Feb 23, 2024 Pharmacokinetics And Pharmacodynamics Assignment
Pharmacokinetics And Pharmacodynamics Assignment
A sample Answer For the Assignment: Pharmacokinetics And Pharmacodynamics Assignment
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).
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).
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Having an advanced age also affects metabolism which mostly occurs in the liver. This occurs in
Pharmacokinetics And Pharmacodynamics Assignment
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.
Introduction
As a critical care nurse, I have worked with patients of all ages and across the health spectrum. Co-morbidities, polypharmacy, and noncompliance are common characteristics of frequently hospitalized patients. Patients with multiple disease processes who are taking multiple medications require special consideration when selecting and managing their medications. The following case study reviews factors influenced by pharmacokinetic and pharmacodynamic processes for a patient with end-stage renal disease (ESRD) and a personalized plan of care for this patient.
Case Scenario
A 76-year-old female who initially presented to the Emergency Room with altered mental status was admitted to the Renal ICU. The patient has a past medical history that includes ESRD, Diabetes Mellitus Type 2, HTN, Hyperlipidemia, Coronary Artery Disease, Peripheral Vascular Disease, Hemodialysis, and depression. Past surgical history includes left below-knee amputation (BKA), AV Fistula, bilateral lower extremity angioplasty, and carotid endarterectomy.
The patient’s medication list includes Humulin 70/30, Novolog, Hydralazine, Lisinopril, Pletal, Atorvastatin, Cymbalta, Glipizide, and Sevelamer. The patient has a history of medication non-compliance and has been hospitalized several times for hypoglycemia, altered mental status, and electrolyte imbalances.
Pharmacokinetic and Pharmacodynamic Processes
Pharmacokinetics is the movement of a drug through the body by absorption, distribution, metabolism, and excretion. In a patient with renal disease, metabolism and excretion are critical factors when prescribing medications. Renal disease, which affects glomerular filtration, tubular secretion, and reabsorption, may alter the renal excretion of unchanged drugs and their metabolites. The changes accompanying renal disease can also lead to modifications in the distribution, transport, and biotransformation of drug substances (Rowland et al., 2014).
The patient, in this scenario, is at extremely high risk for the intensity and duration of drug responses to be increased. This is especially concerning for the antihypertensives and the sulfonylurea she is taking. There is a potential for hypoglycemic and hypotensive episodes. Pharmacodynamics also are affected by renal disease. Pharmacodynamics is concerned with the effect of the drug on the body, including interactions between the drug, its target, and downstream biochemical effects.
Either sub- or supratherapeutic dosing can occur when appropriate dose adjustments are not made in patients with kidney disease, and both have a negative impact on patient outcomes, including morbidity, prolonged hospital admissions, and potentially, death (Lea-Henry et al., 2018).
Another factor influencing both pharmacokinetics and pharmacodynamics is the patient’s age. Aging is known to be associated with an increased prevalence of multiple chronic diseases and is characterized by relevant changes in drug handling, physiological reserve, and pharmacodynamic response. Renal function also declines with aging, mainly due to sclerotic changes in the glomeruli. Furthermore, due to reduced muscle mass, older subjects frequently have depressed glomerular filtration rates despite normal serum creatinine.
Changes in pharmacodynamics are also well documented in the cardiovascular and nervous system. Age-related changes in pharmacokinetics and pharmacodynamics, together with comorbidity and polypharmacy, make elderly patients at special risk for adverse drug reactions (“Age-related Pharmacokinetic and Pharmacodynamic Changes and Related Risk of Adverse Drug Reactions,” 2010)
Personalized Plan of Care
The patient in this scenario has multiple factors that affect pharmacokinetics and pharmacodynamics. Her age, ESRD, polypharmacy, and co-morbidities make her at high risk for adverse drug reactions. A plan of care for this patient should include frequent monitoring of her renal function, electrolytes, blood pressure, and blood glucose levels. A review of her medications should be completed to ensure that all medicines are necessary and produce the desired effects. Given her history of hypoglycemia and ESRD, discontinuing the sulfonylurea may be indicated.
She should be by her PCP and nephrologist every three months and as needed for medication adjustments. Education on her prescribed medications should include indications, adverse effects, and the importance of compliance with the regimen. Education should also have signs and symptoms of hypoglycemia, hypotension, and electrolyte imbalances. She should keep a detailed record of her blood glucose levels and blood pressure for her PCP to review.
References
Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions. (2010). Current Medical Chemistry, 17(6), 571–84. https://pubmed.ncbi.nlm.nih.gov/20015034/Links to an external site.
Lea-Henry, T. N., Carland, J. E., Stocker, S. L., Sevastos, J., & Roberts, D. M. (2018). Clinical pharmacokinetics in kidney disease. Clinical Journal of the American Society of Nephrology, 13(7), 1085–95. https://cjasn.asnjournals.org/content/13/7/1085Links to an external site.
Rowland, Y. K., Aarabi, M., & Jamei, M. (2014). Modeling and predicting drug pharmacokinetics in patients with renal impairment. Expert Review of Clinical Pharmacology, 4(2), 261–74. https://research.com/journal/expert-review-of-clinical-pharmacologyLinks to an external site.
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.
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:
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.
– This work should have Introduction and conclusion
– This work should have at 3 to 5current references (Year 2012 and up)
– Use at least 2 references from class Learning Resources
The following Resources are not acceptable:
1. Wikipedia
2. Cdc.gov- nonhealthcare professionals section
3. Webmd.com
4. Mayoclinic.com
LEARNING RESOURCES
**Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 2, “Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles” (pp. 17-31)
This chapter examines concepts related to pharmacokinetics and pharmacodynamics. It also explores patient factors that health care providers consider when prescribing drug therapy to patients.
Chapter 3, “Impact of Drug Interactions and Adverse Events on Therapeutics” (pp. 33-51)
This chapter explains drug-drug, drug-food, drug-herb, and drug-disease interactions. It also reviews patient factors that influence drug interactions and then covers adverse drug reactions.
Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 53-63)
This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.
Chapter 6, “Principles of Pharmacotherapy in Elderly Patients” (pp. 73-89)
This chapter describes issues and factors that affect drug therapy for elderly patients. It then explores concepts relating to drug selection, administration, and management for elderly patients.
**Scott, S. A. (2011). Personalizing medicine with clinical pharmacogenetics. Genetics in Medicine, 13(12), 987–995. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290900/
This article examines pharmacogenetic testing in relation to personalized drug therapy plans and explores evidence-based guidelines and recommendations on pharmacogenetic testing.
**Drugs.com. (2012). Retrieved August 22, 2012, from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
**Haymarket Media, Inc. (2012). Retrieved from http://www.empr.com/
**Institute for Safe Medication Practices. (2012). Retrieved from http://www.ismp.org/
**WebMD. (2012). Medscape. Retrieved from http://www.medscape.com/
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