Pharmacology Nursing Care Case Study
Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:
- Glipizide 10 mg po daily
- HCTZ 25 mg daily
- Atenolol 25 mg po daily
- Hydralazine 25 mg qid
- Simvastatin 80 mg daily
- Verapamil 180 mg CD daily
- Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.
- Select one of the three case studies, as well as 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.
With these thoughts in mind:
By Day 3
Post an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected. Then, describe how changes in the processes might impact the patient’s recommended drug therapy. Finally, explain how you might improve the patient’s drug therapy plan.
By Day 6
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different case study than you did, in one or more of the following ways:
- Provide alternative recommendations for drug treatments.
- Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
- Validate an idea with your own experience and additional research.
According to Angelo and Peterson (2013), hypertension is a chronic disease affecting about 33% of the adults in the United States. On the other hand, hyperlipidemia is a disorder featured by elevation of cholesterol levels in the blood (Williams, 2009). Research shows that combination of hyperlipidemia and hypertension coupled with other comorbidities increases the rate of mortality and morbidity. The patient selected in this case has a history of atrial fibrillation and transient ischemic attack. The paper analyzes the pharmacodynamics and pharmacokinetics of medication which is crucial for safe and quality healthcare.
Age is one of the factors which influences the pharmacodynamics and pharmacokinetics of drugs. As a result, when prescribing medications, the health professionals always factor a combination of several aspects age being one of them. The older people experiences impairments in several organs of the body such as hepatic and renal parts which are extremely important in the cleansing and absorption of regimes (Arcangelo & Peterson, 2013). There are delays and impairments in the absorption of orally administered drugs in old age. Furthermore, the volume of distribution of the majority of the drugs decreases with age. A more significant percentage of the medicines accumulates in the fat stores with time.
Impacts of the Changes on the Patient’s Drug Therapy
The aging process has corresponding effects on various biological mechanisms. Some of these natural processes include increases in lipid peroxidation, alterations in gene expression, cell apoptosis upregulation, mitochondrial damage, and damages to nuclear DNA arising from an increase in oxidative stress among others. The modifications in organ functioning and body composition alters both pharmacodynamics and pharmacokinetics of drugs. Therefore, the older patients are prescribed to take a lower drug dosage as compared to the younger patients because the health specialists are always concerned about multiple comorbidities, and the elimination process in the body (Sera & McPherson, 2012).
Improving the Drug Therapy of the Patient
There are various changes which can assist in improving the drug therapy of the patient. For instance, in treating type 2 diabetes, the patients should stop using Glyburide 10 mg BID and try Glipizide 10mg instead. The Lisinopril may also potentiate Glipizide. Besides, H.M should stop using Atenolol 100 mg QD therapy for hypertension, and the patient should consider changing to ACE Inhibitor. The H.M should mainly stop utilizing the Atenolol because it is a cardio-selective beta blocker. The process of blocking the beta one masks the flight response which leads to masking of hypoglycemic symptoms such as tachycardia hence affecting the control of diabetes (Williams, 2009). The current therapy has no treatment for hyperlipidemia and thus the patient should use a statin drug such as Simvastatin to treat the condition.
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2006). Pharmacotherapeutics for advanced practice: a practical approach (Vol. 536). Lippincott Williams & Wilkins.
Sera, L. C., & McPherson, M. L. (2012). Pharmacokinetics and pharmacodynamic changes associated with aging and implications for drug therapy. Clinics in geriatric medicine, 28(2), 273-286.
Williams, L. (2009). Wilkins. Professional Guide to Diseases. Ambler.