Pharmacotherapy for Cardiovascular Disorder

With the advancement of modern civilization, a new wave of global killers and co-morbid conditions such as cardiovascular disorders, type 2 diabetes, hypertension, stroke, heart attack, dyslipidemia, to mention the least. However, cardiovascular pharmacotherapy has assisted to manage the disorders across the continuum. For many years, drug therapy has worked as a life-saving option enhancing the quality of life for patients. From the case study, ethnicity is a salient factor influencing the patient's pharmacokinetics and pharmacodynamics processes. In particular, diabetes is an epidemic among African Americans in the US. Mathis et al. (2002) highlighted the prevalence of African Americans being diagnosed increases from one time to the other, and it is influenced by factors such as genetic, insulin resistance, obesity, and physical inactivity, among others. 

Ethnicity might influence the pharmacokinetic and pharmacodynamics process in the patient from the case study. As evidenced in research by Mathis et al. (2002), African American patients who have diabetes are prescribed more drugs than those with In this observation, Kaski and Kjeldsen (2019) concluded that the prevalence of some cardiovascular diseases is related to ethnic groups. The changes were caused to occur due to ethnic sensitive drug disposition (Sunkara et al., 2010). The drugs are forced to undergo significant metabolism hence causing insignificant differences among the group. African American patients appear to require high doses of tacrolimus to achieve appropriate blood level through concentration. The underlying causes of these differences relate to drug transporters, metabolizing enzymes, and genetic factors. 

Changes in the processes might impact the patient recommended drug therapy since therapeutic agents, mainly utilized transplant medications, are metabolized by cytochrome (Johnson, 1997). The drugs are absorbed into the systemic circulation and eliminated via bile excretion; these changes affect the hepatic clearance of drugs, which may be the determinant factor governing pharmacokinetics' variability. Simultaneously, the drugs are not metabolized via the oxidative pathway; this implies a significant difference concerning pharmacokinetics. The pharmacodynamics process is also similar. Glipizide, HCTZ, Atenolol, Hydralazine, Simvastatin, and Verapamil interrupted renin secretion in the case study, causing an increase in plasma concentrations. The changes in the processes impact the patient recommended drug therapy since the tacrolimus clearance is affected. The interaction of the drugs with food causes lower absolute bioavailability due to absorption, elimination, metabolism, and distribution (Mathis et al., 2002). The processes interfere with individual genetic makeup causing alternations in drug receptors, drug transporters, and membrane transporters. 

I might improve the patient's drug therapy plan because pharmacokinetics and pharmacodynamics processes appear to influence drug therapy. I will need to account for inter-individual variability in pharmacokinetic and pharmacodynamics processes rather than looking at ethnicity as the cause of the differences. Factors such as exposure to other medications can cause induction in metabolic enzymes or drug targets hence interfere with drug therapy. Most of the baselines are linked to genetic variants. The differences can be identified to discover isoform-specific polymorphisms; this can improve patient drug therapy since there will be an improvement in drug development and clinical trials (Kaskin& Kjeldsen, 2019). As such, I would make these recommended improvements to help clinicians select optimal drug regimens and doses for patients. This will be done based on specific genes since ethnic background determines the effectiveness of the drug therapy. The plan's improvement will also help clinicians prescribe drugs based on the characterization of essential genes for drug targets, cytokines, and metabolism enzymes. 

References 

Johnson, J. A. (1997). Influence of race or ethnicity on the pharmacokinetics of drugs.  Journal of pharmaceutical sciences ,  86 (12), 1328-1333. https://onlinelibrary.wiley.com/doi/pdf/10.1021/js9702168?casa_token=K6nrIKI5UNUAAAAA%3A66_TeZ7FxunsEbJEl35Kt7wpvrcvszKQ_Sh7kO62n8ckI_TM83dQGXT7yrUJmjptyHvazHcUKgQiUsyY 

Kaski, J. C., & Kjeldsen, K. P. (2019). Cardiovascular pharmacotherapy: a new ESC handbook comprehensively addresses pharmacological treatment issues for patients with cardiovascular disease. https://academic.oup.com/ehjcvp/article/5/4/185/5522939?casa_token=KFrJmApNKmkAAAAA:X9ICF67n6nXarJv0RwBUaay06U83IHeLje4vVtgTMMkWWEIZh61n1yfa5FLdFj8fVEzJsAsi1fMmCQ 

Mathis, A. S., Friedman, G. S., & Knipp, G. T. (2002). Do sex and ethnicity influence drug pharmacokinetics in solid organ transplantation?.  GRAFT-GEORGETOWN- ,  5 , 294-302. https://www.researchgate.net/publication/230676035_Do_Sex_and_Ethnicity_Influence_Drug_Pharmacokinetics_in_Solid_Organ_Transplantation 

Sunkara, G., Yeh, C. M., Ligueros-Saylan, M., Kawashita, H., Koseki, N., & Fukui, Y. (2010). Assessment of Ethnic Differences in the Pharmacokinetics of Valsartan.  Journal of Bioequivalence and Bioavailability ,  2 (6), 120-124. https://www.longdom.org/open-access/assessment-of-ethnic-differences-in-the-pharmacokinetics-and-pharmacodynamics-of-valsartan-jbb.1000043.pdf