Feb 23, 2024 NURS 6521 Week 1 Discussion Pharmacokinetics and Pharmacodynamics
NURS 6521 Week 1 Discussion Pharmacokinetics and Pharmacodynamics
NURS 6521 Week 1 Discussion 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).
Struggling to Meet Your Deadline?
Get your assignment on NURS 6521 Week 1 Discussion Pharmacokinetics and Pharmacodynamics done on time by medical experts. Don’t wait – ORDER NOW!
Meet my deadline
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.
NURS 6521 Week 1 Discussion Pharmacokinetics and Pharmacodynamics
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.
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.
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
Working in an intermediate care unit, I get to see patients from all races with different healthcare needs and conditions. One obvious thing observed from the so many patients that come into the facility is the prevalence of diabetes, hypertension and chronic obstructive pulmonary disease (COPD) in patients ages 20 years and above. Though the diseases are common, the types of medications used in treating them may differ in dose, brand, and pricing. When prescribing medications for an individual patient, the physician considers the effects of the drugs and the mechanism of their action on that particular patient.
Let us consider a 75-year-old male patient who is admitted for uncontrolled Diabetes. The patient has a past medical history of Diabetes type II and takes metformin to control his glucose but had not been able to afford the refills for his medication. On admission the patient presented with a blood glucose of 288 mg/dl and was ordered Lispro on a low dose sliding scale with blood glucose monitoring before meals and at bedtime. The patient was assigned to a young nurse who had recently just started working on the unit.
Just before the lunch trays came in, the nurse went to review the patients’ blood glucose levels the nurse tech had checked. Without paying much attention, the nurse drew up 8 units of lispro insulin and administered it to the patient for what she thought was a blood sugar of 288mg/dl. After about 20 minutes the nurse discovered that the patient was sweating a lot and had an increased heart rate with slight shivers. The young nurse called the attention of an older nurse and explained all the care she had provided to the patient prior to discovering his current state.
The two nurses reviewed the documentation on the computer and saw that the patients’ last blood glucose check was 98mg/dl and not 288mg/dl as the young nurse had thought it was. The older nurse immediately got a glucometer and checked the patients’ blood glucose which was now 52mg/dl, and also discovered that the patient had not eaten anything. The older nurse immediately followed the establishment’s protocol and administered 1 gram of glucagon to the patient, checked his blood glucose which had gone up slightly and then administered another gram, checked his blood glucose again, and then provided the patient with a small cup of orange juice and a cracker.
As nurse practitioners, it is important to know and understand the pharmacokinetics and pharmacodynamic processes. Pharmacokinetics is the process of a drug being absorbed, distributed, metabolized, and excreted from the body (Rosenthal and Burchum, 2021). Pharmacodynamics is the relationship between drug concentration at the site of action and the resulting effects which include the time and severity of therapeutic and adverse effects (DiPiro, 2008).
Lispro Insulin is a rapid-acting insulin that has a short duration of action which is used to improve blood glucose management in patients with diabetes (Rosenthal and Burchum, 2021). It is more effective than the normal human insulin in improving and helping to maintain blood glucose control (Campbell et al., 1996). Factors that might influence the pharmacokinetics and pharmacodynamics of insulin are the size of the dose, the injected volume and the insulin concentration, vigorously rubbing the site of the injection, increase in temperature which increases absorption rate, site of the injection (absorption is faster when administered in the abdomen), and exercising of extremity within an hour of injection can speed up absorption (Donner and Sarkar, 2019).
The patient received a large dose of insulin for an inaccurate blood glucose reading and presented with a hypoglycemic reaction due to the large amount of insulin that was administered.
A personalized care plan for the patient based on influencing factors and the patients history would be to set goals for the patient that include effective treatments to normalize and manage blood glucose levels, decrease the risk for hypoglycemic or hyperglycemic events using insulin medication, diet, and exercise, informing and educating the patient on the importance of compliance with medication regimen and importance of monitoring blood glucose, providing the patient with prescription savings or discount cards like Good Rx, and providing the patient with location to local community clinics that help with providing low-cost prescription medications.
Ensuring that the patient is properly educated and provided with the necessary resources to provide for his medication will promote his participation in self-care and ensure his compliance with monitoring and maintaining manageable blood glucose levels.
References:
Campbell, R. K., Campbell, L. K., & White, J. R. (1996, November). Insulin lispro: its role in the treatment of diabetes mellitus. The Annals of pharmacotherapy. https://pubmed.ncbi.nlm.nih.gov/8913409/.
Donner, T., & Sarkar, S. (2019). Insulin – Pharmacology, Therapeutic Regimens, and Principles of Intensive Insulin Therapy. Endotext [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK278938/.
DiPiro, J. T. (2008). Pharmacotherapy: A pathophysiologic approach. McGraw-Hill Medical.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) Elsevier.
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.
Photo Credit: Getty Images/Ingram Publishing
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.
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.
Thank you for your post discussing malignant hyperthermia (MH). Bin et al. (2021) documented epidemiological findings such as MH patients are more often male (2:1- 4:1) and young (under 18 years old), with patients over 60 years old less common. Further, if a patient has a previous experience of rhabdomyolysis or significant heat intolerance, they may be at risk for MH. Sams et al. (2018) discussed that while MH typically presents near the initial exposure to the responsible substance, cases of delayed onset have been reported.
The case discussed by the authors described a 53-year-old male who underwent CABG with hypothermic cardiopulmonary bypass. The patient left the OR with a normal body temp, and once the paralytic was reversed in the ICU the patient immediately showed signs of MH. The patient was cooled, and dantrolene was administered. The patient survived the event. Zhao et al. (2020) discussed a case of a 55-year-old male with pneumonia who was taking trihexyphenidyl for Parkinson’s disease. The patient presented with MH and refractory hyponatremia determined to be an adverse reaction to the trihexyphenidyl. This patient survived as well.
References
Bin, X., Wang, B., & Tang, Z. (2022). Malignant hyperthermia: A killer if ignored. Journal of PeriAnesthesia Nursing, 37(4), 435–444. https://doi.org/10.1016/j.jopan.2021.08.018Links to an external site.
Sams, S. H., Revilla, S., & Stahl, D. L. (2018). Delayed development of malignant hyperthermia following cardiopulmonary bypass. Seminars in Cardiothoracic & Vascular Anesthesia, 22(1), 95–99. https://doi.org/10.1177/1089253217732128Links to an external site.
Zhao, J., Xu, G., Feng, C., Chen, Y., Kang, Y., Liu, F., & Ma, W. (2020). Trihexyphenidyl induced malignant hyperthermia in a patient with Parkinson’s disease complicated with pneumonia: A case report. Medicine, 99(20), e20129. https://doi.org/10.1097/MD.0000000000020129Links to an external site.
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.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6521 Week 1 Discussion Pharmacokinetics and Pharmacodynamics
As a psychiatric and mental health nurse for the past seven years, I have been involved in caring for and treating a 52-year-old male Caucasian patient at some point with schizophrenia, no known drug allergies who sometimes involves in self-mutilation. The said patient has not been consistent in following his treatment regimen and has many times endorsed suicide ideation with plans of running into traffic or jumping from the bridge. Pt sometimes exhibit violent behavior which had landed him into either four or six points restraints in the past. Most older adults are reluctant to seek help regarding mental illness, which leads to reasons behind the inadequate recognition and treatment of mental disorders among older adults (Tampi & Tampi,2020). The relationship between body, drug, and disease is impacted by age, gender, ethicality, and some pathophysiological changes that occur due to an illness. The purpose of this discussion is to reflect on a patient’s case from past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug. Also, to develop a personalized plan of care based on influencing factors and patient history. For the last four months, he has been on various dosages of Clozaril to find the one that would work for him since it was a medication that has worked for him in the past. During the last two months, he has been complaining of drooling and chest discomfort. Each time he reports the discomfort, the doctor orders Atropine and EKG. For the last few days, he has stated that the pain is becoming worse.
Step by step explanation
Pharmacodynamics
Pharmacodynamics focuses on how drugs exert physiological effects on the body through factors like drug responses, dose-response relationships, interpatient variability, drug receptor interactions, and therapeutic index (Rosenthal & Burchum, 2021) Clozaril is a medication that binds loosely and transiently to dopamine D2 receptors, but the implications of these binding activities are unclear. Clozapine also binds to D1, D3, and DS receptors, and has a high affinity for the D4 receptor” Rosenthal & Burchum, 2021. Some research shows this to include the limbic system. From a pharmacodynamic perspective, clozapine primarily exerts antipsychotic effects through D2 receptor antagonism while also interacting with other neurotransmitter systems such as serotonin receptors. This multifaceted interaction contributes to its comprehensive efficacy in treating treatment-resistant schizophrenia. To effectively optimize patient outcomes necessitates understanding the intricate interplay between clozapine’s pharmacokinetics and pharmacodynamics. Personalized dosing schedules based on therapeutic drug monitoring can facilitate achieving appropriate plasma concentrations while
Order a similar assignment, and have writers from our team of experts write it for you, guaranteeing you an A
