Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders,Strokes because of cardiovascular illnesses are acute incidents whose risk increases with atherosclerosis of blood vessels, the heart, or the brain. Age is another risk factor whereby, in the US, an estimated 83 million adults have one or more types of cardiovascular illnesses and more than 40 million are aged 60 years or older (GBD 2016 Lifetime Risk of Stroke Collaborators, 2018). Additional risk factors include ethnicity, gender, obesity, type 2DM, and hypertension. This knowledge improves NPs understanding of the pharmacology of drugs and can be used to make clinical decisions on the best pharmacologic regimens to prescribe for individual patients.Pharmacotherapy for Cardiovascular Disorders,Case Overview,The selected case involves a patient CB   with a history of strokes and a diagnosis of hypertension, type 2DM, hyperlipidemia, and types 2 DM. The patient has been prescribed the following drugs: glipizide 10 mg PO daily, HCTZ 25 mg daily, Atenolol 25 mg PO daily, hydralazine 25 mg QID, simvastatin 80 mg daily, and verapamil 180 mg CD daily.,How Age Influences Pharmacokinetics and Pharmacodynamics,Age-associated changes observed in people aged 50 years or older include weak baroreceptors and the sympathetic response of the neurons, which increases sensitivity to antihypertensive medications (Schlender et al., 2016). Patients with advanced age have a decreased hepatic clearance and renal clearance rate. This means that drugs can continue to circulate in the body for longer increases the risk of drug-drug interactions, toxicity, and adverse drug events (Arcangelo & Peterson, 2017). It is also worth noting that, the gastric motility of patients aged 60 years or older reduces and this may have a great impact on the absorption of drugs. Generally, a decrease in body water, BMI, renal function, hepatic clearance, and increased gastric motility also affects the metabolism and distribution of drugs.,Recommended Drug Therapy,Currently, the patient’s therapy includes; glipizide 10 mg PO daily, HCTZ 25 mg daily, Atenolol 25 mg PO daily, hydralazine 25 mg QID, simvastatin 80 mg daily, and verapamil 180 mg CD daily. However, in diabetic patients, a dosage of HCTZ mg daily for hypertension is contraindicated. Instead, it is recommended in patients whose rate of creatinine clearance exceeds 30ml/min. Besides, since this patient has a stroke, atenolol has many benefits. If the patient would have been black with heart failure, he was have benefited from hydralazine 25mg. On the other hand, a 25mg dosage of simvastatin is on the higher side and increases the risk of rhabdomyolysis and myopathy (Ezad, Cheema & Collins, 2018). Lastly, in paints with dysfunctioning of either the left ventricle or AV node, prescribers should avoid verapamil 180mg CD daily.Pharmacotherapy for Cardiovascular Disorders,Patient’s Drug Therapy Plan,Currently, the patient takes HCTZ 25 mg daily. The usual recommended initial dose is 25 mg OD and the daily dosage for maintenance may increase to a maximum of 50mg daily. When used with other hypertensive, it should be maintained at a dose of 50 mg once daily.,Glipizide 10 mg PO daily, the usual recommended dose for Glipizide is 2.5-5.0 mg to a maximum of 15mg based on the blood glucose levels and the maximum recommended dosage is 40mg.  However, prescribers must divide any dosages beyond 15mg and administer before meals for adequate glycemic control.,Hydralazine 25 mg QID- the initial dosage of hydralazine is 25mg bid, to a maximum of 200mg. However, Arcangelo & Peterson (2017) suggest that the daily dosage should not surpass 100mg without ascertaining the acetylator status.,Atenolol 25mg PO daily- usually, the initial recommended dose is 50mg once daily and maintenance dose is 50-100mg to a maximum of 100mg. Therefore, this patient’s dosage must be increased to 50mg.,Simvastatin 80 mg daily- the most commonly prescribed dose of simvastatin is 5-40mg/day. The staying dose should be 10/20mg OD in the evening. However, in high-risk patients such as those with a history of stroke, the initial dose is 40mg/day. According to, Arcangelo & Peterson (2017), the patient will also require weekly lipid profile tests to check for the simvastatin blood levels. Since he is also on verapamil 10mg daily, the dosage of simvastatin will have to be decreased.,Verapamil 180mg CD daily- the prescriber will have to adjust this drug based on the patient’s age and underlying cardiovascular risk. Its initial recommended dose is 180mg orally at bedtime to a maximum of 480mg/day. However, the prescriber will have to conduct weekly safety evaluations and therapeutic efficacy before titrating the dosages as deemed appropriate.,Conclusion,As age advances, there are physiological changes that occur in different organs and organ systems, which have a great impact on the pharmacodynamics and pharmacokinetics of drugs. Most importantly, without appropriate dose adjustments of medications used to manage cardiovascular disorders, these physiological changes are likely to result in adverse drug events or toxicity. In other cases, it may be difficult to attain the desired therapeutic goals. NPs must know hoe specific patent factors such as age can influence pharmacotherapy and prescribe medications in the appropriate dosage for optimal health outcomes.  Pharmacotherapy for Cardiovascular Disorders,References,Arcangelo, V. P., & Peterson, A. M. (Eds.). (2017). Pharmacotherapeutics for advanced,            practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.,Ezad, S., Cheema, H., & Collins, N. (2018). Statin-induced rhabdomyolysis: a complication of a commonly overlooked drug interaction. Oxford medical case reports2018(3), omx104.,GBD 2016 Lifetime Risk of Stroke Collaborators. (2018). Global, regional, and country-specific lifetime risks of stroke, 1990, and 2016. New England Journal of Medicine379(25), 2429-2437.,Schlender, J. F., Meyer, M., Thelen, K., Krauss, M., Willmann, S., Eissing, T., & Jaehde, U. (2016). Development of a whole-body physiologically based pharmacokinetic approach to assessing the pharmacokinetics of drugs in elderly individuals. Clinical pharmacokinetics55(12), 1573-1589.,Apendix_1a-,Apendix_1b-,Apendix_1c-,Pharmacotherapy for Cardiovascular Disorders, 

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