Introduction
Cardiovascular disorders continue to be one of the main causes of death in the US and the world. In the US, more than 10 million people have coronary heart disease, a condition which leads to thousands of deaths every year (Arcangelo, Peterson, Wilbur, & Reinhold, 2016). This and similar heart problems can be a result of various issues, including hypertension, diabetes, and hyperlipidemia (Rocca et al., 2014). In turn, these disorders are also caused by a variety of factors. In the first discussed case, patient AO has the diagnoses of hypertension (high blood pressure) and hyperlipidemia (elevated blood cholesterol). Moreover, AO has obesity and continues to gain weight as it has been determined during the last check-up. This progression of weight gain can be considered a factor that contributes to the patient’s health changes and negatively affects the outcomes of the prescribed drug therapy.
Influencing Factor
Obesity is listed as one of the secondary influences on hyperlipidemia (Arcangelo et al., 2017). While one can argue that rapid weight gain can be attributed to some genetic differences, many people become obese as a result of poor eating and behavioral patterns (Cho, Yoon, & Kim, 2013). The overwhelming prevalence of obesity continues to elevate this condition to one of the main worldwide problems. The discussed patient’s weight change suggests that AO has poor nutrition or fails to adhere to some physical activity program. Thus, behavior can be considered a factor that affects the individual’s therapy.
The patient currently takes a number of medications, including the ones that lower cholesterol and regulate blood pressure. Obesity can have a significant impact on these drugs’ pharmacokinetics. For instance, oral drug absorption rates are enhanced in obese patients, as their blood flow increases to perfuse the gut (Cho et al., 2013). Although this difference is not as researched as other drug’s effects, it can affect the way the patient responds to treatment, especially if AO’s lifestyle does not change. Drug distribution is also altered as a result of obesity – one’s body composition (lean mass and fat tissue percentages) increases the volume of distribution for some types of medicine. Thus, some obese patients may respond to drugs differently than persons with lower weight. The effect of drugs may increase due to more active blood circulation and increased fat mass. Thus, a weight-based dosing system does not work for obese patients effectively because it does not take into account the difference in lean and fat tissue contents.
Drug Therapy Plan
It is vital to note that drug therapy for the patient should be complemented by changes in lifestyle, incorporating a healthy diet and physical activity. Moreover, weight loss should be considered by the patient as well because it may help reduce the adverse effects of treatment. Nonetheless, one can also make some improvements to the drug therapy plan outlined in the case. First of all, one should review the dosages of all drugs to ensure that they account for lean body mass and not overall weight of the patient. Furthermore, Sertraline’s side effects should be reviewed, as it has an uncommon occurrence of hypertension – if the patient’s obesity exacerbates the response to this medication, OA may experience severe effects caused by overdosage (“Sertraline side effects,” 2018). If Simvastatin is not effective in decreasing cholesterol levels, bile acid resins can be prescribed either instead of or in combination with the statin (Arcangelo et al., 2017).
Conclusion
Obesity is a condition that affects all parts of one’s life. In the discussed case, the patient’s weight gain contributes to hypertension and hyperlipidemia, increasing the possibility of developing a cardiovascular disorder. Moreover, it changes the effects of pharmacotherapy, making the weight-based system of dosing unreliable. Dosages of all medications should be reviewed to adjust to the increased sensitivity of the patient’s body. Overall, weight loss and a healthy lifestyle should become an inherent part of the treatment plan.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2016). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Cho, S. J., Yoon, I. S., & Kim, D. D. (2013). Obesity-related physiological changes and their pharmacokinetic consequences. Journal of Pharmaceutical Investigation, 43(3), 161-169.
Rocca, W. A., Boyd, C. M., Grossardt, B. R., Bobo, W. V., Finney Rutten, L. J., Roger, V. L.,… St. Sauver, J. L. (2014). Prevalence of multimorbidity in a geographically defined American population: Patterns by age, sex, and race/ethnicity. Mayo Clinic Proceedings, 89(10), 1336-1349.
Sertraline side effects. (2018). Web.