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Pharmacotherapeutics For Cardiovascular Disorders Assignment Paper

Pharmacotherapeutics For Cardiovascular Disorders Assignment Paper

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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. Pharmacotherapeutics For Cardiovascular Disorders Assignment Paper

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Write a 2- to 3-page paper that addresses the following: Pharmacotherapeutics For Cardiovascular Disorders Assignment Paper

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.

LM is an 86-year-old female admitted to the emergency department with delirium. Her spouse is with her and verifies that LM adheres to the medications she is currently prescribed. She does not self-monitor her BP or heart rate at home.

PMH:

A Fib diagnosed 1 month ago

HTN x 10 years

CKD x 5 years

Osteoarthritis x 7 years

GERD x 20 years

Medications:

Digoxin 0.25 mg QD

Metoprolol XL 25mg QD

Warfarin 3 mg QD

APAP 650 mg TID

Omeprazole 20mg QD

Multivitamin QD

Allergies: NKDA

Social History:

Married to husband for 57 years
No smoking, alcohol, limited daily exercise (short walks each morning)
Family History:

None reported

Vitals:
Labs:

Wt 113 lbs Ht 5’4” Na+ 138 K+ 4.0
BP 101/58, HR 52 Cl- 99 CO2 27
BUN 33 Cr 1.2
Gluc 109 INR 3.8
Dig 2.4
PE:

Elderly female with altered level of consciousness, no signs of bruising, bleeding, or other injury.

Influence of Ethnicity on Pharmacokinetics and Pharmacodynamics

Ethnicity can play a significant role in influencing both pharmacokinetic and pharmacodynamic processes in patients. Genetic variations among different ethnic groups can lead to differences in drug metabolism, absorption, distribution, and response to medications (Santos et al., 2018)Pharmacotherapeutics For Cardiovascular Disorders Assignment Paper.

Pharmacokinetics

Genetic differences can affect the absorption rate of drugs. For example, certain ethnic groups may have variations in drug transporters or enzymes that influence the absorption of medications. This could impact the onset of action and bioavailability of drugs. Enzyme polymorphisms, which can vary among ethnicities, may affect the metabolism of drugs. For instance, some individuals may metabolize drugs more rapidly or slowly, leading to variations in drug levels in the body. In this case, the metabolism of Warfarin and Digoxin could be influenced. Variability in renal function, which genetic factors can influence, may affect drug elimination. Since the patient has CKD, ethnicity-related differences in renal function may further impact the clearance of drugs like Digoxin and Metoprolol.

Pharmacodynamics

Genetic variations can also influence receptor sensitivity (Ingelman-Sundberg et al., 2018)Pharmacotherapeutics For Cardiovascular Disorders Assignment Paper. Variations in drug response may also be influenced by ethnicity. Receptor sensitivity, drug target variations, and genetic factors affecting drug receptors can all contribute. For example, the response to Metoprolol, a beta-blocker, may vary among individuals of different ethnicities due to differences in adrenergic receptor characteristics. Ethnic differences can also impact the expression and function of drug targets. In the case of LM, the pharmacodynamic response to anticoagulation with warfarin may be influenced by genetic factors affecting clotting factors.

Impact on Drug Therapy

Given the patient’s high INR of 3.8, which indicates an increased risk of bleeding, and considering the narrow therapeutic index of Warfarin, ethnicity-related variations in Warfarin metabolism and sensitivity to its anticoagulant effects could pose a higher bleeding risk. Warfarin has a narrow therapeutic index, and the patient has an INR of 3.8 (above the target range of 2-3)Pharmacotherapeutics For Cardiovascular Disorders Assignment Paper. Ethnic variations in the metabolism of warfarin could lead to increased sensitivity, requiring a lower dose in certain populations. Genetic testing for polymorphisms in the CYP2C9 and VKORC1 genes could guide dosing adjustments. Ethnicity-related differences may influence the elevated Digoxin level of 2.4 in Digoxin metabolism. This increases the risk of toxicity, leading to symptoms like delirium. The patient’s low heart rate (HR) of 52 may be influenced by individual variations in beta-blocker response based on ethnicity, potentially making her more susceptible to bradycardia and other adverse effects.

Improvements to Drug Therapy

Considering the high INR, a reduction in Warfarin dosage may be warranted. Genetic testing for Warfarin sensitivity (e.g., CYP2C9 and VKORC1 polymorphisms) could provide valuable information to guide personalized dosing. Given the elevated Digoxin level and potential ethnicity-related variations, close monitoring and possible dose adjustment are crucial. Genetic testing for Digoxin sensitivity may also be considered. Considering the low heart rate and the potential for ethnicity-related variability in beta-blocker response, a cautious dose adjustment or consideration of alternative medications with less risk of bradycardia could be explored. Due to CKD and its potential impact on drug elimination, close monitoring of renal function is essential to adjust drug dosages accordingly. Educating the patient and her spouse about the importance of regular monitoring of vital signs, especially heart rate, and adherence to medication regimens, which includes explaining the significance of INR levels and potential signs of drug toxicity (Ibrahim et al., 2022)Pharmacotherapeutics For Cardiovascular Disorders Assignment Paper.

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References

Ibrahim, O. M., Ibrahim, R. M., Ibrahim, Y. A., Madawi, E. A., & Al Deri, M. Y. (2022). Shedding the light on Pharmacists’ roles during COVID-19 global pandemic. Saudi Pharmaceutical Journal30(1), 14-27. https://doi.org/10.1016/j.jsps.2021.12.003

Ingelman-Sundberg, M., Mkrtchian, S., Zhou, Y., & Lauschke, V. M. (2018). Integrating rare genetic variants into pharmacogenetic drug response predictions. Human genomics12, 1-12. https://doi.org/10.1186/s40246-018-0157-3

Santos, M., Niemi, M., Hiratsuka, M., Kumondai, M., Ingelman-Sundberg, M., Lauschke, V. M., & Rodríguez-Antona, C. (2018). Novel copy-number variations in pharmacogenes contribute to interindividual differences in drug pharmacokinetics. Genetics in Medicine20(6), 622-629. https://doi.org/10.1038/gim.2017.156 Pharmacotherapeutics For Cardiovascular Disorders Assignment Paper

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