Advanced Pharmacology
Introduction
A Clinical Nurse Practitioner (CNP) plays an essential role in assessing, diagnosing, giving prescriptions, and monitoring progress. The same symptoms accompany most pulmonary diseases, and this necessitates keen differentiation by CNPs. One of the illnesses is Chronic Obstructive Pulmonary Disease (COPD), which is prevalent among habitual smokers (NHLBI n.p.). In some cases, it results from prolonged exposure to air pollutants such as industrial fumes and dust. It causes inflammation in the lungs and is progressive, meaning that a patient’s condition may deteriorate with time. This paper will evaluate the diagnosis, treatment goals, and drug therapy. It will also explain patient education that the CNP should give, adverse drug reactions, and the recommended health promotion activities for a COPD patient.
Diagnosis, Stage and Treatment Goals
The question has given a diagnosis of COPD. The primary indicators that the patient is suffering from COPD are coughing, fatigue when active and progressive difficulty. The Forced Expiratory Volume is also a key indicator. This patient’s FEV1 is at 58%, which is less than 70%. The patient is at the moderate stage of infection or GOLD 2 since his FEV1 is below 80% but greater than 50% (GOLD 2019). COPD is not curable. Therefore, the goal of pharmacotherapeutic treatment is to slow down the disease’s progression, maintain the patient’s quality of life, reduce symptoms, reduce mortality, and relieve discomfort (Arcangelo and Peterson 318). It also aims at enabling the patient to engage in physical activity.
Recommended Drug Therapy
Drug therapy will mainly consist of bronchodilators. The main drugs that the CNP can prescribe are beta2-agonists. Beta2-agonists provide relief by relaxing the smooth muscle and dilating airways to improve pulmonary function (GOLD 2019). They combat bronchoconstriction. Long-term beta2-agonists (LABA) are preferred over short-term ones (SABA) because SABAs are only useful for mild symptoms (Jenkins 16). Examples of LABAs are salmeterol, formoterol, indacaterol, and vilanterol. Anticholinergics or long-acting muscarinic antagonist (LAMA) are also efficient options. They relax bronchial muscles and prevent them from contracting and decrease mucus secretion (Arcangelo and Peterson 319). They include ipratropium and tiotropium. A LAMA/LABA combination produces better results than using only one of them (Jenkins 16). Miravitlles and Anzueto recommend that LAMA should be tried first before introducing LABAs or combination therapy (Miravitlles and Anzueto 1). This approach reduces the risk of side effects by approaching COPD systematically. If the patient has a respiratory infection, the CNP may prescribe an antibiotic.
Parameters for Measuring Success and Patient Education
The outcomes of drug therapy determine whether treatment is successful or not. Some indicators that CNPs look out for to determine success are an increase in the patient’s quality of life, control of symptoms, and inhibiting disease progression (Van Der Molen, et al. 619). Quality of life is evidenced by the patient’s ability to engage in physical activity without straining, while disease progression is maintained if the FEV1 remains constant. The CNP should provide the patient with information on the prescribed drugs. Further, they should instruct the patient to avoid antihistamines, cough medication, sedatives, beta-blockers, and tranquilizers because they worsen their respiratory condition (Arcangelo and Peterson 322). The CNP should warn the patient against obtaining information on COPD from unofficial sources because inaccurate information would affect their mental and, ultimately, his physical health. The National Heart, Lung and Blood Institute (NHLBI), and American Lung Association websites are examples of approved information sources.
Possible Adverse Reactions and Second-Line Therapy
Patients may react to LAMAs or LABAs. Some of the adverse effects of LAMAs include urinary retention in patients with prostatic enlargement and worsening of glaucoma and atrial arrhythmias (Jenkins 16). LABAs may cause tremors and low potassium levels (GOLD 11). These reactions may necessitate a change in therapy. Second-line therapy usually involves introducing inhaled corticosteroids (ICS), which are anti-inflammatory drugs (Miravitlles and Anzueto 1). They include salmeterol and fluticasone. They suppress inflammation of the airways and prevent narrowing (Arcangelo and Peterson 320). The CNP may prescribe a LAMA/LABA/ICS combination, which is known as triple therapy. This combination is usually effective in preventing the progression of the disease.
Recommended Health Promotion Activities and the Effect of Metoprolol
The patient should change his lifestyle to thwart disease progression and prevent mortality. The main change that he should undergo is to quit smoking because it will accelerate the progress of the disease. The patient should also avoid people with respiratory infection to protect themselves from infection (Arcangelo and Peterson 322). He should watch out for any developing symptoms and increase physical activity by incorporating exercise into their daily routine. Lastly, he should increase their caloric intake and include supplements to boost their immunity and maintain weight. Metoprolol is a beta-blocker, which is safe to use but will interfere with the LABA prescription (Cazzola and Matera 661). It will act antagonistically and prevent the LABA from working.
Conclusion
Handling a COPD patient requires an understanding of the drug therapy that works and all other treatment options available. Oxygen and surgical treatment may be necessary supplemental treatments depending on the symptoms of the disease. The initial treatment that the CNP should apply is LAMA, followed by a combination of LAMA and LABA for advanced treatment. ICS is an effective second-line treatment. The CNP should give the patient all the pertinent information on their condition and health promotion activities that they may engage in to improve their condition. Further, the CNP should monitor the patient to measure the effectiveness of the therapy.
Works Cited
Arcangelo, Virginia P., and Andrew M. Peterson. Pharmacotherapeutics for Advanced Practice: A Practical Approach. Lippincott Williams & Wilkins, 2006.
Cazzola, Mario, and Maria G. Matera. “β-Blockers Are Safe in Patients with Chronic Obstructive Pulmonary Disease, But Only with Caution.” American Journal of Respiratory and Critical Care Medicine, vol. 178, no. 7, 2008, pp. 661-662, doi.org/10.1164/rccm.200806-963ED.
GOLD. “Pocket Guide to COPD Diagnosis, Management, and Prevention.” Global Initiative for Chronic Obstructive Lung Disease- GOLD, 2019, goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-POCKET-GUIDE-DRAFT-v1.7-14Nov2018-WMS.pdf.
Jenkins, Christine. “Drugs for chronic obstructive pulmonary disease.” Australian Prescriber, vol. 40, no. 1, 2017, pp. 15-19, doi:10.18773/austprescr.2017.003.
Miravitlles, Marc, and Antonio Anzueto. “A new two-step algorithm for the treatment of COPD.” European Respiratory Journal, vol. 49, no. 2, 2017, p. 1602200, DOI: 10.1183/13993003.02200-2016.
NHLBI. “COPD.” National Heart, Lung, and Blood Institute (NHLBI), www.nhlbi.nih.gov/health-topics/copd.
Van Der Molen, T., et al. “Measuring the success of treatment for chronic obstructive pulmonary disease — patient, physician and healthcare payer perspectives.” Respiratory Medicine, vol. 96, 2002, pp. S17-S21, www.resmedjournal.com/article/S0954-6111(02)80030-0/pdf.