Pharmacotherapy for Cardiovascular Disorders

The cardiovascular system is very delicate in the human body that works in colligation
with the respiratory system, central nervous system, endocrine, and renal system to bring about
the harmonious function of the vital organs and tissues in the body. Any slight alterations in the
cardiovascular can therefore cause subsequent changes in the functions of other related body
systems putting the individual’s life in danger and can lead to death if not handled well. Changes
in the different organ systems will also affect the normal pharmacodynamics and
pharmacokinetics, which will change what happens to a drug when it is ingested. Other factors
that have a marked effect on the pharmacokinetics and pharmacodynamics of a particular patient
include the patients’ personal and social habits, gender and genetics, and behavioral patterns.
Cardiovascular Disease on Pharmacodynamics and Pharmacokinetics
Patients diagnosed with cardiovascular disease who are experiencing positive symptoms
or complications of any cardiovascular disease have marked defects in the normal functioning of
the body systems, which can affect the metabolism, distribution, and excretion of drugs. The case
study involves the history of patient HM, who presents with episodes of atrial fibrillations and a
history of transient ischemic attack (TIA). He was diagnosed with type 2 diabetes, hypertension,
hyperlipidemia, and ischemic heart disease; he is currently on a multi-drug therapy consisting of
Warfarin, metformin, aspirin, atenolol, glyburide, and Motrin for the different medical
conditions.
Different factors can affect the normal pharmacodynamics and pharmacokinetics of a
patient, for instance, in this case, scenario, gender (Male), underlying comorbidities (Type 2
Diabetes, Hypertension, Hyperlipidemia/Obesity, and ischemic heart disease), multiple drug
therapy (Warfarin, metformin, aspirin, atenolol, glyburide, and Motrin), and other factors. 

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The male gender has been associated with some risk factors for developing certain
medical conditions; for instance, they have been associated with health-seeking habits, non-
adherence to medications, unhealthy personal and social practices like consumption of alcohol
and smoking of tobacco. The male gender has also been linked to unhealthy nutritional habits,
lack of physical exercise, and a balanced diet. Cardiovascular symptoms aggravation has been
linked to several unhealthy habits such as smoking cigarette, excessive consumption of alcohol,
lack of regular physical exercise and cardio. This could also very well affect the
pharmacodynamics of the pharmacological agent. (Lavie et al., 2019).
Since the patient is on multiple drug therapy, their risk of developing a drug to drug
interactions is relatively increased. For instance, Warfarin interacts with aspirin and other
aspirin-containing drugs, thus calling for some actions. Warfarin and aspirin drug interaction can
cause excessive bleeding and hemorrhages that are life-threatening (Moradi et al., 2020). The
patient can also have interaction with some drugs if he has a positive history of alcohol
consumption; for instance, alcohol and atenolol have a drug interaction that has been associated
with dose-dependent hypotension, which is life threatening and can lead to death.
Changes in Pharmacokinetics and Pharmacodynamics and their Effect on Drug Therapy
The patient in the case scenario is on a multi-drug therapy consisting of Warfarin, metformin,
aspirin, atenolol, glyburide, and Motrin to manage different medical conditions. The patient is
presenting with multiple organ dysfunction since chronic conditions like diabetes mellitus,
hypertension, and hyperlipidemia have been linked with defective functioning of respiratory,
renal, hepatic, and nervous systems (Jamwal et al., 2018). When the organ’s ability to function
normally is compromised, the process could negatively impact the pharmacokinetics and
pharmacodynamics. These effects may lead to reduction in metabolism, absorption and reduce

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the renal and hepatic clearance. The resulting changes in the pharmacokinetic factors could lead
to either reduced therapeutic effect or become toxic.  (Van den Anker et al., 2018). 
Multiple drug therapy with increased risk of developing drug-to-drug interactions can
also lead to complications that can affect the normal pharmacodynamics and pharmacokinetics;
for instance, excessive bleeding and hemorrhage from Warfarin- aspirin interaction can lead to
hypotension. Hypotension has been linked with defective hepatic function (hypotensive
hepatopathy), renal function (hypotensive renal failure), and defective nervous system
functioning. 

Plan of Care

The plan of care will consist of modifications in the medical therapy and recommend
certain changes in the personal and social practices of the patient. This process involves utilizing
both pharmacological agents and non-pharmacological agents, for example, making changes on
the type of drugs and recommend regular physical exercises. Physical activity and nutritional
changes have shown good prognostic results in cardiovascular diseases, for instance, reduction of
red meat, food rich in fats and sugar, and inclusion of vegetables and fruits routinely onto their
diet.
The patient should be encouraged to make lifestyle modifications, for instance the patient
is advised to quit smoking, reduce or completely stop taking alcohol, and he should also be
advised to reduce his salt intake. These habits are linked to aggravation of cardiovascular
symptoms. The healthcare worker should manage the number of drug taken at a given time to
reduce drug to drug interactions and motivate the patient to take the medications.

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Summary

Recent research data reveal that cardiovascular diseases and other factors like behavioral
habits and intake of multiple drugs can alter the pharmacokinetics and pharmacodynamics
factors of drugs that involves absorption, metabolism, and clearance. These alterations can lead
to decreased bioavailability of the drugs and subsequent reduced therapeutic effect or can lead to
toxicity via enzyme induction and inhibition processes. 

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References

Jamwal, S., & Sharma, S. (2018). Vascular endothelium dysfunction: a conservative target in
metabolic disorders. Inflammation Research, 67(5), 391-405.
Lavie, C. J., Ozemek, C., Carbone, S., Katzmarzyk, P. T., & Blair, S. N. (2019). Sedentary
behavior, exercise, and cardiovascular health. Circulation research, 124(5), 799-815.
Moradi, S., Farhadian, N., Balaei, F., Ansari, M., & Shahlaei, M. (2020). Multi spectroscopy and
molecular modeling aspects related to drug interaction of aspirin and Warfarin with
pepsin; structural change and protease activity. Spectrochimica Acta Part A: Molecular
and Biomolecular Spectroscopy, 228, 117813.
van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes
in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58,
S10-S25.