NURS 6521 Week 3: Cardiovascular System

NURS 6521 Week 3: Cardiovascular System
Sample Answer for NURS 6521 Week 3: Cardiovascular System Included After Question

Discussion: Pharmacotherapy for Cardiovascular Disorders 

As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This is the result of the extensive treatment and care that is often required for patients with these disorders. While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011). Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors. 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. 

Consider the following case studies: 

Case Study 1: 

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 
Sertraline 25 mg daily 
Simvastatin 80 mg daily 
Case Study 2: 

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following: 

Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun 
Aspirin 81 mg daily 
Metformin 1000 mg po bid 
Glyburide 10 mg bid 
Atenolol 100 mg po daily 
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain 
Case Study 3: 

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 
To prepare: 
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. 

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! 

Submission and Grading Information 

Grading Criteria  

Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. Consider hypertension. An estimated 68 million people in the United States have this disorder (CDC, 2012). However, about 30 percent of these patients are not treated at all, and of those who are treated, less than 50 percent have properly controlled blood pressure levels (University of Maryland Medical Center, 2009). In clinical settings, patients often present with symptoms of hypertension and other cardiovascular disorders making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options. 

This week you examine the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for these disorders. 

Learning Objectives 

By the end of this week, students will: 

Evaluate the influence of patient factors on pharmacokinetic and pharmacodynamics processes 
Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy 
Evaluate drug therapy plans for cardiovascular disorders 
Understand and apply key terms, concepts, and principles related to prescribing drugs to treat cardiovascular disorders 

Photo Credit: GIPhotoStock/Cultura/Getty Images 

NURS 6521 Week 3: Cardiovascular System
Learning Resources 

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below. 

A Sample Answer For the Assignment: NURS 6521 Week 3: Cardiovascular System
Title: NURS 6521 Week 3: Cardiovascular System
Case Study 2 

 Patient HM has an extensive cardiovascular history.  There is a history of atrial fibrillation, ischemic attack (TIA), type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease.  The patient is prescribed a list of medications that include: 

Warfarin 5 mg daily po MWF and 2.5 mg daily T, TH, Sat, Sun  
Aspirin 81mg daily po  
Metformin 1000 mg PO  
Glyburide 10 mg PO BID  
Atenolol 100 mg PO daily  
Motrin 200 mg 1-3 tablets every 6 hours as needed for pain  

Cardiovascular disease affects many people worldwide annually.  Kendir et al. 2018 state that cardiovascular diseases are the most common cause of death from non-communicable diseases (p.46).  Cardiovascular disease can refer to many diseases that affect the heart, and it’s vessels.  Our patient HM had many diagnosed cardiovascular disorders.  Atrial fibrillation which is an arrhythmia the heart due to loss of coordination of electrical and mechanical activity in the atria (Arcangelo, Petterson, Wilbur, & Reinhold, 2017, p.864).  Clots or thrombi can develop from atrial fibrillation causing strokes or ischemic attacks.  Unfortunately, HM had a history of ischemic attacks (TIA).  According to Arcangelo et al. 2017, an ischemic stroke is described as a sudden or progressive onset of focal neurologic sign due to the inadequate blood supply to the brain (p.868).  Having hyperlipidemia which is a high blood level of cholesterol further makes heart disease worse because the cholesterol builds up in vessels affecting blood flow.  Hypertension heightens the potential of developing cardiovascular disease and chronic kidney disease.  Hypertension can go for a long period of time going undetected because it can be asymptomatic.  Finally, HM was diagnosed with type II diabetes, which is caused when adipose and muscle cells become less sensitive to the actions of insulin or the pancreas produces less insulin than the body needs (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.785).  

Patient Factor 

  The disorders that HM has been diagnosed with can happen at any age, however, in elderly patients, they may have a poorer prognosis because medications are not always processed by the body as well or as intended.  The development and worsening of cardiovascular disease are associated with many factors such as genetics, lifestyle choices/behaviors, ethnicity, and age.  With so many other factors as a person ages, it is worsening the disease because that is a factor that cannot be changed.  With the patient HM’s medical history as a provider, you have to be cautious when prescribing because medications are absorption may be affected because of age.  

Drug Therapy Plan 

 The patient’s medical history puts him at higher risk of having a heart attack or stroke from complications of cardiovascular disease.  With this patient, we want to control his diabetes, hypertension, hyperlipidemia, and atrial fibrillation keeping levels within normal limits without over prescribing to this patient.  The first thing that was noticed when looking at the patient’s medication list is that he is talking two medications with anticoagulant effects.  Warfin which is a strong anticoagulant and aspirin.  When taking Warfin routine lab work is needed to check the PT, INR, and aPTT levels in the blood to determine if the medication dose needs to be adjusted.  Added aspirin in could cause increased bleeding, the elderly population with underlying malignancy and those taking interacting drugs that increase warfarins effect are at high risk for bleeding and should receive lower initial doses (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.874). 

 HM has type two diabetes and is taking Atenolol 100mg daily which is a beta-blocker.  Arcangelo et al. 2017 stated, in diabetic patients, beta-blockers can mask all symptom of hypoglycemia except sweating (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.266).  Being on this medication, the patient would have to consistent with monitoring his glucose levels and educated well on signs and symptoms of hypoglycemia.  This patient may benefit better from an Angiotensin II Receptor Blocker such as losartan.  For diabetics, losartan is a better choice because it is more effective than atenolol in lower cardiovascular morbidity and mortality in diabetic patients with hypertension and left ventricular hypertrophy (Arcangelo, Petterson, Wilbur, & Reinhold, 2017,p.267).  Being that HM is elderly, his initial dose should be losartan 50 mg Po daily.  Starting at 50 mg daily leaves enough room to adjust up if needed depending on the patient’s blood pressure (Kizior,2018). 

Reference: 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). 

 Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins 

 Kendir, C., van den Akker, M., Vos, R., & Metsemakers, J. (2018). Cardiovascular disease 

 patients have increased risk for comorbidity: A cross-sectional study in the Netherlands. The European Journal Of General Practice, 24(1), 45–50. https://doi-org.ezp.waldenulibrary.org/10.1080/13814788.2017.1398318 

 Kizior, R. (2018). Saunders Nursing Drug Handbook 2019. Elsevier – Health Sciences Division. 

A Sample Answer 2 For the Assignment: NURS 6521 Week 3: Cardiovascular System
Title: NURS 6521 Week 3: Cardiovascular System

Patient CB has a history of strokes and has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed are              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 

Pharmacological Evaluation 

Glipizide 10 mg PO daily 

               Glipizide is classified as a sulfonylurea (Connective Rx, 2018) which is being utilized to treat the patient’s diabetes. This medication should be administered 30 minutes before meals (Connective Rx, 2018). Dosing starts at 5mg by mouth daily with a max of 40mg per day, and maintenance is usually 10mg-15mg once a day (Connective Rx, 2018). The mechanism of action for glipizide is to lower the blood sugar by stimulation of the pancreatic islet cells, which in turn causes an increase in insulin secretion (Connective Rx, 2018). There is a decrease in efficacy of the medication if there is a decrease in the number of functioning beta cells or a low number of viable cells. This medication is highly protein bound, metabolized by the liver, excreted in the urine, has a half-life of 2-4 hours, and duration of action of 12-24 hours (Connective Rx, 2018). Special considerations include hepatic impairment in which the initial dose should be decreased to 2.5mg by mouth daily (Connective Rx, 2018). Patients with renal impairment have an increased predisposal to hypoglycemic reactions requiring close monitoring of blood glucose levels (Connective Rx, 2018). Within the current drug regime currently prescribed for the patient, drug to drug interactions are present with atenolol and hydrochlorothiazide (HCTZ). Atenolol can hide the symptoms of hypoglycemia which causes the need to monitor blood glucose levels more frequently.  HCTZ can decrease insulin sensitivity and glucose tolerance. 

Hydrochlorothiazide (HCTZ) 25 mg daily 

               Hydrochlorothiazide (HCTZ) is classified as a thiazide diuretic (Connective Rx, 2018) that is being used to treat the patient’s hypertension (HTN). Initial dosage is  12.5mg – 25mg PO once daily with a maximum dosage of 50 mg daily prescribed in one or two doses (Connective Rx, 2018). The mechanism of action for HCTZ is to decrease the excretion of sodium, chloride, and water by inhibiting sodium ion transport across the renal tubule epithelium (Connective Rx, 2018). The main mechanism of action occurs with the inhibition of the chloride reabsorption to the distal portion of the ascending limb or previous parts of the distal tubule (Connective Rx, 2018). Dosage adjustments must be made with renal patients based on the creatinine clearance (Connective Rx, 2018). HCTZ is excreted unchanged in the urine. 61% of it excreted within 24 hours and it has a half-life of 5.6 – 14.8 hours (Connective Rx, 2018). Caution must be considered in individuals with diabetes due to the impaired glucose tolerance that occur with this medication. The administration of glipizide and HCTZ can cause decreased insulin sensitivity (Connective Rx, 2018). 

Atenolol 25mg daily 

               Atenolol is a selective beta-blocker that is also being utilized for blood pressure management. Initial dosing is 25-50mg by mouth daily with a maximum dosage of 100 mg per day (Connective Rx, 2018). The mechanism of action includes a beta-adrenergic antagonist countering the effects of the sympathetic neurotransmitters by fighting for the receptor sites (Connective Rx, 2018). Atenolol is minimally bound to plasma proteins, has little to no metabolism in the liver, 30% of it is excreted in the urine after 24 hours, and has a half-life of 6-7 hours (Connective Rx, 2018). Food reduces the bioavailability by 20% without impacting the overall bioavailability and it has a peak of 2-4 hours after administration. Renal adjustment dosing is done based on creatinine clearance values and 25mg to 50mg can be administered with each standard dialysis session (Connective Rx, 2018). Atenolol can enhance hypoglycemia by interfering with glycogenolysis (Connective Rx, 2018). Atenolol, taken in conjunction with Verapamil, can improve exercise tolerance; however, it can lead to a significant AV nodal blockade, which would manifest as bradycardia, heart conduction abnormalities, or a heart block (Connective Rx, 2018). 

Hydralazine25mg QID 

               Hydralazine is classified as an Arteriole Smooth Muscle Drug being utilized to treat the hypertension. Initial dosing is 10 mg by mouth four times a day, which can be increased to 25 mg by mouth four times a day for the remainder of the week, and can be increased to a dosage of 80 mg by mouth four times a day the second and subsequent weeks (Connective RX, 2018). The max dosage is 300 mg per day (Connective RX, 2018). Hydralazine is a peripheral vasodilator which causes relaxation of arteriolar smooth muscle via a direct effect (Connective RX, 2018). The percentage that binds with plasma proteins is 87%, it is hepatically metabolized (plasma levels depend on the acetylation), it is excreted via the feces and urine (Connective RX, 2018).  The half-life is 3-7 hours, it peaks at 1-2 hours, and lasts 2-4 hours (Connective RX, 2018). Renal dosing is based on creatinine clearance. Dosing can be in intervals of 12-24 hours for patients with intermittent hemodialysis or peritoneal dialysis (Connective RX, 2018). Patient education should include caution with driving when starting the medication to determine the effect of the medication on the patient. It can cause confusion and disorientation (Connective RX, 2018). 

Simvastatin 80mg daily 

               Simvastatin is classified as a statin and being utilized to treat hyperlipidemia. Initial dosing is 10-20 mg daily in the evening with dose adjustments made to achieve lipid level targets (Connective RX, 2018). The maximum daily dose is 40 mg per day for initial therapy and 80 mg per day in individuals with chronic myopathy (Connective RX, 2018). Simvastatin impacts hyperlipidemia by impacting the De novo synthesis of cholesterol, enhancing clearance of LDL, decreasing the total cholesterol, LDL, triglycerides, and apolipoprotein B, while increasing HDL (Connective RX, 2018). It is contraindicated for hepatic impairment and initial dosing is decreased to 5 mg per day with renal impairment (Connective RX, 2018). It is activated in the liver, is 95% plasma protein bound, lipophilic, excreted in the feces (60%) and urine (13%) (Connective RX, 2018). It has a half-life of 1.9 hours, with a peak plasma level of 1.3-2.4 hours (Connective RX, 2018). Bioavailability can be impacted by the consumption of high fat meals (Connective RX, 2018). Caution must be taken with individuals with diabetes mellitus due to simvastatin usually worsening glycemic control during therapy and increasing the hemoglobin A1C (Connective RX, 2018). Simvastatin has a major interaction with verapamil in which the risk of myopathy is increased, including rhabdomyolysis (Connective RX, 2018). The dose should not exceed 10 mg per day in patients taking verapamil or clinicians should consider switching to another statin because verapamil increases the exposure of simvastatin two fold (Connective RX, 2018). 

Verapamil 180 mg CD daily           

               Verapamil is classified as a Phenyaklamine Calcium Channel Blocker that is being used to treat the hypertension. Initial dosing is 80 mg by mouth three times a day, with dosage increases occurring at weekly intervals (Connective Rx, 2018). The maximum dosage is 480 mg per day; however, not much benefit has been observed greater than 360 mg per day (Connective Rx, 2018).Verapamil inhibits the influx of extracellular calcium ions across the vascular smooth muscle and the myocardial muscle cell membrane which deforms the channels (Connective Rx, 2018). Verapamil is impacted by the “first-pass” effect, binds to the plasma protein (90%), excreted by the kidneys (70%), and excreted fecally (16%). The onset is in 1-2 hours with duration of 8-10 hours (Connective Rx, 2018). A 33% decrease in the initial dose must be prescribed for individuals with hepatic impairment. Dosing adjustment has to be made with patients with renal impairments (Connective Rx, 2018). Grapefruit juice must be avoided because it increases the bioavailability of verapamil (Connective Rx, 2018). Drug to drug interactions have been mentioned above. 

  Changes to the Drug Regime 

               After reviewing the medication list, the one change that would be made is selection of a different statin. This change would be made because of the interaction of the statin with the verapamil. Data indicates the need to change the statin, if verapamil is being prescribed in individuals with high doses of simvastatin (Connective RX, 2018). The drug of choice would be Rosuvastatin Calcium. 

Pharmacological Evaluation of the New Drug 

               Rosuvastatin calcium is a statin that is also utilized to treat hyperlipidemia (Connective Rx, 2018). Initial dosing is 10 mg daily with a maximum dose of 40 mg by mouth per day (Connective Rx, 2018). Rosuvastatin calcium  decreases LDL cholesterol, triglycerides, total cholesterol , and apolipoprotein B, while increasing HDL (Connective Rx, 2018). 80 % of Rosuvastatin calcium is bound to the plasma protein, 90% is excreted un-metabolized in the fecal matter, and 10 % by the renal system (Connective Rx, 2018). Just like Simvastatin, caution must be taken with individuals with diabetes mellitus due to simvastatin usually worsening glycemic control during therapy and increasing the hemoglobin A1C (Connective Rx, 2018). The presence of food decreases the bioavailability by 20%; however, it does not impact the overall bioavailability. The medication peaks in 3-5 hours (Connective Rx, 2018). A decreased initial dose should be prescribed to Asians (Connective Rx, 2018). Unlike Simvastatin, Rosuvastatin calcium does not have a serious interaction with Verapamil, which is why this medication was chosen. 

Treatment Optimization and Conclusion  

               The medication regime above would require optimization based on laboratory values, vitals sign readings, blood glucose readings, and the known interaction of verapamil and simvastatin. A lipid panel would be required to determine if the current dosage of simvastatin was effective and the equivalent dose of Rosuvastatin calcium would be prescribed (due to the drug-drug interaction).  If is not effective, re-evaluation would be required due to the change from simvastatin to Rosuvastatin calcium.  Blood glucose readings in conjunction with the vital sign reading would have to be reviewed for optimization of the glipizide, HCTZ, atenolol, verapamil, and Hydralazine. Both Rosuvastatin calcium and HCTZ decreases the body’s sensitivity to insulin, impacting the effects of glipizide; however, atenolol helps counteract those effects because is enhances the sensitivity of the cells to insulin. In order to create a balance between the diabetic management and blood pressure, the first adjustments would more than likely be made to the glipizide and atenolol since they are not maxed out, and they both benefit the diabetic management. An assessment of the patient compliance would be obtained. Identifying compliance would assist with the development of the education plan for the patient and family. A significant amount of patient education would be provided to ensure the patient is aware of the possible side effects, how to handle them, and the impact of not following the medication regime (Arcangelo, Peterson, & Reinhold, 2017). Education about the value of the required tests would also be provided to the patient and/or family. 

  References 

Arcangelo, V. P., Peterson, A. M., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Ambler, PA: Lippincott Williams & Wilkins. 

Connective Rx. (2018). Atenolol. Retrieved from PDR.net: https://www.pdr.net/drug-summary/Tenormin-atenolol-1128.3571 

Connective Rx. (2018). Atenolol. Retrieved from PDR: https://www.pdr.net/drug-summary/Tenormin-atenolol-1128.3571 

Connective Rx. (2018). Glipizide-Drug Summary. Retrieved from PDR: https://www.pdr.net/drug-summary/Glucotrol-glipizide-1635 

Connective RX. (2018). Hydralazine. Retrieved from PDR: https://www.pdr.net/drug-summary/Hydralazine-Hydrochloride-Tablets-hydralazine-hydrochloride-738.119 

Connective Rx. (2018). Hydrochlorothiazide. Retrieved from PDR: https://www.pdr.net/drug-summary/Hydrochlorothiazide-Tablets-hydrochlorothiazide-1973 

Connective Rx. (2018). Rosuvastatin Calcium – Drug Summary. Retrieved from PDR: https://www.pdr.net/drug-summary/Crestor-rosuvastatin-calcium-2318 

Connective RX. (2018). Simvastatin. Retrieved from PDR: https://www.pdr.net/drug-summary/Zocor-simvastatin-402.3285 

Connective Rx. (2018). Verapmil. Retrieved from PDR: https://www.pdr.net/drug-summary/Calan-verapamil-hydrochloride-1693 

A Sample Answer 3 For the Assignment: NURS 6521 Week 3: Cardiovascular System
Title: NURS 6521 Week 3: Cardiovascular System
Case study 1 

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  
Sertraline 25 mg daily  
Simvastatin 80 mg daily  

Hypertension is a chronic condition caused by obesity, sedentary lifestyle, and an increase of salt intake (Nickson, 2015). Hypertension is called the silent killer because the condition can be asymptomatic, no signs or symptoms. (Nickson, 2015). It is a condition that can be treated and maintained if compliant with medications.  

Hyperlipidemia is an increase in cholesterol levels. It is caused by genetic, and environmental factors and It does not cause any symptoms. Hyperlipidemia is a treatable condition if compliant with medication.  

Pharmacokinetic 

  Obesity is a disorder involving excessive body fat which leads to dangerous health problems.   93.3 billions of adults live with obesity in the US. (CDC). Drug administration in obese patients is difficult because the recommended dose of medication is based on pharmacokinetic data from standard weight data (Nickson, 2015). Organs involved in drug elimination can be affected by pharmacokinetics more difficult due to obesity (Nickson, 2015). Obesity affects drug distribution and elimination.  Using total body weight will help. 

Pharmacodynamic 

  Atenolol 12.5 mg daily, beta-adrenoreceptor blocking activity by reducing heart rate and cardiac output, decreasing blood pressure, and isoproterenol-induced tachycardia (Drug.com, 2017).The beta-blocking effects of atenolol measures by reduction of exercise tachycardia are within one hour after administration of a single dose(Drug.com, 2017).  

 Doxazosin 8 mg daily,  reduces in systemic vascular resistance. Max reduction between 2-6 hours following a dose, a greater effect on blood pressure and heart rate in the standing position (Drug.com, 2017). 

Hydralazine lowers blood pressure by peripheral vasodilating effects decreasing the arterial blood pressure(Drug.com, 2017). Hydralazine is rapidly absorbed orally and peaks plasma level 1-2 hours(Drug.com, 2017).   

Sertraline 25 mg daily, blocks the uptake of serotonin into the human platelets. It is a potent and selective inhibitor of neuronal serotonin reuptake and has a weak effect on norepinephrine and dopamine neuronal reuptake (Drug.com, 2017). 

  Obesity is associated with comorbidities like uncontrolled hypertension.  Drug therapy is needed to achieve blood pressure control. Obese hypertensive patients often have metabolic abnormalities. (Scholze & Sharma, 2001). 

  Bases of metabolic profile ace inhibitors, angiotensin receptor blockers, calcium channel clockers, moxonidine, and alpha-blockers can lower  the blood pressure without worsening the metabolic abnormalities 

(Scholze & Sharma, 2001). 

  Reference 

Scholze, J, Sharma, AM. (2001). Treatment of hypertension in obesity. Retrieved from 

https://www.ncbi.nlm.nih.gov/pubmed/11413801 

  Nickson, C. (2015). Obesity and pharmacokinetics. Retrieved from https://lifeinthefastlane.com/ccc/obesity-and-pharmacokinetics/ 

  Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).Pharmacotherapeutics for advanced practice: A practical approach(4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

  Centers for Disease Control and Prevention.(2018). Retrieved from https://www.cdc.gov/obesity/data/adult.html 

Drug.com (2017). Retrieve from https://www.drugs.com 

A Sample Answer 4 For the Assignment: NURS 6521 Week 3: Cardiovascular System
Title: NURS 6521 Week 3: Cardiovascular System
Case Study 1: 

Patient AO is a 35-year-old, white male and has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Patient states he doesn’t understand why his legs are swelling and has shortness of breath.  Drugs currently prescribed include the following: 

Atenolol 12.5 mg daily  
Doxazosin 8 mg daily  
Hydralazine 10 mg qid  
Sertraline 25 mg daily  
Simvastatin 80 mg daily  
Pharmacological Evaluation 

            Patient AO is currently taking Atenolol which has been prescribed to treat his hypertension.  Atenolol is a beta-blocker, has a bioavailability of 46%-60%, metabolized in the liver, and excreted in feces and urine.  Atenolol was prescribed in conjunction to Hydralazine to treat the hypertension, Hydralazine is a vasodilator.  The bioavailability of Hydralazine is 30%-50%, metabolized in the liver, and eliminated through the urine.  Doxazosin is an Alpha blocker that is treating AO’s hypertension.  Doxazosin has a bioavailability of 65%, metabolized extensively in the liver, and eliminated through feces and urine.  Sertraline is an antidepressant, which is a serotonin reuptake inhibitor.  Sertraline’s bioavailability is increased with the intake of food, metabolized by hepatic cytochrome P450 enzymes, and excreted through the urine and feces.  Simvastatin is a statin, a lipid lowering agent which was prescribed to treat his hyperlipidemia.  Simvastatin’s bioavailability is less than 5% and takes 4-6 weeks to have maximum effect.  Metabolized in the liver and eliminated through feces and urine.  (Drugs, 2017).   

Changes to Drug Regimen 

This patient is currently suffering from shortness of breath and lower leg swelling and needs to be treated with a diuretic. The patient will need to be treated with a loop or high-ceiling diuretic such as Furosemide.  Furosemide is administered orally or parenterally.  The half life is rather short which allows patients to know when the effectiveness will occur allowing them to know when they will have diuresis.  Furosemide will help the patient expel the fluid that has built up in his stomach.  By doing this it will also help with his shortness of breath (Whalen, Finkel, & Panavelil, 2015).   

Furosemide has a bioavailability of 47-64%, with onset of 30-60 minutes, and duration of 6-8 hours.  Furosemide is metabolized in the liver and eliminated through the urine.   

Treatment Optimization 

            By giving AO Furosemide the patient needs to be aware that it may react with Sertraline and possible hyponatremia.  Lab work should be ordered on this patient routinely to monitor for hyponatremia.  Atenolol increases serum potassium and furosemide decreases serum potassium; again, the patient will need to have lab work done to monitor his potassium levels.  By the patient taking Furosemide it will help decrease the 9lbs of fluid he has gained and help prevent further weight gain.  The patient needs to be instructed to weight daily and to call his primary care provider if there is a 3lb weight gain/loss.   

References 

Araoye MA, Chang MY, Khatri IM, Freis ED. Furosemide Compared With HydrochlorothiazideLong-term Treatment of Hypertension. JAMA. 1978;240(17):1863–1866. doi:10.1001/jama.1978.03290170045023 

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