Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

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Discussion: Pharmacokinetics and Pharmacodynamics

Patient Scenario and Medical History

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As an inpatient mental health I received a patient from Cook County Hospital Chicago, who had been the ward of the state for most of her life, she was a 28-year-old female with a history of schizoaffective disorder. This patient had been in and out of several psychiatric hospitals over the course of the last 5 years. There

Discussion Pharmacokinetics and Pharmacodynamics NURS 6521

Discussion Pharmacokinetics and Pharmacodynamics NURS 6521

were several other underlining past medical conditions that included, high blood pressure, type 2 diabetes mellites, elevated cholesterol, renal failure and GERD. Lack of stable placement in this young woman’s life resulted in her becoming non medication compliant. With her diagnosis of schizoaffective disorder, I knew that it was necessary for her to be involved in long-term treatment, to avoid relapses, and further hospitalizations. The short-term goal was to reduce symptoms of the diagnosis and delay future relapses and episodes, as there no general.

Pharmacodynamics and Pharmacokinetics

Van der Graaf & Benson 2011 suggests, “Drugs produce their effects by interacting with receptor targets, and drug discrimination is one behavioral procedure that is useful for investigating determinants of this interaction”. Evidence based research has proven that drugs can have different effects on the body, and this reaction of drugs in the body can be broken down into 2 parts that are referred to as pharmacokinetics and pharmacodynamics. Pharmacokinetics refers to how a drug navigates throughout the body system, while the concept of pharmacodynamics deals with is how the drug affects the body as well as its therapeutic or toxic effect in the body (Rosenthal, L. D., & Burchum, J. R, 2018).

Certain medical conditions generally affect the efficacy of psychotropic medications, they include acute and chronic kidney disease, heart diseases (Van der Graaf & Benson, 2011). Patients with these co-morbities have to be observed and monitored closely in pharmacotherapy to achieve optimum drug therapeutic effect. Some of the factors that influence pharmacokinetics of the patient include age and body composition. The malabsorption of the drug causes slower elimination which results in increased levels of the drug in the blood. There is an increased risk of adverse drug reactions because of the direct coloration of the dosage administered and how the body responds to the drug. The half-life of drugs that require metabolism and excretion can be remarkably longer in older people than in younger people (Le, 2020). It would also determine the route of administering medication. The general body composition of the patient such as body weight and height also influenced pharmacokinetics. However, pharmacokinetics also depends on the chemical properties of a drug. Pharmacodynamics may also have been influenced by similar factors.

Plan of care

To accurately establish the diagnosis of schizoaffective disorder, all other mental health issues including substance abuse and chemical dependency must be ruled out. I conducted a thorough head to toe physical assessment to establish a baseline and to find out any prior related complications. Following this I ran some routine tests and screenings, such as a urinalysis and drug screen test. The psychiatrist also requested that an MRI and CT scan be completed. A complete psychiatric evaluation was also done by a mental health professional, and then I collected more data afterwards on family and personal history, as well as issues regarding any major stresses or recent life changes. A full medication list, including dosages and frequencies of vitamins, herbal preparations and supplements, and the dosages

Medical treatment

A medication regimen that would fit the patient’s lifestyle is imperative due to a history of non-compliance with medication, the drug of choice ordered by the psychiatrist was targeted to relieve psychotic symptoms, maintain mood stability and depression. A monthly shot of Invega was prescribed for psychosis. Other drugs for mood stability and depression were prescribed on an as needed basis.

Psychotherapy

It was important to develop a trusting relationship with the patient as this allowed for strong therapeutic communication. The patient was able to understand some of the core dynamics of schizoaffective disorder, which leads to creating normalized thought patten and decrease symptoms. We also explored several other coping strategies for issues and concerns problems, relationships and coping strategies.

Reference

Le, J. (2020, October). Overview of Pharmacokinetics. Retrieved from https://www.merckmanuals.com/professional/clinicalpharmacology/pharmacokinetics/overview-of-pharmacokinetics

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Van der Graaf PH, Benson N. Systems pharmacology: bridging systems biology and pharmacokinetics-pharmacodynamics (PKPD) in drug discovery and development. Pharm Res. 2011 Jul;28(7):1460-4. doi: 10.1007/s11095-011-0467-9. Epub 2011 May 11. PMID: 21560018.

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

 

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s . These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

By Day 6 of Week 1

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion

Week 1-Initial post

     Pharmacokinetics and pharmacodynamics are two major relationships between medications and the body that should be considered when determining patient dosing (Rosenthal & Burchum, 2018). Pharmacokinetics is the absorption, distribution, metabolism, and excretion of a drug. Pharmacodynamics is the biochemical and physiologic effects of a drug.

Patient Case

Mr. K is a 10-years old male with a rare hereditary metabolic disorder glutaric aciduria type 1 (GA1) accompanied by neurologic impairment of speech, feeding difficulties, cerebral palsy, and spastic dystonia. The patient had periodic episodes of dystonic movements whenever he got happy or excited. He would have jerking movements of legs, tighten his body, fists his hands, and sometimes screams or cries. The patient enjoyed watching TV and watching other children play; unfortunately, those were some of his triggers at times. Sometimes the patient’s dystonic movements had no triggers. The patient’s dystonic movements could be periodic most of the day, lasting for up to a minute or the movements may start an hour or two before his next medication time. Mr. K could go a day without any dystonic movements, usually following exhaustion from two to three days of spasticity. The patient was on several medications, such as anticholinergics, benzodiazepine, and muscle relaxants. His primary medication was Baclofen (Lioresal), which he had four times a day through an enteral feeding tube to control his dystonia.

Pharmacokinetics and Pharmacodynamics

Dystonia refers to physical signs or symptoms of involuntary muscle contractions, and in children, it can cause motor disability (Adis Medical Writers, 2018). Dystonia can be acquired or inherited. In Mr. K’s case, his dystonia was due to genetic disorder GA1. Baclofen (Lioresal) is usually prescribed as a spasmolytic agent with GABA-B receptor agonist properties (Simon, Franchitto, & Rolland 2018). The medication comes in oral and intrathecal therapy. Oral Baclofen is rapidly absorbed in the intestinal tract, travels through the bloodstream, and binds with GABA-B receptors in the central nervous system (CNS) (Simon, Franchitto, & Rolland, 2018). Intrathecal Baclofen is administered directly to the spinal cord through a medication pump. Baclofen is metabolized in the liver and excreted by the kidney within 72 hours. The medication peaks plasma concentration in one hour and has a half-life of 3-6 hours.  Eighty-five percent of the drug is excreted unchanged by the kidney, and the remainder is excreted in the feces unchanged (Simon, Franchitto, & Rolland, 2018).

Baclofen binds on GABA-B receptors in the CNS, inhibits calcium influx, and reduces motor neuron excitability (Adis Medical Writers (AMW), 2018). Due to a short medication half-life, frequent administration is required for optimal effect. The maximum dosage is 60mg/day for children older than two years of age. Common adverse effects of Baclofen include drowsiness, dizziness, fatigue, constipation, and hypotonia at high doses. Baclofen cannot be discontinued abruptly due to the risk of withdrawal symptoms such as worsening spasticity, seizures, and hallucination.

Patient’s Personalized Plan of Care

Patient prevention, education, and health promotion should be included in the plan of care. Some conditions may become worse when Baclofen is abruptly stopped. Patient teaching should be centered on tapering medication dosage per healthcare provider’s orders. Urine output should be monitored while the patient is taking Baclofen to avoid toxicity. Sleep inducing and over-the-counter medications that cause drowsiness or mood changes should be avoided while on Baclofen. The provider should be notified of any increased dizziness or any change in the level of consciousness. Fall precautions should also be included in the patient’s plan of care while on Baclofen.

References

Adis Medical Writers. (2018). Tailor the pharmacological management of childhood dystonia to meet the needs of each child. Drugs & Therapy Perspectives34(5), 216–221. https://doi-org.ezp.waldenulibrary.org/10.1007/s40267-018-0495-1

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s Pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Simon, N., Franchitto, N., & Rolland, B. (2018). Pharmacokinetic Studies of Baclofen Are Not Sufficient to Establish an Optimized Dosage for Management of Alcohol Disorder. Frontiers in psychiatry9, 485. 

RE: Week 1-Initial post

Anastasia,

I enjoyed reading your posts. There are limited options in pharmaceuticals when it comes to treating children with dystonia. The two medications used for children for the treatment ofdystonia are Lioresal (baclofen) and Artane (trihexyphenidyl). Deep brain stimulation is used to treat dystonia; however, only few children are appropriate for this treatment for dystonia (Lumsden, 2018). The role of the primary care provider is to identify when dystonia occurs and ensure that the symptom is not being caused by any medications being taken. Interestingly, a few medications can cause dystonia including some antiemetics, antipsychotics such as Haldol(haloperidol), and psychostimulants such as Provigil (modafinil) (Lumsden, 2018).

Other considerations regarding baclofen in the treatment plan include monitoring and managing side effects. A few bothersome and frequent side effects of baclofen can include nausea, constipation, and urinary retention (Rosenthal & Burchum, 2018). You mentioned monitoring for urinary retention in your care plan. I think that monitoring for nausea could be crucial as well in that your client has impaired speech. Perhaps, monitoring of food intake and bowel movements could help identify any gastrointestinal upset that could be due to baclofen. There are limited options for treating dystonia in children and baclofen is reported to have frequent bothersome side effects, as discussed.

References

Lumsden, D. E. (2018). The child with dystonia. Pediatrics and Child Health, 28(10), 459–467. DOI:10.1016/j.paed.2018.04.016

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Name: NURS_6521_Week1_Discussion_Rubric

Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3
First Response
Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response
Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed. .

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days
Total Points: 100
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