Feb 23, 2024 Discussion: NURS 6521 Pharmacokinetics and Pharmacodynamics
Discussion NURS 6521 Pharmacokinetics and Pharmacodynamics
A sample Answer For the Assignment: Discussion NURS 6521 Pharmacokinetics and Pharmacodynamics
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).
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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
Discussion NURS 6521 Pharmacokinetics and Pharmacodynamics
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.
I recently had a 68-year-old female patient who had decompensated hepatic cirrhosis related to alcohol consumption. “Decompensated cirrhosis is a frequent reason for admission to the acute medical unit, and such patients typically have complex medical needs” (Mansour, 2018). She is prescribed lactulose BID, and infrequently missed doses. This patient was alert and oriented with intermittent confusion, jaundice, and non-ambulatory, and had a keo tube feed in place with continuous feedings.
The patient was still able to take an oral puree diet with thickened liquids, with the tube feeds running she was placed on long-acting insulin and also on a sliding scale of short-acting with blood sugar checks every 6hr. History of COPD was on 2L NC and had developed PNA during the admission. This patient also has a history of pancreatitis with Creon given every 3hr. Receiving albumin, “corrects the altered pharmacokinetics of loop diuretics typically seen in patients with cirrhosis” (Liumbruno,2009), unasyn, Diflucan.
Her platelets were low in the 40s, her hemoglobin was trending, down, and ended up receiving a unit of PRBCs. Presented one morning with worsening coarse lung sounds and wheezing. Creatinine was increased to 1.2 from a baseline of around 0.9 and was initially placed on a continuous LR infusion which was then stopped out of concern for volume overload. She underwent subsequent IV Lasix diuresis with improved urinary output and with the creatinine two days later back to her baseline.
Pharmacokinetics is defined as the study of drug movement throughout the body through absorption, distribution, metabolism, and elimination. Pharmacodynamics studies the effects of drugs and their mechanism of action. I was able to work closely with the Hospitalist ARNP who was following this patient’s case and we both were able to come up with the plan of care together I wouldn’t have changed anything that was done to treat this patient. Different therapies were considered given her complex medical history and rapidly changing clinical course.
We considered Torsemide which is longer-acting and a less potent loop diuretic. We also considered how this might affect her pre-existing pulmonary disease and if that would favor one therapy over others. Also considered just holding fluids and further blood if possible and allowing for her to naturally diuresis any extra volume. Considering that she had received transfusion in conjunction with IV fluids, the patient was likely significantly volume overloaded in the setting of her acute decompensated liver disease and required a fast-acting, potent medication that would help take some of the fluid off. Ultimately leading us to Lasix. “Intravenous diuretics are considered to be more potent than oral doses” (Qavi, 2015).
Reference:
Liumbruno, G. M., Bennardello, F., Lattanzio, A., Piccoli, P., Rossettias, G., & Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) (2009). Recommendations for the use of albumin and immunoglobulins. Blood transfusion = Trasfusione del sangue, 7(3), 216–234. https://doi.org/10.2450/2009.0094-09Links to an external site.
Mansour, D., & McPherson, S. (2018). Management of decompensated cirrhosis. Clinical medicine (London, England), 18(Suppl 2), s60–s65. https://doi.org/10.7861/clinmedicine.18-2-s60
Qavi, A. H., Kamal, R., & Schrier, R. W. (2015). Clinical Use of Diuretics in Heart Failure, Cirrhosis, and Nephrotic Syndrome. International journal of nephrology, 2015, 975934. https://doi.org/10.1155/2015/975934
Discussion: NURS 6521 Pharmacokinetics and Pharmacodynamics
NURS6521 Advanced Pharmacology
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.
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When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic 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.
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.
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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.
Understanding pharmacokinetics, pharmacodynamics, and pharmacogenomic relationships of a drug support a successful drug therapy to impact a disease across all ages optimally. Ideally, age is a continuum factor that complements adaptability of drugs impact and disposition (Van den Anker et al., 2018). The discussion seeks to reflect on the case of patients I observed in my clinical practice from the last five years. The discussion will elaborate on the factors that might influence the pharmacokinetics and pharmacodynamics process presented by the patient and explain the details of a personalized care plan that I would develop influencing factors and patient history.
The case study involves an 80-year-old male with diabetes mellitus with end-stage renal diseases complaining of loss of sensation, decreased endurance undertaking activities, and reduced balance. The past medical history includes hypertension, gout, and chronic lymphocytic leukemia. His son, who always accompanies him to the clinic, highlighted that he skipped his entire dose due to hypoglycemia, and his glucose was above 200 mg/dL, and 6.9% glycosylated hemoglobin (HbA1c).
As such, the patient was diagnosed with an average glycemic control, although he presented intolerable episodes of severe hypoglycemia. Besides, the patient’s renal function deteriorated despite showing tolerated glimepiride in the over the years. The current medications of the patient include atorvastatin 10 mg QD and glimepiride 4 mg BID.
According to Ponticelli et al. (2015), many organs’ function decreases with advancing age. The decline in functional reserve is associated with reduced lean body mass, a reduction in glomerular filtration rate, and reduced liver flow in aging patients. The associated presence of renal problems further impairs the deterioration of the condition. The presented patient is affected by comorbid development and should be administered multiple medications (Ponticelli et al., 2015).
Notably, the aging process alters interactions of some drugs such as the affinity of some medication receptors, the amount of receptor, and the response of cells upon activation of receptors (Ponticelli et al., 2015). Hence, elderly patients with renal problems are prone to risks of adverse drug interactions. Also, elderly patients suffer from unintentional poor compliance with drugs. Therefore, the prescription of medications for the patient is perplexed on the scarcity of information regarding the pharmacokinetics and pharmacodynamic profile of drugs (Segall et al., 2017).
In this case, the treatment goal is to maintain normal glucose levels with minimal or no hypoglycemia association. Therefore, the patient is recommended to take drugs that are not cleared renally excreted since he is diagnosed with moderate renal impairment or medicines that need adjustment based on the kidney or serum creatinine’s functioning. The risk factors associated with the patient’s condition are renal dysfunction and aging (Ponticelli et al., 2015). The personalized care plan will involve discontinuing insulin glargine and introduce dipeptidyl peptidase-4 inhibitor by oral administration at discharge, epitomized by a lower rate of hypoglycemia and ease of use (Scheen, 2015).
More importantly, the patient should be prescribed with Linagliptin 5 mg/day and recommend a follow-up visit scheduled after two weeks (Lutz, Jurk & Schinzel, 2017). The drug has a predominately nonrenal clearance route and low risk of hypoglycemia and does not need adjustments, hence minimizing glucose complexity lessening treatment with numerous comorbidities. The treatment plan is aimed to lower glucose treatments in the elderly patient by administering drugs that will prevent drug interaction, renal dysfunctions, and hypoglycemia based on the patient’s comorbidities.
References
Lutz, J., Jurk, K., & Schinzel, H. (2017). Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations. International journal of nephrology and renovascular disease, 10, 135.
Ponticelli, C., Sala, G., & Glassock, R. J. (2015, May). Drug management in elderly adult with chronic kidney disease: a review for the primary care physician. In Mayo Clinic Proceedings (Vol. 90, No. 5, pp. 633-645). Elsevier.
Scheen, A. J. (2015). Safety of dipeptidyl peptidase-4 inhibitors for treating type 2 diabetes. Expert opinion on drug safety, 14(4), 505-524.
Segall, L., Nistor, I., Van Biesen, W., Brown, E. A., Heaf, J. G., Lindley, E., … & Covic, A. (2017). Dialysis modality choice in elderly patients with end-stage renal disease: a narrative review of the available evidence. Nephrology Dialysis Transplantation, 32(1), 41-49.
Van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58, S10-S25.
Good post! Opposite of pediatrics, geriatric patients usually have more co-morbidities which can complicate pharmacokinetics (Rosenthal & Burchum, 2021). These changes range from decrease body mass, delayed gastric emptying, decrease cardiac output, decrease in hepatic functioning, and more. It is also important to look at older patients medication lists. Sometimes they can be on more medication than other ages but it is always important to look at their other medications no matter the age because many can interact or affect absorption, distribution, or excretion (Rochon & Schmader, 2019). With your patient you mentioned, I think it would also be important to add into the care plan a plan for home care. If the patient has Alzheimers, they may have problems taking their medication appropriately.
References
Rochon, P. A., & Schmader, K. E. (2019). Drug prescribing for older adults. Dostpuno na https://www. uptodate. com/contents/drug-prescribing-for-older-adults. Pristupljeno.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
I apologize, 82 year old Caucasian female with rotator cuff tear due to recent fall. Patient denies significant medical history, but states she can take one extra strength tylenol for pain and experience relief. No medications taken the morning of surgery. Pt is 5’2 and weighs 107 lbs. All vitals within normal limits prior to procedure. BP 118/76, pulse 64, oxygen 97% on room air. Pt receives 1mg versed and 50 mcg fentanyl prior to nerve block. 2L nasal cannula in place at time of administration, pulse oximeter in place. Pt oxygen saturation drops to 87%, pulse 52, BP 98/56, does not respond to verbal ques.
Anesthesiologist continues procedure, O2 increased to 3L, O2 rises to 90%. Several minutes pass patient mutters response after sternal rub and verbal stimulation. As minutes pass, patient awakens some, but is confused. Nurse instructs patient to take slow, deep breaths in through the nose and out through the mouth. Nurse stays with patient to monitor until O2 is titrated back to 2L, patient oxygen saturation remains stable, and patient is more oriented. Anesthesiologist and nurse agree to skip versed in future scenarios similar to this case. This was not too bad, but could’ve been easily worsened.
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