Pharmacotherapy for Cardiovascular Diseases

Cardiovascular diseases are one of the major public health concerns since they contribute to 7 million hospitalizations annually and death. As a result, the identification of suitable treatment options for the diseases is important in order to enhance patient outcomes. Advanced practice nurses play a critical role in recommending appropriate treatment options for patients with these disorders. This process entails examining aspects that could influence the patient’s pharmacokinetic and pharmacodynamic procedures. For this paper, I have selected Patient AO who has gained 9 pounds, has a history of obesity, and suffers from hyperlipidemia and hypertension. Arcangelo & Peterson (2013) classify hypertension as a disorder that affects one in three American adults and hyperlipidemia as increase in the levels of blood cholesterol. These two conditions are regarded as foundations for serious health conditions like heart failure.

The selected patient factor for this case is ethnicity, which influences the development of hypertension and cardiovascular diseases among different groups of people. Epidemiological studies have shown that African Americans are at high risks of developing hypertension and have mortality rates in comparison to whites or other races (Ortega, Sedki & Nayer, 2015). According to Saab et al. (2015), African Americans are at high risk of cardiovascular and metabolic disorders like stroke and obesity unlike other racial or ethnic groups. African Americans are at high risks of developing these conditions because of inactivity and physiological attributes that enhances the likelihood of low levels of circulating renin and excess angiotensin II levels.
One of the factors that could have contributed to Patient AO’s obesity, hypertension, and hyperlipidemia is ethnicity. The patient’s weight gain is a major concern since it increases his/her hypertension by between 5mm and 20mm. Treatment for these conditions involve a combination of medication and lifestyle changes or therapy. Some of these lifestyle changes include maintaining a healthy diet, increased physical activity and exercise, stress management, maintaining a healthy weight, reducing alcohol consumption, and avoiding smoking. Patient AO is currently under the maximum dosage of doxazosin i.e. 8mg daily though the reason for the high dosage is not specified in the case. On the other hand, the patient is on an extremely low dosage of atenolol whose normal daily dose is 50mg while the maximum daily dose is 200mg, which is administered orally. The extremely low dosage of this medication could be attributable to the fact that the patient is under increased dosage of doxazosin. The patient’s weight gain could be brought by sertraline medication, which is within the normal dosage range and contributes to weight gain as one of its side effects. However, this patient is under high dosage of simvastatin, which should be reduced as diet and exercise changes are made.
The patient’s pharmacokinetic and pharmacodynamic processes are affected by poor nutrition and decreased nutrition. Poor nutrition could be evident in the patient’s case since its one of the pharmacokinetics that usually accompanies obesity. Changes in these processes could affect the recommended drug therapy by resulting in prescription of drugs that enhance circulation and lifestyle changes that improve diet and exercise. This could involve increasing atenolol dosage since it’s a beta blocker that affects the heart and circulation as well as lessening simvastatin dosage with diet and exercise changes. Changes in these processes could also lead to reduction of doxazosin and hydralazine dosage to help relax arteries and veins. In light of these factors, I would improve the patient’s drug therapy plan increasing atenolol dosage to 50mg daily and lessen simvastatin dosage to 40mg daily. I would also eliminate hydralazine medication and maintain sertraline dosage at 80mg while monitoring the patient for better fluid retention or cholesterol.
References
Arcangelo, V.P. & Peterson, A.M. (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Ortega, L.M., Sedki, E. & Nayer, A. (2015, March-April). Hypertension in the African American Population: A Succinct Look at its Epidemiology, Pathogenesis, and Therapy. Nefrologia, 35(2), 139-145.
Saab et al. (2015, February). New Insights on the Risk for Cardiovascular Disease in African Americans: The Role of Added Sugars. Journal of the American Society of Nephrology, 26(2), 247-257.