in the long term (Brennan et al., 2014). Good Early childhood education (ECE) can encourage good dieting and physical activities for children and cultivate a healthy culture. In that regard, I would suggest the state of Missouri to continue encouraging healthy eating habits for children at a young age. While there is a state policy which requires licensed ECE programs to allow breastfeeding on site up to at least a year, it should be extended to even unlicensed ECE programs. This is to ensure that the rate of obesity is lowered in the state.

References

Brennan, V. M., Kumanyika, S. K., & Zambrana, R. E. (Eds.). (2014). Obesity interventions in underserved communities: evidence and directions. JHU Press.

Dietz, W. H. (2015). The response of the US Centers for Disease Control and Prevention to the obesity epidemic. Annual review of public health, 36, 575-596. Essay on state of adult obesity in Texas

Obesity in Miami Essay

To offer discussion response to Obesity in Miami Essay

Miami-Dade County, Florida. According to the website that I researched (County Health Rankings, 2017), health in this county seems to be pretty good. Ninety-nine percent of individuals living in this county have access to exercise opportunities however, obesity is a problem because 21 percent of the individuals are physically inactive – this corresponds to an adult obesity rate that is also 21 percent. Although this sounds like a fairly high rate (a little more than one-fifth of the population) it is important to keep  in mind that it is quite a bit less than the national adult obesity rate of 36.5 percent (CDC, 2016). Obesity in Miami Essay

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Obesity is an important health problem that should not be ignored as it contributes to several different types of adverse health outcomes. These include cardiovascular disease, diabetes, some cancers, and stroke risk (CDC, 2016). There are several lifestyle factors that contribute to obesity, and the main ones are dietary intake and physical inactivity. It seems pretty clear from the statistics in County Health Rankings (2017) that physical inactivity in Miami-Dade, Florida and obesity are going hand-in-hand, as the physical inactivity rate and the obesity rate in that county are exactly the same. Dietary intake is also important in that individuals who consume too much food are at great risk of obesity, especially when this consumption of food (and therefore the input of energy) greatly outpaces the activity level of the individual (and therefore the outflow of energy). Some health resources available to address the problem include the availability of counseling and therapy services, and weight loss centers and programs (for individuals who have enough money to afford these), and self-help groups like Overeaters Anonymous that are free and therefore available to people with lower income levels as well. These methods are useful for addressing the food-intake component of obesity. For addressing the physical inactivity component, there are gyms and county and neighborhood parks that everyone can utilize to increase their activity levels.

CDC. (2016). Overweight and obesity. Retrieved March 7, 2016, from http://www.cdc.gov/obesity/data/index.html

County Health Rankings. (2017). County Health Rankings and Roadmaps. Retrieved from http://www.countyhealthrankings.org/ Obesity in Miami Essay

 

NUR4636 – Community Health Nursing Essay

NUR4636 – Community Health Nursing

Case Study

Chapter 14

Theoretical Basis of Community/Public Health Nursing

Public health nursing is a community-oriented, population-focused nursing specialty

that is based on interpersonal relationships. The unit of care is the community or

population rather than the individual, and the goal is to promote healthy

communities NUR4636 – Community Health Nursing Essay. The community health nurse has been assigned to count and

interview homeless people sleeping in the local park to help in identifying programs

to provide food, clothing, shelter, health care, and job training for the population.

The community health nurse has to consider the eight principles of public health

nursing in community health nursing practice when completing the assignment

1. There are essential characteristics of nursing service when a community is

the client. Describe community-oriented, population-focused care, and

relationship-based care. What type of care is been completed by the

community health nurse who has been assigned to count and interview

homeless people sleeping in the local park to help in identifying programs to

provide food, clothing, shelter, health care, and job training for the

population?

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2. The goals of public health nursing, to promote and protect the health of

communities, are facilitated by adhering to eight principles identified by the

American Nurses Association (2007) for public health nursing practice. The

community health nurse has to consider the eight principles of public health

nursing in community health nursing practice when completing the

assignment with homeless individuals. What are the eight principles?

3. There are numerous models of nursing practice that can be utilized in

community health nursing practice. Theories and models of

community/public health nursing practice aid the nurse in understanding the

rationale behind community-oriented care. What are five of these models of

nursing practice with a brief summary of the model? NUR4636 – Community Health Nursing Essay