effectofagingtocardiovacsulardrugtherapyplan.edited x

EFFECTS OF AGING ON CARDIOVASCULAR THERAPY PLAN

Effects of aging on a cardiovascular therapy plan

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According to statistical research such as “Products – Data Briefs – Number 328 – November 2018” (2019), it has been identified that type 2diabetes, hypertension, and hyperlipidemia disease are among the top 10 killer diseases in the world. This has brought a lot of concern to my professional career as an advanced practice nurse. I have become more determined to study and analyze the determinant of different diseases such as cardiovascular disease in which I have select to concentrate on economic factors, culture changes, and population aging. In this article, I will give an analysis of a case study that shows how aging affects both pharmacokinetics and pharmacodynamics processes. To the two processes, the article will also show how the changes in the two processes as a result of aging affect my patient drug therapy plan using the specific drug list prescribed for the patient. It will also give some recommendations that can be used to improve the drug therapy plan and the reasons as to why I recommend those adjustments.

The pharmacokinetic process is a crucial process that doctors and nurses need to understand, and it involves the absorption of the drug into the body, distribution, and elimination from the body system through metabolism and excretion. The whole process helps to balance plasma drug concentration in the body, and there is the primary factor used by prescribers to choose the maximum dosage level to give to a patient during drug therapy. Also, as an individual gets old various pharmacokinetic processes such as metabolism and excretion of drugs in the body decreases, therefore the drug dosage should decrease as one age (“Effects of Aging on Pharmacokinetic and Pharmacodynamic Drug Processes,” 2009). The decrease in metabolism and excretion of drugs implies that the body is not effective enough to get rid of the toxicity, thus increasing the concentration and making the person feel more lethargic. Moreover, the process through which the toxic accumulates in the system is very slow, and it can take up to weeks before any signs of toxicity in the body. Age has a close connection with reducing insulin sensitivity, and at the time, it can cause insulin resistance, especially for individuals with type 2 diabetes mellitus.

Aging also affects the pharmacodynamics process by altering how the body cells respond or maintain stable homeostasis between drug sensitivity and body functions (“Effects of Aging on Pharmacokinetic and Pharmacodynamic Drug Processes,” 2009). Some of the drug sensitivity changes that take place as one get older include increasing in response to some drugs such as warfarin and decrease in receptor responsiveness. Also aging increases the response to opioid analgesics. Under homeostasis, aging increases impairment in several body functions such as temperature regulations, the blood pressure is altered, the bladder may cause dysfunction, and the blood sugar level, fluids, and electrolyte are imbalanced. Therefore it is more complicated to treat an elderly patient with cardiovascular disorder as compared to a young patient.

Aging may lead to changes in the prescription given to the patient. For example, the list of ‘patient CB’ in the case glipizide is prescribed to be used daily, and the primary purpose of the drug is to cause the pancreas to produce insulin and help to balance blood sugar in the patient’s bloodstream. This means that for an older adult the drug will not be as effective as compare to a young person because aging induces insulin resistance or decreases its sensitivity. 2

Hydrochlorothiazide (HCTZ) is another drug prescribed in the list for patient CB, but it can be excluded for the list if the patient is elderly. First, as this article had discussed earlier, aging is associated with an increased possibility of body part impairment, bladder dysfunction, and electrolyte imbalance.

On the other hand, for HCTZ to work, it relies on the kidney to extract sodium and inhibits the transportation of sodium chloride to the tubule to lower hypertension (Gray & Pack, 2010). However, due to its side effects that are related to aging, the drug can be excluded from the list depending on the age of the patient and especially if the patient is very elderly. This is because of some if it side effects includes electrolyte imbalance and dysfunction of some body part such as pancreas which is closely related to some of the cause of the effect by aging in pharmacodynamics process such as electrolyte imbalance.

Hydralazine can also be influence by aging because it relies on the muscles to help low blood pressure through relaxation mechanisms, which can be lead to chronic conditions for an elderly patient. This is mainly because aging reduces metabolism, causing an individual to feel lethargic, which increases the severity of some of the side effects of hydralazine drugs such as numbness and tiredness (Gray & Pack, 2010). It also requires extensive and hepatic metabolism in which is excreted through urine as metabolites, and therefore, an elderly patient may have toxicity issues while using this drug.

While using glipizide, I prefer to be very observant of the patient’s age. If it is an elderly patient, I must ensure that he or she does not have contradictions conditions such as heart failures or allergies to glipizide. In any case of these issues, I would change the prescription by using other drugs such as repaglinide or insulin.2. Moreover, I will check whether the patient has hypoglycemia and if the results are positive, I will also change the preferences to use the dipeptidyl peptidase 4(DPP-4) inhibitor because it is not affected by fats (Gray & Pack, 2010). I would also recommend the patient always have a yearly checkup for other microvascular complications such as neuropathy or foot ulcers because these complications are closely related to cardiovascular disease. Early detection of any of these complications will help to manage them efficiently. Some of the drugs may have severe side effects like simvastatin may have dark red urine symptoms, blisters, lack of energy, and yellowing of the skin. Due to the possibility of such incidence, I recommend the patient to report back immediately or call so that I can take immediate effect to avoid farther complications. It will also help in adjusting the medication so that the patient can have the best drug therapy that fit s his or her physiological functioning.

In conclusion, aging leads to a decrease in metabolism during the process of pharmacokinetic and results in a high concentration of toxic in the body. This makes an individual feel lethargic. Aging also introduces a new change into the body, which includes altering how the cells respond to or maintain homeostasis, causing a difference in drug sensitivity and effectiveness. Therefore as an individual age, the body will respond differently to temperature changes, blood pressure levels, fluids, electrolytes, and body functions. The list of drugs prescribed for the patient CB is also affected by aging due to the change it causes to the two processes. For example, aging causes a reduction in metabolism, which may increase the impact of the side effect of Hydralazine drug and impairment caused by affects how Hydrochlorothiazide (HCTZ) works. To improve drug therapy, I have recommended that it is crucial to consider how old the patient is and included various alternatives such as dipeptidyl peptidase 4 (DPP-4) inhibitor repaglinide and insulin.2 in case the patient is elderly. Other recommendation includes keen observation on the side effects of the drugs like for simvastatin may have dark red urine and blister are signs of severe complication which show the need for immediate adjustment in the drug therapy plan.

References

Amery, A., Fagard, R., Lijnen, P., & Staessen, J. (2012). Hypertensive Cardiovascular Disease: Pathophysiology and Treatment: Pathophysiology and Treatment. Berlin, Germany: Springer Science & Business Media.

Effects of Aging on Pharmacokinetic and Pharmacodynamic Drug Processes. (2009). Journal of Psychosocial Nursing and Mental Health Services, 47(10), 15-18. doi:10.3928/02793695-20090902-06

Gray, R., & Pack, L. (2010). Medical treatment and approaching the end of life. Cardiovascular Disease in the Elderly, 287-301. doi:10.1093/med/9780199570591.003.0013

Products – Data Briefs – Number 328 – November 2018. (2019, June 7). Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm