Discussion: Pharmacokinetics and Pharmacodynamics

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Discussion: Pharmacokinetics and Pharmacodynamics

Discussion: Pharmacokinetics and Pharmacodynamics

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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. When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharamcodynamic processes. 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. In this Discussion, you reflect on a case from your past clinical experiences and consider how a particular patient’s pharmacokinetic and pharmacodynamic processes altered his or her response to a drug.

To prepare:

Review this week’s media presentation with Dr. Terry Buttaro, as well as Chapter 2 of the Arcangelo and Peterson text, and the Scott article in the Learning Resources. Consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last five years. Select a case from the last five years that involves a patient whose individual differences in pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.

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.

With these thoughts in mind:

By Day 3

Post a description of the case you selected. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient from the case you selected. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case.

By Day 6

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 pharmadynamic processes of the patients in their case studies. In addition, suggest how the personal care plan might change if the age of the patient were different and if the patient had a comorbid condition such as renal failure, heart failure, or liver failure.

Week 2 discussion

Discussion: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. In this Discussion, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

Scenario 1:

As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.

Scenario 2:

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

Scenario 3:

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.

Scenario 4:

During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life.

To prepare:

Review Chapter 1 of the Arcangelo and Peterson text, as well as articles from the American Nurses Association, Anderson and Townsend, the Drug Enforcement Administration, and Philipsend and Soeken.

Select one of the four scenarios listed above.

Consider the ethical and legal implications of the scenario for all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family.

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario.

With these thoughts in mind:

By Day 3

Post an explanation of the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario.

By Day 6

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different scenario than you did, in one or more of the following ways:

Suggest additional ethical and legal implications for all stakeholders in your colleagues’ scenarios.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Discussion: Pharmacokinetics and Pharmacodynamics

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Initial Discussion: Pharmacokinetics and Pharmacodynamics

Discussion: Pharmacokinetics and Pharmacodynamics

Case Scenario

I encountered a case of patient Z, and reflected upon the pharmacokinetic and pharmacodynamic processes in her treatment. Patient Z is a 62-year-old African American female presenting with morbid obesity and a history of asthma, stage III Chronic Kidney Disease (CKD III), fibroids, uterine leiomyomas, congestive heart failure (CHF), uncontrolled diabetes type II, and hypertension. During the encounter, she had presented to the hospital after experiencing abdominal pain and nausea/vomiting for three days. Laboratory tests showed hyperkalemia, hyperglycemia, and an acute kidney injury (AKI). An abdominal and pelvic CT scan revealed an enlarged fibroid which was then scheduled for surgical removal. The surgery was successfully completed. However, interventions to normalize the deranged laboratory values of Blood Urea Nitrogen to Creatinine ratio (BUN/Cr) and serum Potassium levels did not yield the desired results as the values remained elevated. The patient was administered multiple insulin, calcium gluconate, and Kayexalate (sodium polystyrene sulfonate) doses to stabilize potassium levels by initiating potassium elimination. Later, the patient was scheduled to begin dialysis after vein mapping. The patient eventually had her first dialysis session. Notably, the patient files indicated that she was on oral insulin for diabetes control alongside multiple medications for the chronic conditions.

Factors Influencing Pharmacokinetic and Pharmacodynamic Processes

The unresponsiveness of the patient electrolyte values to medication is attributable to various factors related to pharmacodynamics and pharmacokinetics. First, according to Chen et al. (2017), diabetes has been demonstrated to decrease gastrointestinal motility in patients and compromise membrane permeability. Therefore, reduced motility and membrane permeability affects the absorption of drugs and bioavailability in the different body locations. Besides, hyperglycemia results in glycation of serum albumin and hemoglobin. Albumin is the primary binding protein in serum, responsible for drug bunding and transportation. Glycation reduces albumin’s drug binding affinity hence decrease in drug distribution to the target sites. Thirdly, diabetes compromises the liver metabolism through development of fatty liver disease. Fatty liver blocks the activity of the CYP 450 system in the hepatic acinus’ zone three responsible for modification of drugs to make them active. Thus, the drugs are not sufficiently activated to prompt desired effects at their target sites (Elbarbry & Tran, 2016). Fourth, nephropathy caused by hyperglycemia compromises the drug elimination process, resulting in high elimination from the kidneys, and lower drug concentration in the body (Sahasrabudhe et al., 2017). These pharmacokinetic and pharmacodynamic processes within patient Z present unique challenges and are a pointer to the unresponsiveness to medications targeting electrolyte control.

Personalized Plan of Care

Patient Z’s personalized plan of care will significantly involve diabetes management as it is the main factor contributing to most of the observed problems (Elbarbry & Tran, 2016). Her renal insufficiency as shown by the high BUN/Cr would require consideration of specific medication dosages. Care therefore would need to involve consideration of the route of drug administration due to the pharmacokinetic and pharmacodynamic challenges presented by the comorbidities. First, to overcome the drug absorption challenges, I would administer intravenous medication rather than the oral, hence increasing bioavailability. Secondly, the prescription will include mostly active drug forms that would not require modification within the liver (Arcangelo et al., 2017). The objective will be to achieve therapeutic levels within the blood. Therefore, therapeutic drug monitoring of serum concentrations will be needed to inform dosage adjustments for patient Z.

 

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Chen, T. Y., Ferruzzi, M. G., Wu, Q. L., Simon, J. E., Talcott, S. T., Wang, J., … & Janle, E. M. (2017). Influence of diabetes on plasma pharmacokinetics and brain bioavailability of grape polyphenols and their phase II metabolites in the Zucker diabetic fatty rat. Molecular nutrition & food research61(10), 1700111.

Elbarbry, F., & Tran, M. (2016). Influence of diabetes mellitus on pharmacokinetics of drugs. MOJ Bioequivalence & Bioavailability2(1). doi:10.15406/mojbb.2016.02.00016

Sahasrabudhe, V., Terra, S. G., Hickman, A., Saur, D., Shi, H., O’Gorman, M., … & Cutler, D. L. (2017). The effect of renal impairment on the pharmacokinetics and pharmacodynamics of ertugliflozin in subjects with type 2 diabetes mellitus. The Journal of Clinical Pharmacology57(11), 1432-1443.

Discussion Post Main

           Pharmacokinetic and pharmacodynamic factors affect how our bodies respond the pharmaceuticals. Factors influencing drug responses include age, body weight, kidney and liver function, PH, genetic variants, gender, and metabolic tolerance (Rosenthal & Burchum, 2018). In my experience, I recall an elderly female who was on Coumadin (warfarin) for atrial fibrillation.  She was retired and lived home alone. She experienced wide fluctuations in INR and required frequent INR monitoring as a result. She had a history of chronic kidney disease, but she did not require hemodialysis.

Factors to consider were her body weight, comorbidities especially chronic kidney disease, age, and diet. The elderly population are vulnerable to increased effects of drugs, usually due to a decline in organ function, and the presence of multiple comorbidities (Rosenthal & Burchum, 2018). In her case, she was elderly, along with comorbid chronic kidney disease, both affecting drug responses. Several factors must be considered when on Coumadin (warfarin) due to risks for bleeding, including risks for falls, history of peptic ulcer disease, and thrombocytopenia (Lam, Ma, & Yan, 2011). Another factor to consider when using Coumadin (Warfarin) is medication compliance, as this is a massive issue in the U.S. health care system, causing about 290 billion a year. The most common reasons for noncompliance are forgetfulness, ran out, could not afford, and did not like the side effects (Rosenthal & Burchum, 2018). These concerns will be addressed in the client’s plan of care.

The individualized care plan will consider that everyone reacts to medications differently based on multiple factors previously discussed.  I would perform a fall risk assessment on every visit with this elderly client as she is on a drug that thins the blood and carries a significant risk for hemorrhage (Rosenthal & Burchum, 2018). The care plan would include patient teaching regarding bleeding signs and symptoms to monitor herself for and report to the provider. Additionally, the care plan would include considerations of alternative oral anticoagulants that might be able to treat atrial fibrillation while minimizing the frequent INR monitoring required by Coumadin (warfarin), especially when her levels were rarely able to stay within the therapeutic range. More recently, other oral anticoagulants are being looked at to replace Coumadin (warfarin), including Pradaxa (dabigatran), Eliquis (apixaban), Savaysa (edoxaban), and Xarelto (rivaroxaban) (Rosenthal & Burchum, 2018). The care plan should include a discussion of genetic testing, including variant genes that code for VKORC1 and CYP2C9, as these cause increased risks for bleeding from Coumadin (warfarin) (Rosenthal & Burchum, 2018). Dietary teaching in the care plan would include discussing how Vitamin K foods reduce the anticoagulant effects of Coumadin (warfarin) (Rosenthal & Burchum, 2018). However, they do not need to be avoided but rather consumed consistently if Vitamin K type foods are desired in the client’s diet.

Pharmacokinetic and pharmacodynamic factors affect how our bodies process medications. Multiple factors play a role, such as age, weight, gender, genetics, comorbid medical conditions, and metabolic tolerance. An elderly client with atrial fibrillation was discussed, considering a few key items that I would include in her care plan. Individuals respond differently to same medications for a variety of reasons highlighting the importance of individualized care tailored to meet the needs of each client.

 

References

Lam, Y.-Y., Ma, T. K. W., & Yan, B. P. (2011). Alternatives to chronic warfarin therapy for the prevention of stroke in patients with atrial fibrillation. International Journal of Cardiology, 150(1), 4–11. DOI: 10.1016/j.ijcard.2010.10.017

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

Main Post Week 1

Pharmacokinetic and Pharmacodynamic

Pharmacokinetics explains the effect the body has on a drug, from ingestion time to every transformation until elimination time. Factors such as weight, kidney function, and liver function affect drug absorption in the body. Some medications are administered based on weight, and lipophilic drugs are absorbed based on fat storage. Lipophilic drugs distribution correlates with body weight and is easily absorbed and excessively distributed into adipose tissue in an obese patient. Excess absorption into adipose tissue results in more significant volume distribution and prolonged half-life (Barras & Legg, 2017). On the other hand, pharmacodynamics can be explained as the effects of drugs on the body. Pharmacodynamics includes drug-to-drug interaction, desired outcomes, and side effects. Understanding pharmacokinetics and pharmacodynamics ensures that therapeutic medication range is achieved.

Case Study Based on Experience

As a rehabilitation nurse, I work with patients admitted for rigorous therapy post-surgery, and most of these patients require pain management. I recently admitted a 79-year-old Caucasian man who was five days post right Total Hip Arthroplasty (THA) with a primary medical history of hypertension, diabetes, and BPH. He was admitted at night and was sleepy; however, he AOX4 on admission, NWB as ordered on RLE. Pharmacy reconciled home medication, and he was taking Lisinopril 10mg PO daily, metoprolol 25mg PO BID, Metformin 500 mg PO BID, and on a diabetic diet; for his BPH, he was taking Tamsulosin 0.4mg PO daily. The admitting MD prescribed acetaminophen 650 mg for pain 0-4 and Acetaminophen-Hydrocodone 325mg-5mg for pain 4-10, Q6hrs. His Norco was administered once during the night, and he had a relatively uneventful night. He had therapy the following day, and on the report, the day shift nurse reported that his pain was not well managed, and he refused physical therapy due to uncontrolled pain. MD increases his NORCO dosage to 10mg and frequency to Q4hrs. The following week when I returned, he had been admitted for six days with no recorded bowel movement and continued use of his opioids every 4 hours. He had other non-pharmacological interventions for pain and a lower dose of pain management, all of which he claimed never worked. He was on day 6 with no BM, constipated with hypoactive bowel sounds, and complaining of abdominal pain.

Personalized Plan

Older adults are at an increased risk of developing constipation due to peristalsis slowing with age. The prevalence of constipation is higher among older adults than other age groups, and studies suggest that patients with preexisting conditions such as diabetes are at increased risk of constipation (Abdul Wahab et al., 2022). The patient described above is at an increased risk of developing constipation due to his recent surgery causing limited mobility, age, and his continued use of opioids, which led to opioid-induced constipation. Opioid-induced constipation (OIC) is the most common adverse reaction to opioid use. It affects patients who require pain management through opioids, and research suggests that 40% of patients taking opioids will experience constipation (Rosenberg, 2019). On admission, the patient should have been started on a bowel movement regimen with a plan to treat and administer something on day three if there was no bowel movement. He was eventually started on MiraLAX daily and given a one-time bisacodyl suppository dose. He had a bowel movement that shift, and his MiraLAX helped keep him regular.

 

References

Abdul Wahab, P., Mohd Yusoff, D., Abdul Kadir, A., Ali, S. H., & Yeong Yeh, L. (2022). Prevalence, symptoms, and associated factors of chronic constipation among older adults in North-East of Peninsular Malaysia. Clinical Nursing Research, 31(2), 348–355. https://doi.org/10.1177/10547738211033934

 

Barras, M., & Legg, A. (2017). Drug dosing in obese adults. Australian Prescriber, 40(5), 189-193. https://doi.org/10.18773/ austprescr.2017.053

Rosenberg, J. B. (2019). Recognizing and treating opioid-induced constipation in chronically ill children. Pediatric Nursing, 45(1), 7–11. https://web.s.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=5&sid=641ff465-b100-4187-99d2-477ca4c29f69%40redis

Pharmacokinetics and Pharmacodynamics

In every process which involves the use of drugs, drugs usually impact the body in different ways, and on the other side the body also impacts the drugs In several ways, all that is based on Pharmacokinetics and Pharmacodynamics. Pharmacokinetics is all about the reaction of the drug in the personal body which involves the movement of the drug via the body and the impact of the body on the drug (Daggenvoorde et al, 2013).  On the other side, there is Pharmacodynamics which deals with the effects of the drugs on the body. Based on the observation, I have observed a 72-year-old African-American male who had bipolar disorder.  This paper will talk about the scenario, factors that affect Pharmacokinetics and Pharmacodynamics as well as a personalized plan of care.

Scenario

The patient was an African –American male aged 72 years old by the name of John. He has a history of bipolar disorder and other related complications such as diabetes. According to the family of the man mostly his son, John had been refusing to take food for the last 3 days by the time he was brought to the healthcare facility, he was isolating himself most of the time and seemed to be confused. But despite all that he used to take his drugs (Salem & Fristad, 2020).

Factors that affect Pharmacokinetics and Pharmacodynamics

Based on that, there is gender whereby males have high hepatic metabolism than females. That metabolic rate can also be altered by the reproductive hormones. Then in terms of age, in Pharmacokinetics, the body fats increase but there is always a decrease of body water (Schmiegelow, 2017). Then in terms of Pharmacodynamics, there is always an increase in the sensitivity thus drugs with intended CNS effects are used due to age.

Personalized Plan of Care

First I prefer to use lithium to make sure that I prevent mood instability and also the I treat mania. That can help in the treatment of aggressive behavior in the process of acute manic episodes (Daggenvoorde et al., 2013).

 

References

Daggenvoorde, T. H., Goossens, P. J., & Gamel, C. J. (2013). Regained control: A phenomenological study of the use of a relapse prevention plan by patients with bipolar disorder. Perspectives in Psychiatric Care, n/a-n/a. 

Salem, T., & Fristad, M. A. (2020). Integrative medicine and lifestyle management in the treatment of the bipolar disorder. Bipolar Disorder, 267-284. 

Schmiegelow, K. (2017). Faculty opinions recommendation of prophylactic trimethoprim-sulfamethoxazole does not affect pharmacokinetics or pharmacodynamics of methotrexate. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature

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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