Pharmacotherapy for Cardiovascular Disorder - Research Paper

Introduction

It is estimated that about 6.4 million American aged 20 and above have from a stroke. The overall prevalence of stroke in the United States is estimated at 2.9% (Adams, Basile, & Gorelick). Besides, it is estimated that 200000 to 500000 incidences of transient ischemic attack (TIA) are registered in the United States. Unfortunately, patients with a medical history of a stroke or TIA have increased chances of developing another stroke or vascular events (Adams, Basile, & Gorelick). Age-related changes in pharmacodynamics and pharmacokinetics affect drug metabolism, absorption, distribution, and elimination (Hammerlein, Derendorf, & Lowenthal, 1998).

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The elderly (over 65 years of age) in the United States constitute 12% of the total population \m Mur18 (Hammerlein, Derendorf, & Lowenthal, 1998; Murphy, Xu, Kochanek, & Arias, 2018). Moreover, this group of people accounts for over 30% of the total drug expenditure (Hammerlein, Derendorf, & Lowenthal, 1998). Age-related changes thus make the elderly vulnerable to many drug adverse effects, including those with chronic conditions. Therefore, there remains a dire need to manage and adhere to recommended therapies. This reflection essay, accordingly, assumes that the patient is elderly and aims to address the above case and reflect on how age-related factors influence the patient's pharmacokinetic and pharmacodynamics processes.

Pain Management

The case does not provide a previous medical history of the patient's pain history. As a result, depending on the effectiveness of the currently prescribed drugs (Aspirin 81 mg PO daily), HM may continue with the drugs. However, using ibuprofen regularly (daily) for mild pains may result to increased risk of GI bleeding because of the metabolic reaction between Ibuprofen, aspirin, and Warfarin (Drugs.com, 2019; Li et al., 2014). To avoid the risk of GI bleeding, the patient should change to Tylenol. Moreover, muscle weakness, and reduced metabolic activities in older adults have influenced the absorption rate of aspirin; therefore, continued use Ibuprofen will lead to the reduced antiplatelet effect of aspirin requiring the aspirin dosage to be increased (Li et al., 2014).

Atrial Fibrillation and TIA medical history

Mr. H.M use of Warfarin and Coumadin for TIA and atrial fibrillation is on a lower dose of aspirin. His age and physical activities serve a perfect condition for the drugs to work effectively. However, there is a slight risk of bleeding by using Coumadin with aspirin; therefore, depending on the patient's response to pain and recovery, reducing the Coumadin dosage to 325 mg. Nevertheless, both medicines work perfectly for the patient medical history provided that PT/INR is within the correct therapeutic range (Munger, Wu, & Shen, 2013).

Ischemic Heart Disease, Hypertension, Atrial Fibrillation

Atenolol is a cardio-selective beta-blocker which is among the most effective drugs for controlling the ventricular rate in atrial fibrillation. Therefore, prescription Atenolol 100 mg PO Daily is an appropriate choice for ventricular rate control; alternatively, calcium channel blocker can be used (Benjamin, Virani, Callaway, Chamberlain, Chang, & Susan Cheng, 2018, p. e222). Mr H.M diabetic control is likely to be affected by a beta-blocker since the blocking of beta 1 masks the flight or fight response and hypoglycemia symptoms (Reese et al., 2015). I firmly believe the use of Atenolol 100 mg PO Daily is not the best option for blood pressure treatment because of the diabetic and ischemic heart disease medical history. Assuming that his in controlled blood pressure of 140/80mmHg and on a calcium channel blocker, I recommend the following:

A baseline BUN and creatinine and initiate an Angiotensin-converting Enzyme (ACE) inhibitor (Reese et al., 2015; Li et al., 2014). Under the AHA 2012 ischemic heart disease guidelines, in the presence of hypertension and diabetes, an ACE inhibitor would be the most appropriate cause of action and with a JNC-8 for patients 60, (Mr H.M. is in his 60s) (Benjamin, Virani, Callaway, Chamberlain, Chang, & Susan Cheng, 2018, p. e311). Alternatively, the patient can be initialized with an ACE or ARB before using Atenolol if the condition does not improve within three days after initialization (Benjamin, Virani, Callaway, Chamberlain, Chang, & Susan Cheng, 2018).

Hyperlipidemia

According to the case, there is no specific medication that was prescribed for hyperlipidemia. It is therefore likely that the physician opted for more natural and lifestyle implemented modification such as physical exercises, balanced diet, and reduced cholesterol intake. However, Mr H.M diabetic history suggests that more is needed to the lifestyle medication. Thus, initializing with Statin ( 2 mg -2.5 mg daily) (Mannu, Zaman, A Gupta, & Myint, 2013). According to the American Diabetic Association (2015), the use of Statin drugs under the standards care for diabetes should be implemented on risk factors alone regardless of LDL level. He will need a baseline liver profile. Besides, a Lipitor to be started at 10mg and increased based on response. Lipitor absorption remains the same regardless of age or when it is taken; however, for statins, it is recommended to be taken at night (Mannu, Zaman, A Gupta, & Myint, 2013).

Type II Diabetes

Mr H.M will require an evaluation of hemoglobin A1c and baseline renal function f decisions about his or a correct choice on his diabetic medications. Nevertheless, combining Metformin 1000 mg (maximum daily dose) and Glyburide 10 mg indicates that Mr H.M.'s diabetes was not well controlled. Starting with a shorter half-life drug such as Glipizide dose (2.5-5.0 mg) once daily and titrated according to their response (Drugs.com, 2019).

References

Adams, R. J., Basile, J. N., & Gorelick, P. B. (n.d.). Case Study 2: Patient With Atrial Fibrillation and Prior Transient Ischemic Attack (TIA): Anticoagulant Therapy, Uncontrolled Hypertension, Dyslipidemia. Retrieved from Bristol-Myers Squibb: https://www.medscape.org/viewarticle/744735

Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., & Susan Cheng, S. (2018). Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. American Heart Association journals, e67-e492.

Drugs.com. (2019, May 31). Ibuprofen Dosage. Retrieved from Drugs.com: https://www.drugs.com/dosage/ibuprofen.html

Hammerlein, A., Derendorf, H., & Lowenthal, D. (1998). Pharmacokinetic and pharmacodynamic changes in the elderly. Clinical implications. Clinical Pharmacokinetics, 35(1), 49-64.

Li, X., Fries, S., Li, R., Lawson, J., Propert, K., Diamond, S., et al. (2014). Differential impairment of aspirin-dependent platelet cyclooxygenase acetylation by nonsteroidal antiinflammatory drugs. Proceedings of the National Academy of Sciences of the United States of America, 111(47), 16830-5.

Mannu, G., Zaman, M., A Gupta, 4. R., & Myint, P. (2013). Evidence of Lifestyle Modification in the Management of Hypercholesterolemia. Current Cardiology Reviews, 2-14.

Munger, T. M., Wu, L., & Shen, W. K. (2013). Atrial fibrillation. The Journal of Biomedical Research, 28(1), 1-17.

Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. CDC.

Reese, H. E., Scahill, L., Peterson, A. L., Crowe, K., Woods, D. W., Piacentini, J., et al. (2015). The Premonitory Urge to Tic: Measurement, Characteristics, and Correlates in Older Adolescents and Adults. Behavioral Therapy, 45(2), 177-186.