Ischemic heart disease

Exploration of Pharmacology & Pathophysiology through Medication
The essay is to look at the pharmacodynamics and pharmacokinetics of the drug
Atorvastatin in relation to a patient (Simon) with a past medical history of Ischaemic heart
disease and hypertension. The essay is also to explore/discuss the anatomy & physiology,
pathophysiology associated with the drug’s action. Furthermore, what would this mean to
you as a nurse in relation to the patient.

Ischemic heart disease is one of the common chronic ailments identified among a large
percentage of individuals in different countries around the world. It refers to an illness
characterized by minimal blood supply to the human heart. This heart complication is one of the
key causes of demise among the citizens of such western nations as the United States. The
coronary arteries are responsible for supplying blood to the muscles situated within the heart. For
this reason, a blockage in these blood vessels will reduce blood supply to the heart and the
subsequent attainment of the ischemic heart disease (Parker & Parker 2003, p 39). A large
number of such health-related cases occur due to atherosclerosis, which is observable despite the
normal appearance of the artery lumens. The narrowing of these blood vessels results in
rupturing and a subsequent heart attack.
Another common health complication related to the crucial functioning of the human
heart is high blood pressure. This ailment, which is also referred to as hypertension, is a chronic

Exploration of Pharmacology & Pathophysiology 2
disease caused by the elevation of the blood pressure within the arteries. The blood pressure of a
normally functioning heart ranges between 100 and 140 mmHg and 60-90 mmHg systolic and
diastolic respectively. Hypertension occurs when the readings surpass 140/90 mmHg (Grundy
2007, p 114). Owing to the severity of this health condition, patients suffering from high blood
pressure often exhibit other complications including the coronary artery disease or the
hypertensive heart ailment. High blood pressure is also one of the key factors that put patients at
the risk of suffering from stroke, chronic kidney illness, or the peripheral arterial ailment.
Nonetheless, there exists certain treatment approaches used to improve the health condition of
patients suffering from high blood pressure or the ischemic heart disease.
One of these effective treatments that may be applicable in Simon’s case entails
Atorvastatin as part of the prescription. This drug is a calcium salt branded as Lipitor. It belongs
to the class of statins and is used to reduce blood cholesterol in addition to the prevention of such
heart complications as the cardiovascular disease. Similar to other drugs under this
classification, Atorvastatin functions by interfering with the capability of the HMG-CoA
reductase (Atorvastatin Global Investigators Meeting, Larosa & Pedersen 2004, p 27). This is an
enzyme situated with the liver tissue, which is crucial in the production of cholesterol within the
human body. In line with its efficacy in handling such health complications as those exhibited by
Simon in this case study, Atorvastatin is used as a primary medical approach of preventing
stroke, heart disease, and the requirement for certain revascularization proceedings on patients
with such risk factors as high blood pressure, a family history of heart complications, or a
developed coronary heart ailment (Mohammad 2012, p 55). In line with the health condition of
Simon, such a drug will aid in preventing further bodily complications associated with
hypertension and the ischemic heart disease.

Exploration of Pharmacology & Pathophysiology 3
With reference to Simon’s health condition and the pharmacodynamics of Atorvastatin,
the key site of action of this drug is the liver. This is because the liver is the main site for the
production of cholesterol and clearance of LDL. However, medical practitioners focus on the
dosage of Atorvastatin as opposed to the systemic drug concentration in order to attain a
significant reduction of LDL-C (Purcell & Schachter 2007, p 61). The absorption aspect of the
drug’s pharmacokinetics is also a crucial element that highlights the effectiveness of Atorvastatin
with reference to improving Simon’s health condition. This drug undergoes hasty absorption
when administered orally with the period of maximum plasma concentration being between 1
and 2 hours. Atorvastatin’s absolute bioavailability and the systematic accessibility for the
activity of HMG-CoA reductase is 14 % and 30 % correspondingly (Wong 2005, p 15). The
main trigger for the reduced systemic availability entails the drug’s high intestinal clearance as
well as its fast-pass metabolism. Although food stuffs do not have a noteworthy effect on the
drug’s efficacy of lowering LDL-C, administering this prescription with food results in 25 % and
9 % of its rate and extent of absorption respectively. In addition, administering the drug in the
evening lowers by AUC and C max by 30 % correspondingly (Wong 2005, p 20). With reference
to the drug’s distribution, the mean distribution volume of this medication is 381 liters. Since it is
substantially protein-bound, it is often released through human breast milk. Furthermore, its
metabolism is often through cytochrome P450 3A4 hydroxylation in order to produce ortho,
parahydroxylated, and beta-oxidation metabolites. It is mainly excreted through hepatic biliary
with approximately 2 5 being identifiable in urine (Wong 2005, p 23).
Owing to the key elements regarding the action of Atorvastatin and my skills as a nurse, I
would recommend Lipitor to Simon in order to improve his health condition. This is addition to
the consideration of other key factors such as exercise, healthy diets, and the avoidance of

Exploration of Pharmacology & Pathophysiology 4
obesity (Ebdrup 2008, p 44). This will not only be useful in lowering the patient’s blood pressure
and managing the ischemic heart disease but it will also be a valuable approach of preventing
other heart complications and stroke. For this reason, it is rational for most medical practitioners
to recommend this form of medication to such patients as Simon.

Exploration of Pharmacology & Pathophysiology 5


Atorvastatin Global Investigators Meeting, Larosa, J. C, & Pedersen, T. R, 2004, Second
Atorvastatin Global Investigators Meeting, Paris, France, April 28-30, 2002, New York,
Ebdrup, L, 2008, LPS-induced acute inflammation in a large animal model and the impact of
atorvastatin treatment: PhD thesis, [Aarhus], Faculty of Health Sciences, University of
Grundy, S, 2007, Atorvastatin in the management of cardiovascular risk: from pharmacology to
clinical evidence, Auckland [u.a.], Adis Internat.
Mohammad, M, 2012, Rosuvastatin versus a combination of Atorvastatin and Ezetimibe The
Better Choice in Metabolic Syndrome, Saarbrücken, LAP LAMBERT Academic
Parker, J. N, & Parker, P. M, 2003, Atorvastatin a medical dictionary, bibliography, and
annotated research guide to internet references, San Diego, CA, ICON Health
Purcell, H., & Schachter, M, 2007, Amlodipine and atorvastatin in the treatment and prevention
of cardiovascular disease, Edgbaston, Sherborne Gibbs Limited.
Wong, V. S. C, 2005, Mechanisms of insulin sensitization by omapatrilat, a vasopeptidase
inhibitor, and atorvastatin, a 3-hydroxyl-3-methylglutaryl coenzyme A reductase
inhibitor, Thesis (M. Sc.)–University of Toronto, 2005.