Order Description

 

Write a paragraph response for each scenario using the following:
• Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

 

 

Scenario 1:

Thrombolytic Disorders
There are many thrombolytic disorders that can occur in a person. Per Arcangelo, Peterson, Wilbur, and Reinhold (2017) Several disorders warrant anticoagulant therapy; including venous thromboembolism (VTE) prevention and treatment, stroke prevention in atrial fibrillation, and thromboembolism prevention with mechanical heart valves (p. 863). Treating the associated symptoms is important when dealing with these disorders.
VTE is a thromboembolic event occurring in the venous system, and it is manifested as either deep vein thrombosis (DVT) or pulmonary embolism (PE) (Arcangelo, Peterson, Wilbur, & Reinhold,p. 863, 2017). Atrial fibrillation is a cardiac arrhythmia characterized by loss of coordination of electrical and mechanical activity in the atria (Arcangelo, Peterson, Wilbur, & Reinhold, p. 864, 2017). Valvular disease is most commonly caused by degenerative valve disease due to increasing life spans and rheumatic heart disease, in which prosthetic heart valves confer a high risk of systemic embolism (Arcangelo, Peterson, Wilbur, & Reinhold, p. 865, 2017).
Treatment
Preventing the development of a stroke is the primary goal of antithrombotic therapy in patients with AF and prosthetic heart valves and in those with a history of cardioembolic stroke (Arcangelo, Peterson, Wilbur, & Reinhold, p. 870, 2017). Anticoagulant treatment in patients with existing DVT/PE is initiated to prevent extension of the thrombus; thromboembolic complications, including postthrombotic syndrome; and development of a new thrombus (Arcangelo, Peterson, Wilbur, & Reinhold, p. 870, 2017).
Typical associated symptoms for thrombolytic disorders are treated with anticoagulant drugs such as heparin, Lovenox, and coumadin are medicines that reduce the ability of the blood to clot (Drugs.com, 2017). These drugs required monitoring of blood work such as PT/INR to assure that a patient is in a therapeutic range. Antithrombotic therapy includes antiplatelet drugs such as aspirin, Plavix, and Abciximab all which have a different mechanism of action when dealing coronary symptoms (Watson, Chin, & Lip, 2002). Routine blood work is required for these types of medications as well, however, monitoring is less extensive.
Factor
A major factor with utilizing these treatments is age. Patients who have a chronic history coronary disease or bleeding disorders may not be suitable certain medications such heparin. The functioning status of major organs is important as well. Mental status can be affected by certain medications, therefore, caution should be taken in the elderly. In order to decrease the negative side effects, I would start with low doses or do weight-based medications.
References
Arcangelo, V. A., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. (4th ed.). Ambler, PA: Wolters Kluwer
Drugs.com. (2017). Anticoagulants. Retrieved from https://www.drugs.com/drug-class/anticoagulants.html
Watson, R., Chin, B., & Lip, G. (2002). Antithrombotic therapy in acute coronary syndrome. BMJ, 325(376): 1348-1351. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124806/

 

Scenario 2:

Anemia is a deficiency in the number of circulating red blood cells (RBC) or in the volume of these RBCs (Arcangelo, Peterson, Wilbur, and Reinhold, 2017). Anemias can be further classified by the size of the RBC as either microcytic or macrocytic and further broken down according to their pathologic etiology (Arcangelo, Peterson, Wilbur, and Reinhold, 2017). When planning a course of treatment for the anemic patient, the first consideration of the practitioner must be the vital stability of the patient (Arcangelo, Peterson, Wilbur, and Reinhold, 2017). For example, a patient who is anemic secondary to a gastrointestinal bleed (GI), must be vitally stable and the GI condition addressed before treatment for pharmacological treatment for an anemia can begin or be successful.
An anemia that the practitioner may see often is the anemia of chronic kidney disease (CKD). Risk factors for CKD include hypertension, diabetes, autoimmune disease, age, family history, proteinuria, and functional anatomic dysfunction of the urinary tract (Arcangelo, Peterson, Wilbur, and Reinhold, 2017). As nephrons are damaged functionally, the kidney loses its ability to excrete phosphorous and EPO deficiencies occur which negatively influence total number of RBC (Arcangelo, Peterson, Wilbur, and Reinhold, 2017).
The treatment of this particular anemia begins with replacing vitamins, supplementing iron stores, and using calcium based agents to bind phosphorous to treat the hyperphosphatemia that is often present (Arcangelo, Peterson, Wilbur, and Reinhold, 2017). The ultimate goal is to stop or delay as long as possible the deterioration of the kidney, reduce the number of transfusions required for the patient, and stabilize the hemoglobin between 11-12 (Arcangelo, Peterson, Wilbur, and Reinhold, 2017).
The prototype medicine for this regimen of treatment is Epogen, which is administered subcutaneously three times a week and it should be administered intravenously in dialysis patients (Arcangelo, Peterson, Wilbur, and Reinhold, 2017). Epogen has been approved by the FDA since 1989 and legislation in 2009 allowed biosimilar products to be developed to help drive down medicine costs (Stalker, et al., 2016). This led to the development of epoetin Hospira. Epoetin Hospira was shown in a 28-day study to have equivalent results to Epogen when administered to healthy individuals and was found to have a statistically similar rate of adverse events (Stalker, et al., 2016).
Age is major factor in the development of CKD, which extrapolates to a major factor in the development of anemias secondary to decreased EPO production. Researchers found in a retrospective study of over 2 million subjects, that although age increases the risk for development of CKD, that mortality rates were steady across age groups with similar stage of CKD (Susan,