NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS 

Walden University  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS   assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS  

Whether one passes or fails an academic assignment such as the Walden University  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS   depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS  

The introduction for the Walden University  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS   is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS  

After the introduction, move into the main part of the  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS   assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS  

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for  NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS  

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS 

Introduction

The prevalence and impact of cardiovascular disorders in the U.S. are undeniable,
especially in contributing to the nation’s morbidity and mortality rates. Effective
pharmacotherapeutic strategies are paramount, and these must be tailored according to individual
patient characteristics. The case of LM, an 89-year-old female with a vast array of health
complications, serves as a vivid representation of the complexities involved. Central to this
discussion is the role of age, a factor with significant implications on both pharmacokinetics (the
journey of a drug through the body) and pharmacodynamics (the body’s response to the drug).

Age’s Impact on Pharmacokinetics and Pharmacodynamics

Age plays a pivotal role in determining how drugs interact with the body. Elderly
individuals often undergo physiological changes that can drastically alter the absorption,
distribution, metabolism, and excretion of drugs. For instance, delayed gastric emptying and
reduced gastrointestinal blood flow can result in a slower absorption rate for many medications
in older adults. Similarly, reduced muscle mass and decreased serum albumin can impact how
drugs are distributed throughout the body. When it comes to metabolism, the decrease in hepatic
blood flow and liver mass commonly seen in elderly patients can reduce the body’s ability to
process drugs effectively. Finally, diminished renal function, evident in LM’s eGFR of 45
ml/min, can affect drug excretion, posing potential risks for toxicity (Nightingale et al., 2019).

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Moreover, the body’s response to drugs, or pharmacodynamics, undergoes changes with
age. Older adults might experience heightened sensitivity to certain medications, leading to
unpredictable or altered responses, thus increasing the potential for adverse reactions
(McKearney & Coleman, 2020).

Implications for LM’s Drug Therapy

Given LM’s age and observed health metrics, there is a pressing need for keen scrutiny of
her medication regimen. Amlodipine, prescribed for her hypertension, may be contributing to her
experience (Rafeq & Salzman, 2022). The diuretic, Furosemide, when combined with her
diabetes medications, Metformin and Glyburide, poses a potential risk for significant shifts in her
electrolyte levels, which could be exacerbating her risk for falls (Ali et al., 2019). Celecoxib,
prescribed for osteoarthritis, has known potential to aggravate hypertension and further decline
kidney function, especially in the elderly (White et al., 2000).

Recommendations for Drug Therapy Modification

In light of the pharmacokinetic and pharmacodynamic considerations induced by age and
LM’s evident health complexities, it is essential to revisit and possibly modify her medication
regimen.

A thorough reevaluation of her antihypertensive medications is a priority. Given her
recorded supine blood pressure, an adjustment in the dosage or a switch from amlodipine to
another antihypertensive class with fewer side effects related to edema might be beneficial.

Regular monitoring of LM’s glucose, potassium, and overall renal function can ensure the
safety of her diabetes medications combined with the diuretic (Davies et al., 2022). Additionally,

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her pain management strategy needs to be readdressed. It might be more advantageous to explore
non-drug interventions or consider switching from celecoxib to acetaminophen, a medication
with a better safety profile for the elderly (Alorfi, 2023).

Also Read:

ASTHMA AND STEPWISE MANAGEMENT

PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS

DIABETES AND DRUG TREATMENTS

DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL

COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER

WOMEN’S AND MEN’S HEALTH, INFECTIOUS DISEASE, AND HEMATOLOGIC DISORDERS

OFF-LABEL DRUG USE IN PEDIATRICS

Conclusion

The case of LM underscores the importance of meticulous pharmacotherapeutic planning,
especially in elderly patients with multiple health challenges. Age-induced changes in
pharmacokinetics and pharmacodynamics necessitate a tailored approach, ensuring not just
effective treatment but also the well-being and safety of the patient. Collaborative and informed
medical decisions remain the linchpin in achieving optimal therapeutic outcomes.

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References

Ali, S., Peterson, G. M., Bereznicki, L. R., & Salahudeen, M. S. (2020). Association between
anticholinergic drug burden and mortality in older people: a systematic review. European
Journal of Clinical Pharmacology, 76(3), 319–335. https://doi.org/10.1007/s00228-019-
02795-x

Alorfi NM. (2023). Pharmacological Methods of Pain Management: Narrative Review of
Medication Used. International Journal of General Medicine, ume 16, 3247–3256.

Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S.
E., Del Prato, S., Mathieu, C., Mingrone, G., Rossing, P., Tankova, T., Tsapas, A., &
Buse, J. B. (2022, November 1). Management of Hyperglycemia in Type 2 Diabetes,

2022. A Consensus Report by the American Diabetes Association and the European
      Association for the Study of Diabetes. Diabetes Care, 45(11), 2753.

McKearney, K., & Coleman, J. J. (2020). Prescribing medicines for elderly
patients. Medicine, 48(7), 463–467. https://doi.org/10.1016/j.mpmed.2020.04.004

Nightingale, G., Schwartz, R., Kachur, E., Dixon, B. N., Cote, C., Barlow, A., Barlow, B., &
Medina, P. (2019). Clinical pharmacology of oncology agents in older adults: A
comprehensive review of how chronologic and functional age can influence treatment-
related effects. Journal of Geriatric Oncology, 10(1), 4–30.
https://doi.org/10.1016/j.jgo.2018.06.008

Sample Answer 2 for NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS 

The promotion of safety and quality in the treatment of patients with different conditions is important in nursing practice. Nurses and other healthcare providers utilize their knowledge in pharmacokinetics and pharmacodynamics to select treatments that will optimize outcomes while minimizing the potential of patient harm. Factors such as age, gender, ethnicity, and genetics among others influence the pharmacokinetics and pharmacodynamics of the medications prescribed to patients. Therefore, this essay examines the influence of age on LM’s pharmacokinetic and pharmacodynamics processes. The essay also discusses the impact of the changes in the patient’s recommended drug therapy and how the treatment can be improved.  

Effect of Age on Patient’s Pharmacokinetic and Pharmacodynamics Processes 

The selected factor that affects the pharmacokinetic and pharmacodynamics of LM processes is age. Age significantly affects pharmacokinetics of drugs. Aging is associated with decreased small-bowel surface area, reduced gastric emptying, and elevated gastric PH. Changes such as an increase in the gastric PH affects the absorption of drugs such as calcium and enteric coated medications (Koren et al., 2019).  

Aging also results in the decrease in the total body water and increase in the total body fat. The increase in body fat volume increases the total volume of distribution of lipophilic drugs and their elimination half-lives. Aging also lowers hepatic metabolism of most drugs. The decrease in cytochrome P-450 lowers the metabolism of drugs in the liver. This also affects first-pass metabolism of drugs before they enter the circulatory system. Aging is also associated with a decline in renal elimination of medications. The elderly patients have reduced glomerular filtration rate, which affects the elimination of drug metabolites from the body (Drenth-van Maanen et al., 2020; Koren et al., 2019; Peeters et al., 2019). As a result, there is an increased risk of drug toxicity due to the accumulation of the metabolites in the body. These pharmacokinetic changes affect the treatment options and health status of LM.  

Aging also affects pharmacodynamics of drugs. Pharmacodynamics refers to the study of the drug effect on the body. Aging is associated with reduced pharmacodynamics processes. One of the mechanisms contributing to the reduced pharmacodynamics is the limited functioning of drug receptor sites. There is also the reduction in the available drug receptors for drug binding. This reduces the effect of the drug on the body while increasing its blood bioavailability (Kratz & Diefenbacher, 2019). An example is seen in patients diagnosed with diabetes. They have low insulin receptors, which result in the elevated blood glucose levels.  

The effect of aging on pharmacodynamics can also be seen from the exaggerated response to some drugs among this population. For example, older adults tend to show exaggerated responses to drugs that stimulate the central nervous system. The observation is because of the increased sensitivity to drugs by this population. In addition, aging reduces Gs protein interactions in the elderly patients. The decrease lowers cardiac, pulmonary, and vascular tissue to drugs such as those used in the treatment of hypertension(Stader et al., 2020). Therefore, nurses should consider these changes when prescribing drugs to elderly patients and other vulnerable populations.  

Impact of the Changes in Processes on Patient’s Recommended Drug Therapy 

The changes in the pharmacokinetic and pharmacodynamics processes affect the patient’s recommended drug therapy. A decline in the drug metabolism in the liver affects the selection of drugs for the patient. Nurses and other healthcare providers should prescribe medications that do not undergo first-pass metabolism to preserve optimum hepatic function. A decline in renal function also affects the client’s recommended drug therapy(Peeters et al., 2019). Nurse practitioners prescribe medications that have other routes of excretion such as feces to promote renal functioning.  

There is also the consideration of drug dosages with the changes in the pharmacokinetics and pharmacodynamics. Accordingly, nurse practitioners lower the dosage and frequency of hepatotoxic and renal toxic medications in patients with advanced ages to minimize the risk of harm and drug toxicity (Thürmann, 2020). The reduction in drug absorption due to lowered gastric physiological processes also increases the need for prescribing drugs that are administered through other routes such as intravenously and intramuscularly.  

Improving Patient’s Drug Therapy 

I will improve the patient’s drug therapy by avoiding polypharmacy. The patient currently uses several drugs that predispose her to harm and medication errors. An effective approach to her treatment would be reducing the number of drugs taken at a time to promote her health, safety, and quality. The other way in which I will improve her drug therapy is by titrating the drug dosage upwards. Elderly patients should be initiated on low dosage and increased upwards based on tolerance and efficacy (Koren et al., 2019). I will modify the patient’s current treatment. I will lower the dosage of celecoxib to minimize the risk of hepatotoxicity and renal toxicity. I will also stop glyburide and retain metformin. Metformin has the benefit of reducing the risk of cardiovascular mortality in patients with multiple comorbidities that include cardiovascular conditions (Guo et al., 2019).  

Conclusion 

Aging affects pharmacokinetics and pharmacodynamics processes. Advancing age lowers pharmacokinetic processes such as drug absorption, metabolism, and elimination. It also affects pharmacodynamics processes such as drug binding to their receptor sites. These changes affect the recommended treatment plan for the patient in the case study. Polypharmacy should be avoided in treating LM for safety and quality outcomes. 

References 

Drenth-van Maanen, A. C., Wilting, I., & Jansen, P. A. F. (2020). Prescribing medicines to older people—How to consider the impact of ageing on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921–1930. https://doi.org/10.1111/bcp.14094 

Guo, L., Ma, J., Tang, J., Hu, D., Zhang, W., & Zhao, X. (2019). Comparative Efficacy and Safety of Metformin, Glyburide, and Insulin in Treating Gestational Diabetes Mellitus: A Meta-Analysis. Journal of Diabetes Research, 2019, 9804708. https://doi.org/10.1155/2019/9804708 

Koren, G., Nordon, G., Radinsky, K., & Shalev, V. (2019). Clinical pharmacology of old age. Expert Review of Clinical Pharmacology, 12(8), 749–755. https://doi.org/10.1080/17512433.2019.1632188 

Kratz, T., & Diefenbacher, A. (2019). Psychopharmacological Treatment in Older People. Deutsches Ärzteblatt International, 116(29–30), 508–518. https://doi.org/10.3238/arztebl.2019.0508 

Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opinion on Drug Metabolism & Toxicology, 15(4), 287–297. https://doi.org/10.1080/17425255.2019.1588249 

Stader, F., Kinvig, H., Penny, M. A., Battegay, M., Siccardi, M., & Marzolini, C. (2020). Physiologically Based Pharmacokinetic Modelling to Identify Pharmacokinetic Parameters Driving Drug Exposure Changes in the Elderly. Clinical Pharmacokinetics, 59(3), 383–401. https://doi.org/10.1007/s40262-019-00822-9 

Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anesthesiology, 33(1), 109. https://doi.org/10.1097/ACO.0000000000000814

Sample Answer 3 for NURS 6521 PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Asthma is one of the most common conditions affecting more than 20 million individuals in the United States and over 150 million across the globe. It takes up to $14 billion to treat asthma annually. Particularly hard hit are adolescents and children between the ages of 10 to 18 years. Studies show that up to 14% of children and adolescents in the inner city are diagnosed with asthma. A larger percentage of asthmatic patients in the emergency rooms are children and adolescents. Consequently, most patients hospitalized as a result of asthma or asthma-related problems are also children. As such, appropriate interventions must be implemented to help in managing asthma among children and adolescents hence reducing their visits to the ER or hospitalization. In the same line, Sentara Home Care Services came up with an innovative program to help in improving asthma management among children and adolescents through home-based strategies such as “Life Coaches” where they are educated on the proper use of medication and lifestyle behaviors for both the patient and their families. This paper reviews different pieces of literature for a better understanding of the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents.

Methods

Quite a significant number of internet sources were available talking about different approaches that can be utilized in managing asthma among children and adolescents. However, only peer-reviewed articles directly relating to the study PICOT questioned were used for this paper. These articles were arrived at by use of several inclusion and exclusion criteria. For instance, the inclusion criteria included studies that had been published within the last 5 years, in English, with participants who are children and adolescents. The studies however could be either experimental or literature review. Exclusion criteria included articles published more than 5 years, in languages other than English. Consequently, relevant keywords such as asthma,  Sentara’s Asthma Disease Management plan, children and adolescents, and decreased ER/unscheduled PCP visits were utilized. A wide variety of search engines were used for this study, such as Google Scholar, PubMed/MEDLINE, and Cochrane. Generally, only peer-reviewed articles and experimental studies covering the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents, were used for this study.

Synthesize the Literature

Part A: Components of Each Article

The study carried out by Naar et al., 2018, was aimed at bridging the gap for proper interventions for the management of asthma among African American adolescents who appear to be at high risk of asthma morbidity and mortality. The randomized control trial study revealed the significance of comprehensive family and community-based treatment strategies for better medication adherence, reduction in the frequency of asthma symptoms, and reduced inpatient hospitalization among African American adolescents. The strategies revealed in this study align with the initiatives and goals outlined in Sentara’s Asthma Disease Management plan for children and adolescents.

According to Woods et al., 2016, the hospitalization rate of Black and Hispanic children diagnosed with asthma is quite high as compared to white children. As such Woods et al., 2016, carried out a study to evaluate the effectiveness of community asthma initiatives in the management of asthma, hence reducing the hospitalization rate among this high-risk population. Data was collected and analyzed using the longitudinal evaluation of the participants and comparing the results to the control sample. It was noted that the community asthma initiative helped in reducing the health disparities related to asthma, with reduced hospitalization rate among Blacks and Hispanic children. The results support the study PICOT question on the effectiveness of Sentara’s Asthma Disease Management plan in reducing visits to the ER and hospitalization among children and adolescents diagnosed with asthma. 

Bellin et al., 2017, conducted a study aimed at finding out the knowledge of children diagnosed with asthma, from low-income families on home-based asthma management strategies. The study utilized a convenience sampling strategy to select appropriate participants. The collected data were analyzed using the grounded theory coding techniques. Based on the findings, it was recommended that more reinforcements need to be put towards providing a multipronged approach aimed at improving asthma control measures among this high-risk population. Such measures include ongoing child and family education, environmental control, and self-management home-based strategies, just like the ones illustrated in Sentara’s Asthma Disease Management plan.

The study carried out by Jonas, Leu, & Reznik, 2020, was aimed at evaluating the effects of utilizing Community Health Workers for the delivery of home-based Wee Wheezers asthma education program for better manage asthma symptoms among children. A randomized controlled trial was employed for this study. According to the results, delivery of home-based asthma education programs led to the improvement of symptoms, hence reduced disparities in children’s health outcomes. The study supports Sentara’s Asthma Disease Management plan, whose main goal is to educate patients and caregivers on the disease process of asthma, for better treatment outcomes.

Leas et al., 2018 carried out a study evaluating the effectiveness of home-based asthma prevention initiatives such as allergen reduction interventions on asthma outcomes. The utilized systematic literature review of both nonrandomized interventional studies and randomized controlled trials for this study. Based on the collected result, the effectiveness of indoor allergen reduction intervention helps in preventing an asthma attack. However, the effectiveness of this intervention was quite inconclusive as a result of inadequate support from previous studies. Indoor allergen reduction interventions are among the several home-based interventions outlined in Sentara’s Asthma Disease Management plan for children and adolescents.

Part B: Compare and contrast the articles:

 All five studies revolve around the same goal of reducing disparities as a result of asthma among children and adolescents by utilizing community and home-based initiatives. According to Sentara’s Asthma Disease Management plan, “life coaches” and home-based strategies are utilized in assessing, teaching, and monitoring asthma through self-management strategies to reduce disparities hence reduced hospitalization and ER visits. The same concept, despite the use of different languages, has been addressed in all five studies. However, some of the studies were experimental such as Naar et al., 2018, Jonas, Leu, & Reznik, 2020 and Bellin et al., 2017, while others were literature reviews, Leas et al., 2018 and Woods et al., 2016.

Several limitations were however experienced in some of the reviewed studies. For instance, according to Leas et al., 2018, there was limited information availed by studies carried out on the effectiveness of some home-based asthma prevention initiatives such as indoor allergen reduction. Consequently, most of these studies only reveal the kind of home and community-based initiatives for the management and prevention of asthma among children and adolescents, instead of how effective these initiatives are in reducing ER visits and hospitalization rates among these individuals. Lastly, there were no recent studies, within the last five years, which evaluated the significance of Sentara’s Asthma Disease Management plan in increasing the control of asthma and decrease ER/unscheduled PCP visit’s for children/adolescents, making it hard to conclude on the PICOT question.

Areas of Further Study

Several studies have revealed the relevance of community and home-based interventions in reducing the disparities as a result of asthma among children and adolescents. These interventions have been proven to reduce the number of visits by this age group to the ER, in addition to a reduction in hospitalization rates. However, very few studies have established the effectiveness of distinct interventions in achieving such outcomes. Consequently, very few recent studies have also revealed the effectiveness of Sentara’s Asthma Disease Management plan for children and adolescents (Naar et al., 2018). As such, there is a need for further evaluation of the effectiveness of individual home-based interventions for better evidence-based practice in the management and prevention of asthma among children and adolescents.

References

Bellin, Melissa H., Angelica Newsome, Cassie Land, Joan Kub, Shawna S. Mudd, Mary Elizabeth Bollinger, and Arlene M. Butz. 2017. “Asthma Home Management in the Inner-City: What Can the Children Teach Us?” Journal of Paediatric Health Care. 31, no. 3: 362-371. https://doi.org/10.1016/j.pedhc.2016.11.002

Jonas, J. A., Leu, C. S., & Reznik, M. (January 01, 2020). A randomized controlled trial of a community health worker delivered home-based asthma intervention to improve pediatric asthma outcomes. The Journal of Asthma: Official Journal of the Association for the Care of Asthma, 2020, 1-12. https://doi.org/10.1080/02770903.2020.1846746

Leas BF, KE D’Anci, AJ Apter, T Bryant-Stephens, MP Lynch, JL Kaczmarek, and CA Umscheid. 2018. “Effectiveness of Indoor Allergen Reduction in Asthma Management: A systematic Review”. The Journal of Allergy and Clinical Immunology. 141, no. 5: 1854-1869. https://doi.org/10.1016/j.jaci.2018.02.001

Naar, S., Ellis, D., Cunningham, P., Pennar, A. L., Lam, P., Brownstein, N. C., & Bruzzese, J.-M. (October 01, 2018). Comprehensive Community-Based Intervention and Asthma Outcomes in African American Adolescents. Paediatrics, 142, 4.)  DOI: https://doi.org/10.1542/peds.2017-3737

Woods, E. R., Bhaumik, U., Sommer, S. J., Chan, E., Tsopelas, L., Fleegler, E. W., Lorenzi, M., … Dulin, R. (February 12, 2016). Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma. Mmwr Supplements, 65, 1, 11-20. DOI: http://dx.doi.org/10.15585/mmwr.su6501a4.

The factor you selected might influence the pharmacokinetic and pharmacodynamic processes.

Age and how it affects the pharmacokinetic and pharmacodynamic processes in the patient. M is considered to be elderly because he is 89 years old. Being senior has its fair share of challenges. alterations in anatomy and physiology;
One’s ability to cope with pressure from outside sources is diminished. Additionally, as people age, the interindividual Physiological reactions become more varied. The term “ageing” refers to the accumulation of cumulative molecular, cellular, and tissue effects that are local. The outcome of these fundamental adjustments, not the origin ageing. There isn’t a universal definition of ageing, but some characteristics are recognized. an absence of the most stable units over time are functional units. These are the smallest constructions but are nonetheless able to perform the particular physiological functions of the organ in which they are present (e.g. nephrons, alveoli or neurons). Another example is the disruption of a number of regulatory systems that encourage functional integration between cells and organs. feature. As a result, homeostasis cannot be maintained under physiological stress. This decline in performance A decrease in viability and an increase in susceptibility are associated with reserve. More than just a continuation, ageing It also results in anatomical and physiological alterations that, if they persist past a certain point, might lead to functional decline. A certain point, however, could result in the relevant system’s decompensation. The physiological adjustments that take place as Explored is how individuals age. The full description of pharmacodynamics (drug absorption, distribution, metabolism, and excretion) and pharmacokinetics (drug absorption, distribution, metabolism, and excretion) follows. excretion) alterations (a drug’s impact on its target site) that arise with ageing. the patient’s condition depending on modifications to the pharmacokinetic and pharmacodynamic processes recommended drug treatment. It will slow down the rate of protein binding, distribution, first-pass metabolism, and absorption. the clearance of drugs. M is ageing and his organs, such as his kidney and liver, are less efficient, so he half-lives of several medications, such as furosemide. This was related to a poorer renal clearance and a lengthier hospital stay in older patients. half-life. Age-related changes in the effects of frusemide appear to be caused by a decrease in tubular secretion. A There may be a decrease in renal plasma flow as the cause of the latter.

Implications for pharmacodynamics
It is challenging to draw generalizations because the impact of age on drug sensitivity varies depending on the material is assessed, as is the reaction. The measurement of drug sensitivity is necessary for medication concentrations in plasma because age-related changes in pharmacokinetics may increase or decrease disparities in response to drugs.

Modifications of furosemide to fit M.

It’s critical to evaluate the patient’s clinical condition, daily weight, and fluid intake in order to assess how well furosemide is working for them. consumption, urine production, electrolytes including potassium and magnesium, and serum testing for kidney function serum blood urea nitrogen levels and creatinine. When electrolyte depletion occurs, replete electrolytes are a factor. As a diuretic, furosemide should be administered in smaller doses or maybe not at all if laboratory testing is positive. shows signs of renal dysfunction. Patients undergoing furosemide therapy in an ambulatory care setting are similarly monitoring is necessary in this situation to evaluate renal function, intermittent electrolytes, and therapy response. monitoring to replenish electrolytes, control furosemide dosage as necessary, and detect any additional negative effects of the furosemide treatment and appropriately handle them. Modification will benefit from the following; Always keep an eye out for negative drug responses. Encourage the patient to consume adequate water to enhance kidney function. The dosage should be decreased to 20 mg QAM of furosemide to affect faster rates of absorption, bioavailability, and first-pass drug clearance, protein binding, distribution, and metabolism.

Reference:

Sager, R., Lindstedt, I., Edvinsson, L., & Edvinsson, M. L. (2020). Increased mortality in elderly heart failure patients receiving infusion of furosemide compared to elderly heart failure patients receiving bolus injection. Journal of geriatric cardiology : JGC, 17(6), 359–364. https://doi.org/10.11909/j.issn.1671-5411.2020.06.009

Howard, P. A., & Dunn, M. I. (2001). Aggressive diuresis for severe heart failure in the elderly. Chest, 119(3), 807–810. https://doi.org/10.1378/chest.119.3.807

Rodríguez-Molinero, A., Miñarro, A., Narvaiza, L., Gálvez-Barrón, C., Gonzalo León, N., Valldosera, E., De Mingo, E., Macho, O., Aivar, D., Pinzón, E., Alba, A., Passarelli, J., Stasi, N., Collado, I., & Banegas, J. R. (2022). Mortality in Elderly Patients Taking Furosemide: Prospective Cohorts Study. International journal of hypertension, 2022, 4708259. https://doi.org/10.1155/2022/4708259

NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Case Study 

A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and presented to her gynecologist for her annual GYN examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap; other than that, Pap smears have been normal. Home medications are Norvasc 10mg QD and HCTZ 25mg QD. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was one month ago. 

Treatment Regimen 

            After analyzing the symptoms, I concluded that the patient is experiencing peri-menopausal symptoms. For many people, menopause begins around age 45 though the onset of symptoms varies across different people. She is undergoing the early stages of menopause which is a stage that begins with experiencing changes in the uterus, breasts, increased fat deposit, and the urogenital tract undergoing several changes such as a shrinking cervix, and reduced muscle tone in the pelvic area. At that age, the level of estrogen production is low hence, leading to hot flashes and night sweats. Therefore, her treatment regime will focus on taking into consideration the patient has Hypertension already. Hormone therapy will be eliminated and prescribe vaginal cream that would help her manage genitourinary symptoms such as vaginal dryness and dyspareunia (Yoo et al., 2020). Mood changes and hot flashes are common symptoms of menopause hence the patient will be prescribed low-dose antidepressants such as venlafaxine and sertraline. Besides, herbal treatment has been proven to be effective in managing vasomotor symptoms hence the patient can be prescribed black cohosh which helps in reducing many menopausal symptoms (Mahady, et al., 2002). 

As people continue to age, their bones become weak and this increases their chances of suffering born fractures. Therefore, the patient will be given vitamin D supplements to the increase production of estrogen which reduces with age and reduces cases of bone fractures. 

During the clinical interview, I realized that the patient is taking Norvasc 10 mg and hydrochlorothiazide (HCTZ) 25 mg. I would advise her to discontinue taking Norvasc since the drug acts as a calcium blocker hence leading to hypertension and besides, its side effects increase menopause symptoms. Since she has hypertension, I would recommend that she takes lisinopril 20 mg daily. This should help alleviate the flushing that the patient has been experiencing (Li et al., 2016). Additionally, the patient has a history of ASCUS, hence I will advise her to continue with her PAP smear exams. With her blood pressure being high currently, and the fact that she is taking Norvasc, she will be encouraged to stop Norvasc but increase the HTCZ dosage to 50mg daily. The patient is expected to come regularly for assessment and examination of the drugs and symptoms.  

Patient Education Strategies 

Patient education has become an effective strategy to influence patients’ behavior to start living a quality life. The patient will be educated on ways to maintain weight through diet modification, become physically active, and practice relaxation as one way to reduce the severity of menopause symptoms and chances of getting breast cancer (Paterick et al., 2017). The patient will be educated about things she needs to avoid such as the use of exogenous hormones to reduce getting breast cancer going to her family history (Stuenkel et al., 2015). All this information will be passed to the patient through her patient portal which is deemed the best instructional method for her as she can access the information from the comfort of her home. 

References 

Li, R. X., Ma, M., Xiao, X. R., Xu, Y., Chen, X. Y., & Li, B. (2016). Perimenopausal syndrome and mood disorders in perimenopause: prevalence, severity, relationships, and risk factors. Medicine, 95(32). 

Mahady, G. B., Fabricant, D., Chadwick, L. R., & Dietz, B. (2002). Black cohosh: an alternative therapy for menopause?. Nutrition in Clinical Care, 5(6), 283-289. 

Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017, January). Improving health outcomes through patient education and partnerships with patients. In Baylor University Medical Center Proceedings (Vol. 30, No. 1, pp. 112-113). Taylor & Francis. 

Manson, J. E., & Kaunitz, A. M. (2016). Menopause management—getting clinical care back on track. N Engl J Med, 374(9), 803-6. 

Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 100(11), 3975-4011. 

Yoo, T. K., Han, K. D., Kim, D., Ahn, J., Park, W. C., & Chae, B. J. (2020). Hormone replacement therapy, breast cancer risk factors, and breast cancer risk: a nationwide population-based cohort. Cancer Epidemiology, Biomarkers & Prevention, 29(7), 1341-1347.