Feb 23, 2024 NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
NURS 6521 Week 1 Discussion Pharmacokinetics and Pharmacodynamics
A sample Answer For the Assignment: NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
Misoprostol is a drug used for two different types of labor and delivery situations. It can be used to induce labor by softening the cervix and initiating contractions. It can also be used as a uterotonic during a postpartum hemorrhage. I worked as a labor and delivery nurse at a Trauma 1 center in Irvine, California, for many years. During that time, I witnessed many high-risk patients hemorrhage after delivering. In this event, it is crucial that the healthcare team acts fast and provides the patient with the necessary drugs to contract the uterus and stop the bleeding.
However, it is essential to consider the patient’s vitals and medical history when deciding which uterotonic to use. Some uterotonics are contraindicated in patients with asthma or hypertension. Although other uterotonics have a faster absorption rate and longer duration, Misoprostol is safe for hypertensive or asthma patients. Misoprostol can be given vaginally, rectally, sub-lingual, or buccal. One study compared the effects of the drug when given rectally versus sub-lingual and found that intra-operative bleeding and postpartum hemorrhaging during a cesarian delivery were lower when given sub-lingual (Sweed et al., 2018). This is because the administration route affects the absorption and distribution rate. I was caring for a woman who had complications during the placenta delivery. I was working at a teaching hospital where residents worked as physicians on the unit. The resident decided to administer Misoprostol vaginally. The woman continued to hemorrhage despite the residents’ efforts. This was because of the route of administration. The Misoprostol could not be absorbed and cross the cell membrane because of the amount of blood coming out of her vagina.
Therefore, the plasma drug concentration could not reach a level high enough to be therapeutic. Because the patient was only 25 and in good medical condition, age did not affect the effectiveness of the medication. Infants and the elderly are at risk because of decreased drug-metabolizing capacity and kidney function (Rosenthal et al., 2021). In this scenario, the baby was unaffected because the umbilical cord had been cut and no longer shared blood with its mother. The patient’s personalized plan of care would be to change the route of administration to sub-lingual. The drug would be able to take full effect by absorbing into the blood, where it will stimulate uterine contractions, which will help stop the bleeding. Misoprostol acts as a prostaglandin that binds to the smooth muscle cells in the uterine lining and causes the uterus to contract.
A common side effect of the drug is abdominal pain and diarrhea. This is due to the byproduct misoprostolic acid released during the drug’s metabolism at its peak plasma concentration (Krugh & Maani, 2022). Because diarrhea is a common side effect, I would increase the patient’s fluids to ensure she does not become dehydrated or hypovolemic.
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References
Krugh, M., Maani, C. (2022). Misoprostol. In StatPearls. StatPearls Publishing.
Rosenthal, L. D., Burchum, J. R., & Rosenthal, L. D. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier.
Sweed, M. S., El-Saied, M. M., Abou-Gamrah, A. E., El-Sabaa, H. A., Abdel-Hamid, M. M., Hemeda, H., Mansour, A. M., Shawky, M. E., El-Sayed, M. A., & Mohamed, R. M. (2018). Rectal vs. sublingual misoprostol before cesarean section: double-blind, three-arm, randomized clinical trial. Archives of Gynecology & Obstetrics, 298(6), 1115–1122. https://doi.org/10.1007/s00404-018-4894-2
Introduction
The processes that a medicine goes through in the body after administration are referred to as pharmacokinetics. Absorption, distribution, metabolism, and excretion are all included in this. Pharmacodynamics, on the other hand, deals with the effects that drugs have on the body, such as adverse effects. Variables like a patient’s genetics, gender, ethnicity, age, behavioral factors, medical history, and concurrent drugs all have an impact on pharmacokinetics and pharmacodynamics. According to the case study, these variables especially age do indeed change the drugs pharmacokinetics and pharmacodynamics (Rosenthal. & Burchum, 2018).
NURS 6521 Week 1 Discussion Pharmacokinetics and Pharmacodynamics
Age influencing pharmacodynamics and pharmacokinetics
The patient is of advanced age whereby it has been stated that they are 74 years old this is indeed can affect the pharmacodynamics and pharmacokinetics related to the drug. In advanced age you find the boy’s physiology has changed thus affecting the pharmacokinetics and elements such as absorption, distribution, metabolism and excretion. One of the most significant impacts in old age is whereby you’ll have a decreased glomeruli filtration rate which determines the level of drug elimination. Since it is decreased it could lead to the drug being retained in the system and leading to toxicity (Sieder et al., 2016).
In old age there is also decreased gastrointestinal motility thus leading to delayed absorption rate. This leads to delayed onset of pharmacological effects of drugs thus making them less effective. The peak drug concentrations are also affected hence the drug doesn’t reach its maximum capacity for effect (Mangoni & Jarmuzewska, 2019).
Age also increases the body fat which could lead to increase the volume of distribution increases. Therefore if the drug has to be distributed to a wider area than affection it will affect its expected performance thus not delivering the desired therapeutic effect. Due to the increased body fat there is also decreased body water levels thus leading to the drug’s elimination half-lives also getting increased (Sieder et al., 2016).
Having an advanced age also affects metabolism which mostly occurs in the liver. This occurs in due to the decreased required enzymes that may no longer be available due to the physiological changes that occur because of age. This also leads to decreased clearance hence the already metabolised drug aren’t cleared from the system (Mangoni & Jarmuzewska, 2019).
Age impacting pharmacodynamics occurs through decrease in effect for beta-adrenergic agents. This is due to decrease in response in the vascular, cardiac, and pulmonary tissues due to a decline in some required proteins. There is also reduced sensitivity to drugs due to the body’s receptors undergoing physiological changes. Therefore if the response and sensitivity is inhibited the desired therapeutic effect isn’t achieved.
Homeostatic mechanisms are also seen to influence the pharmacodynamics in that in advanced age it is reduced. The mechanisms are seen to reduce in old age. Therefore in the case the drugs lead to adverse effects the body takes a longer period of time to return to the initial state (Sieder et al., 2016).
Changes in the Process that Impact the Patient’s Recommended Drug Therapy
Due to the old age the pharmacodynamics and pharmacokinetics has been impacted. The absorption has been delayed due to decreased gastric motility, on the distribution end the volume of distribution has increased due to the increased body fat and the metabolism due to decreased enzymes has also decreased.
The physiological changes in the glomeruli has decreased the glomeruli filtration rate hence decreasing excretion and could lead to toxicity. The pharmacodynamics due to decrease in sensitivity, decrease in response and reduced homeostatic mechanisms negatively affect it (Mancia et al., 2014).
Therefore encompassing all this there is a definite change in the recommended drug therapy in order to benefit the patient. The changes are in medication such as atenolol will be used in place of the beta-blocker metoprolol, starting at 25 to 200 mg per day. However, fast response is attainable with longer release modules and can be delivered thrice daily, thus it’s advised to begin new medication, notably such as beta-blockers, with prolonged release formulae.
Instead of ibuprofen that is contraindicated with warfarin patients should be prescribed acetaminophen orally 500mg thrice daily to manage the pain. I would also advise using lipid-lowering drugs other than statins to lower the low-density lipoprotein cholesterol levels (Mangoni & Jarmuzewska, 2019).
How to Improve the Drug Therapy Plan
Patients with a high risk of cardiovascular disease, a heart attack, or is known diabetic, such as this patient, are advised to begin taking a moderate-intensity statin with the aim of reducing LDL-C levels by 30% or more. For this patient, it is advised to utilize Ezetimibe, administered orally at a dose of 10 mg each day. Cardiovascular diseases, diabetes mellitus, left ventricular dysfunction and diabetic neuropathy can receive treatment by use of angiotensin converting enzyme inhibitors.
They can also be used to prevent strokes. Starting doses of ramipril range from 1.25 mg to 2.5 mg orally every day. This medication is also recognized to lessen myocardial infarctions, strokes, and fatalities. Moreover aside from changes in medications can make other alterations such as diet change, smoking cessation, weight loss, provision of health education from medical professionals and physical activity is required (Mayor, 2017).
Conclusion
The majority of deaths globally are currently caused by cardiovascular disorders, and diabetes is frequently found in these people. It is thought that people with type diabetes are more likely than non-diabetics to die from cardiovascular illnesses. In order to get the best results in the management of cardiovascular diseases which aims to maximize the benefits of available treatments while minimizing patient harm clinicians must possess basic knowledge of pharmacokinetics and pharmacodynamics (Rosenthal. & Burchum, 2018).
References
Hoover, L. E. (2019). Cholesterol management: ACC/AHA Updates guideline. Https://eds-a- ebscohost-com-ezp.waldenulibrary.org/eds/pdfviwer/
Mayor, S. (2017). Pharmacokinetics: Optimizing safe and effective prescribing. Https://onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1551
Rosenthal, L.D. & Burchum. J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Sieder, S. T., Kalus, J. & Lanfear, D. E. (2016). Cardiovascular pharmacokinetics, Pharmacodynamics and Pharmacogenomics for the clinical practitioner. Https://eds-a- ebscohost-com.ezp.waldenulibrary.org/eds/delivery/
Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., & Galderisi, M.(2014). 2013 ESH/ESC Practice guidelines for the management of arterial hypertension: ESH-ESC: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Pressure, 23(1), 3-16.
Mangoni, A. A., & Jarmuzewska, E. A. (2019). The influence of heart failure on the pharmacokinetics of cardiovascular and non‐cardiovascular drugs: A critical appraisal of the evidence. British Journal of Clinical Pharmacology, 85(1), 20-36.
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Pharmacokinetics and Pharmacodynamics
Pharmacokinetics of a drug depends on patient-related factors as well as on the drug’s chemical properties. Some patient-related factors example, renal function, genetic makeup, sex, age can be used to predict the pharmacokinetic parameters in populations. For example, the half-life of some drugs, especially those that require both metabolism and excretion, may be remarkably long in older people.
Pharmacodynamics sometimes described as what a drug does to the body is the study of the biochemical, physiologic, and molecular effects of drugs on the body and involves receptor binding, post receptor effects, and chemical interactions(Merck Manuals,2021).
Patient Scenario
I was assigned a month ago to an 80-year-old male Hispanic patient, admitted with cardiogenic shock, with an ejection fraction of 10%, generalized edema, and hypotension. He has underlying
history of substance use, coronary artery disease, MI in 2013- LAD stented x1, hypertension, diabetics type 2, hyperlipidemia, and chronic kidney disease stage 1(patient still voiding). Patient was rushed to the cath. lab for intra-Aortic balloon pump placement to help with his cardiac output(preload/ afterload) PA catheter placement for hemodynamic monitoring. Mirilnone drip 0.125, dopamine 5 mcg/kg/min, heparin gtt 500 units and bumex gtt started as well as other medications.
Personalized Care Plan
Decreased cardiac output- due to impaired contractility, increased afterload, and increase/ decrease ventricular filling (preload).
Goals and outcomes- Patient demonstrates adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal parameters for patient; strong peripheral pulses; and an ability to tolerate activity without symptoms of dyspnea, syncope, or chest pain (Wayne, 2019).
Assessment – Assess heart rate and blood pressure. Most patients have compensatory tachycardia and significantly low blood pressure in response to reduced cardiac output. Inspect fluid balance and weight gain. Weigh patient regularly prior to breakfast. Check for pedal and sacral edema. Check for peripheral pulses, including capillary refill (Wayne, 2019).
Reference
Wayne, G. (2019). Decreased Cardiac Output – Nursing Diagnosis & Care Plan …nurseslabs.com › Nursing Care Plans › Nursing Diagnosis.
Merck Manuals. (2021). Overview of Pharmacokinetic- Clinical Pharmacology. www.merckmanuals.com>professional>overview .
Week 1 discussion
Pharmacokinetics and Pharmacodynamics
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.
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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. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
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.
Description of Patient
Many of the patient’s details were lost to memory and time. The patient was a male aged 45-55. He was incarcerated and housed in the Behavioral Health unit, which indicates he required routine monitoring and regular planned interaction with mental health professionals. Security staff reported to Behavioral Health staff that the patient was behaving abnormally. Behavioral Health staff met with the patient and determined he needed to be placed in Medical for further assessment. Ultimately, the patient’s blood levels of lithium were toxic. The patient’s speech was unclear and nonsensical. He was disoriented, and his movements were slow.
Factors that may have Influenced Pharmacokinetic and Pharmacodynamic Processes
Without a health history, factors that may have influenced the movement of lithium within the body and the physiologic effects of the drug and its movement on the body will have to be hypothetical (Burchum & Rosenthal, 2021). Senner et al. (2021) discussed recent studies looking for genetic connections in patients who either benefit or experience substantial side effects from treatment with lithium. The authors’ state there are promising findings, but more study is required with increased sample sizes.
Menculini et al. (2022) found a sex difference in the treatment response of females only to anticonvulsants. This author found one document that discussed ethnicity and lithium response, but complete information could not be found and will not be included in this discussion. Age and renal function could increase the risk of lithium toxicity. Often, the incarcerated are in poorer health than those not incarcerated. Zentko and Hahn (2018) highlighted the very narrow therapeutic window for lithium and the fact that it is excreted almost entirely by the kidneys, and excretion can be impacted by simple dehydration.
Details of Personalized Plan of Care
To personalize the discussed patient’s plan of care would require a detailed health history and monitoring of lithium levels during titration and routinely once at a therapeutic dose. Monitoring the patient’s overall health, health habits, and especially his kidney function would be critical. Clear and simple education with reinforcement at each visit would be necessary. In the future, genetic testing could guide lithium treatment protocols.
References
Burchum, J., & Rosenthal, L. D. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences (US). https://mbsdirect.vitalsource.com/books/9780323554954Links to an external site.
Menculini, G., Steardo, L. Tiziana, S., D’Angelo, M., Lanza,L., Cinesi, G., Cirimbilli, F., Moretti, P., Verdolini, N., De Fazio, P., & Tortorella, A. (2022). Sex differences in bipolar disorders: Impact on psychopathological features and treatment response. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.926594Links to an external site.
Senner, F., Kohshour, M. O., Abdalla, S., Papiol, S., & Schulze, T. G. (2021). The genetics of response to and side effects of lithium treatment in bipolar disorder: Future research perspectives. Frontiers in pharmacology, 12 (638882). https://doi.org/10.3389/fphar.2021.638882Links to an external site. Zentko, P. & Hahn, C. (2018, August 13). In A. Koyfman & B. Long (Eds.), Common psychiatric medications: Pearls & pitfalls for the ED. emDocs. http://www.emdocs.net/common-psychiatric-medications-pearls-pitfalls-for-the-ed
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. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
Week 2 – 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. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics
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.
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