Advanced Pharmacology Week 10 Assignment

Advanced Pharmacology Week 10 Assignment

Advanced Pharmacology Week 10 Assignment

A healthy heart has an EF between 50-75%, which indicates that the heart is pumping well and can deliver an adequate supply of blood to the body and brain. The patient has a low EF (38%) yet no evidence of ischemia or recent acute coronary syndrome. A low EF can occur if the heart muscle has been damaged due to a heart attack, a diseased heart valve, or heart failure. The tiredness, dyspnea on mild exertion (trouble breathing when walking 2-3 blocks), orthopnea, and pedal edema are all cardinal manifestations of heart failure. She is hypertensive and has arthritis as well. The systemic inflammation underlying arthritis is an independent risk factor for cardiovascular disease (Kerekes et al., 2014). With the above stated, the patient’s heart failure can be classified as stage C.

Advanced Pharmacology Week 10 Assignment

Verapamil is a calcium channel blocker. The entry of calcium ions into the muscle cell is necessary for muscle fibers to contract. This group of drugs blocks the entry of calcium ions into the muscle cells in the arterial wall, resulting in relaxation of the arteries’ muscle and dilatation. “Calcium channel blockers are not as protective as other antihypertensive agents against heart failure” (Eisenberg et al., 2004). Verapamil should be withheld. ACE Inhibitors or beta-blockers can be used in place of verapamil. Hydrochlorothiazide is used to treat edema in heart failure. It may also serve as an antihypertensive agent either alone or with other hypotensive agents. It should be increased to 25mg daily to improve edema symptoms. Digoxin, a cardiac glycoside, can also help manage the symptoms of heart failure. Ibuprofen is contraindicated in people with hypertension. It is associated with increased blood pressure in patients with arthritis and increased risk of cardiovascular disease (European Society of Cardiology, ESC, 2017). Celecoxib should be used instead.

Since digoxin is indicated, the patient’s heart rate should be monitored as often as possible. Before digoxin is administered, the heart rate is checked. It should be withheld if the heart rate is 60 or less. Blood pressure should also be checked and recorded at least every four hours. A fluid intake and output must be monitored. The patient should have both physical and mental rest.  This is because rest reduces the workload of the heart. Caloric intake should be reduced if the patient is overweight. A low or no salt diet should be served and must be light and easily digestible.  The patient should restrict fluid intake, avoid smoking and take alcohol in moderation or quit if possible (Gibbs & Jackson, 2000).

References for Advanced Pharmacology Week 10 Assignment

  • Eisenberg, M. J., Brox, A., & Bestawros, A. N. (2004). Calcium channel blockers: an update. The American Journal of Medicine, 116(1), 35-43. https://doi.org/10.1016/j.amjmed.2003.08.027
  • European Society of Cardiology (ESC). (2017). “Ibuprofen associated with blood pressure rise in arthritis patient at cardiovascular risk.” ScienceDaily. www.sciencedaily.com/releases/2017/08/170828094844.htm
  • Gibbs, C. R., & Jackson, G. (2000). Non-drug management. The BMJ, 320(7231), 366-369.
  • Kerekes, G., Nurmohamed, M. T., Gonzalez-Gay, M. A., Seres, I., Paragh, G., Kardos, Z., Barath, Z., Tamasi, L., Soltexz, P., & Szekanecz, Z. (2014). Rheumatoid arthritis and metabolic syndrome. Nat Rev Rheumatol, 10, 691-696. https://doi.org/10.1038/nrrheum.2014.121