Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders

Pharmacokinetic and pharmacodynamic influence of drug factor on patient metabolism.

              Warfarin

Its is useful in treating blood clots as it acts as an anticoagulant reducing deep vein thrombosis. Warfarin is fully absorbed in 2 to 6 hours. It divides into small units and is eliminated with a low clearance by hepatic metabolism. A warfarin concentration of 1.5mg/L will inhibit the complex prothrombin synthesis by 50%. The anticoagulant takes an average of 3 days to stabilize at a constant level (Kim, K. Y., & Mancano, M. A. (2003)

                Aspirin and Motrin

It inhibits platelet cyclooxygenase. It relieves pain and significantly reduce the risk of death in the event of a heart attack. An oral dose of 81mg of aspirin has linear pharmacokinetics. Motrin is a Non-Asteroidal Anti-inflammatory drug that relieves headache, dental and muscular pains. It has a high peak concentration and rapid absorption compared to aspirin. It has dominant inhibition on enzyme COX2(Lynch et al., 2006)

                   Metformin and Glyburide

Metformin is useful in treating type 2 diabetes mellitus. Its pharmacokinetic profile reaches a steady state at the fourth dosage day(Henry et al., 2012). Pharmacokinetic pharmacodynamics parameters of glyburide are closely similar between two age groups, between 0 to 12 years and in the elderly. Ageing does not correlate the glyburide pharmacodynamics. Significant difference exists between glyburide pharmacodynamics and pharmacokinetics (Moretti et al.,.). Careful dosage is vital to achieving the targeted therapeutic response in patients.

                 Atenolol

It is an oral drug used to manage hypertension. It prolongs plasma elimination renal failure half-life. It causes a reduction in arterial blood pressure and resting heart rate.  The pharmacokinetic relationship is logarithmic between urinary atenolol excretion and the concentration of the drug in the plasma(Liebowtz et al.,1988).

               Impact of Changes in Recommended Drug Therapy

Taking into account that the patient has a history of atrial fibrillation and transient ischemic attacks, this may imply the presence of blood clots in the plasma causing irregular and rapid heart rate. This disorder may as well be caused by hyperlipidemia. Warfarin will assist in anticoagulation while Atenolol will manage the high blood pressure reducing the secondary chance of ischemic heart disease (Kim, K. Y., & Mancano, M. A. (2003). Aspirin is necessary to relieve headache and other pains associated with hypertension. The combined effect of metformin and glyburide will help manage diabetes mellitus.

Improving the Patient’s Drug therapy

Lipid-lowering and antihypertensive drugs have a better hypotensive effect than Angiotensin-converting enzymes and Calcium Channel Blockers. Atenolol is most likely to develop patient drug therapy for its high antihypertensive effect and reduced side effects. Diltiazem is a complementary drug likely to boost atenolol in managing hypertension(Liebowtz et al.,1988). Anticoagulation effect of warfarin may be adverse on the patient. Nutritional substitution of warfarin may be obtained from food types with a natural source of coumarins. This because warfarin requires regular monitoring in its administration as compared to anticoagulants obtained from natural sources.

The problem of hyperlipidemia may be largely contributing to hypertension. The patient may take on physical exercise to reduce this contributing factor. This is because a high build-up of metformin in the body may lead to asthenia, diarrhoea and flatulence (Henry et al., 2012). Nutritional complements of glyburide, e.g. Gymnema, will support the patient’s therapy plan.

              Actualizing the Recommended Improvement.

This would be done through close monitoring of the patient. He may be admitted in hospitals, and I make a regular visit to his house to monitor the drug therapy process from the beginning to the dosage end. The patient may be advised to take food types that enhance insulin secretion to manage type 2 diabetes and do physical exercises that will aid in managing hyperlipidemia and ultimately, hypertension.

References

Kim, K. Y., & Mancano, M. A. (2003). Fenofibrate potentiates warfarin effects. Annals of Pharmacotherapy, 37(2), 212-215.

Liebowitz, M. R., Gorman, J. M., Fyer, A. J., Campeas, R. B., Levin, A. P., Sandberg, D., … & Goetz, D. (1988). Pharmacotherapy of social phobia: An interim report of a placebo-controlled comparison of phenelzine and atenolol. The Journal of clinical psychiatry.

Henry, R. R., Murray, A. V., Marmolejo, M. H., Hennicken, D., Ptaszynska, A., & List, J. F. (2012). Dapagliflozin, metformin XR, or both: initial pharmacotherapy for type 2 diabetes, a randomised controlled trial. International journal of clinical practice, 66(5), 446-456.

Moretti, M. E., Rezvani, M., & Koren, G. (2008). Safety of glyburide for gestational diabetes: a meta-analysis of pregnancy outcomes. Annals of pharmacotherapy, 42(4), 483-490.

Lynch, M. E., & Watson, C. P. N. (2006). The pharmacotherapy of chronic pain: a review. Pain Research and Management, 11(1), 11-38.