Week 2: Cardiovascular System

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. In clinical settings, patients often present with symptoms of several 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 patient factors that may lead to changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.

Learning Objectives

Students will:

• Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes
• Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies
• Evaluate drug therapy plans for cardiovascular disorders

Learning Resources

Required Readings (click to expand/reduce) 

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 33, “Review of Hemodynamics” (pp. 285–289)
Chapter 37, “Diuretics” (pp. 290–296)
Chapter 38, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 297–307)
Chapter 39, “Calcium Channel Blockers” (pp. 308–312)
Chapter 40, “Vasodilators” (pp. 313–317)
Chapter 41, “Drugs for Hypertension” (pp. 316–324)
Chapter 42, “Drugs for Heart Failure” (pp. 325–336)
Chapter 43, “Antidysrhythmic Drugs” (pp. 337–348)
Chapter 44, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 349–363)
Chapter 45, “Drugs for Angina Pectoris” (pp. 364–371)
Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)

Required Media (click to expand/reduce) 

Assignment: Pharmacotherapy for Cardiovascular Disorders

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.  

Photo Credit: Getty Images/Science Photo Library RF

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.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

• Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
• Review the case study assigned by your Instructor for this Assignment.
• Select 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.

By Day 7 of Week 2

Write a 2- to 3-page paper that addresses the following:

• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

For Week 2, you will examine how patient factors may influence pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics used in the treatment of cardiovascular disorders.  You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.  

When writing your Week 2 Assignment, consider the following scenario:

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

Evidence-based clinical practice guidelines are fundamental to clinical practice, as they assist providers with clinical decision making.  I have attached some applicable guidelines below for your reference.  

Have a great week!

2017 ACC-AHA Guideline Mgmt HTN in Adults  
2018 AHA-ACC Guideline on Mgmt Blood Cholesterol  
2017 ACC-AHA-HFSA Guideline Mgmt HF  
ASH 2018 Guidelines Mgmt of VTE_Optimal Anticoag  
2019 AHA-ACC-HRS Guideline for Mgmt A Fib  
2017 AHA-ACC Guideline Mgmt Valvular Heart Disease