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. 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

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.

Required Readings

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

• Chapter 19, "Hypertension" (pp. 230-246)

This chapter examines the relationships between the cardiovascular, nervous, and renal systems. It then describes diagnostic criteria for hypertension patients, drugs used to treat hypertension and possible adverse reactions, monitoring patient response, and patient education.

• Chapter 20, "Hyperlipidemia" (pp. 247-262)

This chapter explores causes of hyperlipidemia, treatments for hyperlipidemia patients, and methods for monitoring patient response. It also reviews strategies for risk assessment and patient education.

• Chapter 21, "Chronic Stable Angina" (pp. 263-277)

This chapter begins by exploring factors that contribute to chronic stable angina, types of drugs used in treatment, and diagnostic criteria for initiating drug therapy. It also examines methods for monitoring patient response to treatment and educating patients on self-care.

• Chapter 22, "Heart Failure" (pp. 278-297)

This chapter examines the process of prescribing drugs to treat heart failure and explores effects of prescribed drugs, proper dosages, and possible adverse reactions.

• Chapter 49, "Anticoagulation Disturbances" (pp. 764-803)

This chapter covers drug therapy options for three disorders requiring anticoagulants: venous thromboembolism, atrial fibrillation, and ischemic stroke. It also explains the process of initiating and managing drug therapy for patients with these disorders.

Drugs.com. (2012). Retrieved from http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

Required Media

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:

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.