Feb 23, 2024 Discussion: Pharmacokinetics and Pharmacodynamics: NURS 6521 Week 1
Discussion Pharmacokinetics and Pharmacodynamics NURS 6521 Week 1
A sample Answer For the Assignment: Discussion: Pharmacokinetics and Pharmacodynamics: NURS 6521 Week 1
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.
Discussion Pharmacokinetics and Pharmacodynamics NURS 6521 Week 1
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).
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.
In this discussion post we review a clinical experience of how the pharmacokinetic and pharmacodynamic process interact and affect patient outcomes. We will consider factors that influence the patient’s pharmacokinetics and pharmacodynamics. Then develop a personalized plan of care while considering the influencing factors that contribute to the patient.
Pharmacokinetics is the study of how the body interacts with drugs through four different processes such as absorption, distribution, metabolism, and excretion (Rosenthal & Burchum, 2020). Absorption is the process that takes the drug from its administration route to the blood stream (Grogan & Preuss, 2023). Distribution defines how drugs move throughout the body from the blood stream to the site of action (Grogan & Preuss, 2023).
Metabolism is defined as the enzymatic alteration of the drug structure (Rosenthal & Burchum, 2020). Excretion is the process of elimination of the drug from the body (Rosenthal & Burchum, 2020). Pharmacodynamics is the study of the drugs molecular, biochemical, physiologic effects or actions produced (Marino et al., 2023). All drugs interact to the biological structure to produce a change in how the target molecular functions (Marino et al., 2023). These actions include stimulating activity, depressing activity, blocking receptors or antagonistic, stabilization, and direct chemical reaction (Marino et al., 2023).
The elderly patients are at an increased risk of adverse drug events related to pharmacokinetics and pharmacodynamics. This population takes multiple medications which places them at an increased risk for drug-drug interactions. The elderly population is also at increased risk for drug toxicity since their metabolism naturally slows and excretion is decreased due to age-related changes. An example that comes to mind is 77-year-old Caucasian female admitted to the hospital for severe clozapine toxicity (neutropenia and ileus).
The patient had been taking 700 mg clozapine for years along with other prescribed medications. Clozapine is an atypical antipsychotic used to treat schizophrenia. It acts as an antagonist to the dopamine and serotonin receptors (Rosenthal & Burchum, 2020). Black box warning for clozapine are like threatening agranulocytosis (dangerously low WBC) another rare black box warning is myocarditis (Rosenthal & Burchum, 2020).
The plan of care for this individual is ongoing monitoring and assessment of this medication and possible side effects. To reduce the possible for clozapine toxicity one could prescribe clozapine serum concentration levels be checked regularly. Ongoing assessment for drug-to-drug interaction of medication such as drugs that induce cytochrome P450 isoenzymes have been known to lower clozapine levels or drugs that are known to raise the clozapine levels such as drugs that inhibit P450 isoenzymes (Rosenthal & Burchum, 2020). Due to the individual diagnosed with neutropenia continue monitoring of the patients WBC and absolute neutrophil count (ANC) should be ongoing monitoring (Rosenthal & Burchum, 2020).
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 FOR Discussion: Pharmacokinetics and Pharmacodynamics:
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 of Discussion: Pharmacokinetics and Pharmacodynamics
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.
Pharmacokinetics and Pharmacodynamics
Pharmacokinetics studies how drugs are absorbed, distributed, metabolized, and excreted. In clinical pharmacokinetics, pharmacokinetic principles manage medications safely and effectively in an individual patient. Pharmacokinetics in clinical practice is concerned with enhancing the efficacy and reducing the toxicity of a patient’s drug therapy.
Thanks to strong correlations between drug concentrations and pharmacologic effects, clinically relevant pharmacokinetic principles can now be applied to actual patient situations. Pharmacodynamics refers to the relationship between drug concentration and the results, including the time course and intensity of therapeutic and adverse effects (Tozer & Rowland, 2018)
Description of the patient case
I recall a case almost three years ago of a 72-year-old female living alone with a medical history of hypertension (HTN), right foot ulcer, and chronic back pain. The patient reported taking ibuprofen to relieve his pain. Symptoms include frequent urination, excessive thirst, unexpected weight loss, and blurry vision. Diabetic myelitis, kidney disease, and peripheral neuropathy were diagnosed in the patient.
Factors influencing the pharmacokinetic and pharmacodynamic processes.
Diabetes can affect the pharmacokinetics aspects of oral and intravenous drugs administered to this individual due to the blood glucose levels and interactions with the diabetes medication. In addition, diabetes medication interactions will interfere with the other medications administered to the individual. Chronic kidney disease can cause ineffective drug clearance, and the elimination/excretion will be impaired. These interferences with pharmacokinetics will affect pharmacodynamic processes. As a result of the disease, blood flow to adipose tissues is altered, enzymes are involved, other biomolecules are altered, and albumin is glycated, which affects absorption (Make the Connection, 2021).
Personalized plan of care
The personalized plan of care I would develop based on the influencing factors starts with Glycemic control is the most crucial aspect in controlling the adverse effects of diabetes mellitus. I will start Drug canagliflozin, approved by the FDA to lower glucose levels in diabetics, can slow the progression of kidney disease. Currently, the only treatment approved to protect kidney function in people with Type 2 diabetes, canagliflozin, improves on a nearly two-decade-old therapy. Canagliflozin was also found to reduce the risk of major cardiovascular events in the trial. With canagliflozin, glucose is excreted through the kidneys more efficiently. The Food and Drug Administration has already approved it for lowering blood glucose in patients with Type 2 diabetes.
Additionally, it has been approved to reduce the risk of major adverse cardiovascular events in patients with Type 2 diabetes and established heart disease (Drug Reduces Risk of Kidney Failure in People With Diabetes, Study Finds, 2019). Also, I will order Tylenol instead of ibuprofen for chronic back pain, which will help the kidneys. NSAIDs can damage your kidneys. For example, heavy or long-term use of some of the medicines, such as ibuprofen, naproxen, and higher dose aspirin, can cause chronic kidney disease (Make the Connection, 2021)
Decreasing A1C is essential to avoid microvascular complications.
Improve physical activity.
Avoid sugary food intake.
Instruct the patient to take the medications as prescribed.
Instructed to follow a healthy exercise regimen.
Blood works to make sure the kidney and liver are functioning well.
Instructed to check blood glucose levels daily.
Encourage more fruits and vegetables.
Regular follow-up with a primary care provider is also another critical factor.
References
Drug reduces risk of kidney failure in people with diabetes, study finds. (2019). News Center. https://med.stanford.edu/news/all-news/2019/04/drug-reduces-risk-of-kidney-failure-in-people-with-diabetes.html
Links to an external site.
Make the Connection. (2021). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/diabetes-kidney-disease.html#:~:text=CKD%20is%20common%20in%20people,diabetes%20can%20cause%20kidney%20disease.&text=Kidney%20diseases%20are%20the%209th,death%20in%20the%20United%20States.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Tozer, T. N., & Rowland, M. (2018). Introduction to Pharmacokinetics and Pharmacodynamics: The Quantitative Basis of Drug Therapy. http://ci.nii.ac.jp/ncid/BA84446210
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.
For about two years I have been working in the intensive care unit, where patients are usually critically ill. In many situations patients have multiple comorbidities. Beside the main diagnose that they are admitted to the hospital, patient take multiple drugs/medications in order to help with the extended history of comorbidities that they might have. Not to long ago, I had a 75 year old patient with a history of diabetes type two, CHF, kidney failure, COPD, OSA, obese and admitted for sepsis pneumonia. Patient had low blood pressures in the ED and was placed on a levophed drip in order to maintain systolic BP >90.
Beside the levo drip patient was also on many other medications regarding his other comorbidities. For the COPD patient was on steroid IV push and inhalers, for the DM patient was on long actin insulin lantus and short actin insulin lispro. for the PNA patient was on two different antibiotics based on the organism that sputum cultures grew. For the CHF patient was on Lasix at home, however, in the ICU diuretic was on hold because his worsened kidney function and at the same time low BP as result of sepsis PNA. In arrival to the ICU patient had a potassium of 3.1.
For antibiotics patient was on vancomycin and zosyn as patient had resulted MRSA positive. Based on an article by Bergen at al, as simply increasing polymyxin dosage regimens is not an option for optimizing their PK/PD due to nephrotoxicity, combination therapy with other antibiotics has great potential to maximize the efficacy of polymyxins while minimizing emergence of resistance (2019).
When it comes to antibiotics, selecting an appropriate dose and appropriate time to administer the dose with dosing frequency requires extensive understanding of the interplay between drug pharmacokinetics/pharmacodynamics (PK/PD), the host immune system, and bacterial-resistant mechanisms (Luterbach and Rao, 2022).
Patient’s pharmacokinetic and pharmacodynamic processes alter his response to a drug as well. In my patient’s case, he already had some degree of kidney failure, comb
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