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Pharmacotherapy for Venous Thromboembolism Prevention and Treatment

Case Study Instructions:

Using a minimum of five evidence-based resource articles, not older than three years, and the course textbook (Woo, J. J. (2016), PHARMACOTHERAPEUTICS FOR ADVANCE PRACTICE NURSE PRESCRIBERS fourth edition, Philadelphia, PA : A. Davis Company).

 

Pharmacotherapy for Venous Thromboembolism Prevention and Treatment

D. G. is a 74-year-old African American woman who arrives at the emergency room complaining of shortness of breath, palpitations (for two days), and lower extremity edema. Her medical history includes diabetes mellitus, hypertension, heart failure with reduced ejection fraction, and osteoarthritis. She had a left heart catheterization and coronary angiography last year and has no significant coronary artery disease. She has a biventricular pacemaker/implantable defibrillator for heart failure symptom treatment and sudden cardiac death prevention. The patient’s current medications are losartan 100 mg/d, metoprolol succinate 50 mg/d, metformin 500 mg twice daily, spironolactone 25 mg/d, furosemide 40 mg/d, and naproxen 500 mg twice daily.

Vital Signs

  • Blood pressure of 140/80 mm Hg
  • Respiratory rate of 30 bpm and heart rate of 120 bpm
  • ECG shows atrial fibrillation with a rapid ventricular response
  • Echocardiography reveals a moderately dilated left atrium, left ventricular systolic ejection fraction of 35% (unchanged), chronic kidney disease (baseline serum creatinine 1.01 mg/dL), and moderate mitral regurgitation.

Pertinent Laboratory Values

  • Hemoglobin 12 g/dL, hematocrit 36%, platelets 300,000/microliter, and serum creatinine 1.20 mg/dL (estimated creatinine clearance 39 mL/min).
  • Her weight is 60 kg (increased from 55 kg), and height is 5 feet 3 inches.
  • She does not smoke and does not drink alcohol.
  • Dietary habits include one can of Ensure daily, with other meals provided by a social service agency (Meals on Wheels).

Social Concerns

Social concerns include the fact that she lives alone, but a son visits every one to two weeks and transports her to physician appointments. She is living on a limited budget. With regard to her medication adherence, her son states that she occasionally forgets to take her afternoon medications, but overall, she is considered to be reasonably adherent with her drug regimens.

Diagnosis: Atrial Fibrillation, Acute Onset

  1. List specific goals of treatment for D. G.
  2. What drug therapy would you prescribe for stroke prevention in atrial fibrillation? Why?
  3. What are the parameters for monitoring success of the anticoagulant therapy?
  4. Discuss specific patient education based on the prescribed therapy.
  5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
  6. What would be the choice for the second-line therapy?
  7. What over-the-counter (OTC) or alternative medications would be appropriate for D. G.?
  8. What lifestyle changes would you recommend to D. G.
  9. Describe one or two drug-drug or drug-food interactions for the selected agent.

Directions

  1. Craft a therapeutic plan.
  2. Using Beers Criteria and rational drug prescribing, review the medications and diagnoses listed for D. G. What three prioritized changes would you make to the medication regimen? Include a detailed and evidence-based rationale for all changes, including, but not limited to, monitoring, drug-drug interactions, drug-disease interactions, pharmacokinetics/pharmacodynamics, age, gender, and culture.
  3. What would be your pharmacological-related patient education?
  4. Would you order any laboratory testing? Provide rationale for all decisions.
  5. Describe a follow-up plan of care with rationale.

Instruction

Using a minimum of five evidence-based resource articles, not older than three years, and the course textbook (Woo, J. J. (2016), PHARMACOTHERAPEUTICS FOR ADVANCE PRACTICE NURSE PRESCRIBERS fourth edition, Philadelphia, PA : A. Davis Company).

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Case Study Sample Content Preview:

Pharmacotherapy for Venous Thromboembolism Prevention And Treatment
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Introduction
Venous thromboembolism, or simply VTE, is the formation of blood clots within the innermost areas of the veins, especially in far-flung parts of the body such as the arm or the leg. Once they form, these clots, through the normal process of blood circulation, find their way to the lungs, where they block some parts of it. It is a severe cardiovascular disease. The disease is often life-threatening due to the severe damage it can cause to the affected organs if proper medical care isn't sought. For patient D. G. who is a 74-year-old African American woman, there is the need for appropriate pharmacotherapy for venous thromboembolism, which can lead to management.
Venous Thromboembolism (VTE)
VTE is a combination of two diseases, Deep Vein Thrombosis, and the Pulmonary Embolism. The formation of the blood clots in the various parts of the body, such as the leg or arm, is what constitutes DVT. On the other hand, when these clots break off the veins and move to the lungs, clogging, and even preventing proper blood supply to the lungs, it is called pulmonary embolism (Taxbro, 2019). Quite typically, the clogging of the lungs is usually a product of clots originating mostly from the thighs than any other part of the body. This makes such types of clots deadlier.
Patients suffering from VTE are usually subject to morbidities that might even last their entire lifetimes. For example, the after-effects of the disease include pulmonary hypertension, which is, in most cases, lifelong. The other one is the post-thrombotic syndrome, which, as the name suggests, is the physical complications that occur after recovery or management of VTE. It often occurs at the part of the body that has been primarily affected by the disease and usually appears as a skin induration, edema, or pain around that area. Sometimes these symptoms can be so severe that an individual loses some normal functioning of the body (Watson, Ong & Cheng, 2018). The syndrome is also lifelong.
The symptoms of VTE are usually quite wide-ranging, from asymptomatic to severe physical shocks. The symptoms include pain and redness of the skin on the affected part of the body. This swelling is often a result of the formation of the clot deep in the vein. There is also difficulty in breathing and chest pains as the clots start clogging the lungs (Wang, 2019). As a result, the patient might even begin to experience irregular heartbeats as the heart tries getting more oxygenated blood from the lungs, which as clogged. In extreme cases, the patient might begin coughing out blood and even fainting. D.G arrives at the healthcare facility complaining about shortness of breath as well as palpitations of the heart, which has gone on for two days. This is a potential symptom of VTE.
Risk Factors and People at Highest Risk
Generally, people who are advanced in age are at the most significant risk, especially adults who are over 60 years of age (Thatchil & Bagot, 2018). While it can affect individuals of any age, it has never occurred on kids. D.G. is 74 years old, which in itself is already a risk factor here. In addition to those who are overwe...
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