Pharmacotherapy for Cardiovascular Disorders | 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
explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected.
The patient factor I selected is behavior factors which focuses on the AO’s obesity. Obesity is a risk factor for both hypertension and hyperlipidemia, as well as other conditions such as diabetes that have the potential to complicate treatment for cardiovascular disorders (Arcangelo & Peterson, 2013). Two factors affecting the pharmacokinetics for this patient include poor nutrition and reduced circulation (Arcangelo & Peterson). It is assumed that this patient’s nutrition is poor, as this usually accompanies obesity. Reduced circulation can be affected by limited physical activity, vasoconstriction that accompanies hypertension, and the potential for plaque build-up in hyperlipidemia. Understanding these risk factors as well as the potential effects they may have on the patient’s ability to respond appropriately to a medication regimen and receive therapeutic treatment, the patient should be encouraged to modify his or her diet and exercise habits as well, particularly through recommendation of the DASH diet (Arcangelo & Peterson).
Improving the Drug Therapy Plan
There are several areas for improvement in AO’s drug plan. First, beta-blockers are known to contribute to hyperlipidemia (Arcangelo & Peterson, 2013). Also, beta-blockers are not commonly used as a first-line treatment for hypertension (Arcangelo & Peterson). Understanding this, the atenolol should be discontinued. Because the atenolol is being discontinued, hydralazine should also be discontinued, as it should ideally be given with a beta-blocker and a diuretic (Arcangelo & Peterson). Because the recommended first line of treatment for hypertension is diuretics (Arcangelo & Peterson), a dose of 12.5 mg of hydrochlorothiazide should be initiated daily. This drug was selected because thiazide diuretics are considered safe in diabetics, with a reduction in mortality from heart disease and stroke (Arcangelo & Peterson). The dose was selected because, though they are considered safe and beneficial, diabetics should be administered thiazide diuretics at the lowest possible dose (Arcangelo & Peterson). Though the patient is not a known diabetic, he or she does possess many risk factors for the disease, and it should be considered a very real possibility that the patient either already has or will soon develop diabetes. Simvastatin is an appropriate choice for hyperlipidemia, as the statin drug class is the recommended first-line treatment and individual drug choice is dictated by the cholesterol levels (Arcangelo & Peterson), which I was not provided with.
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
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