Feb 23, 2024 PHARMACOKINETICS AND PHARMACODYNAMICS NURS 6521
PHARMACOKINETICS AND PHARMACODYNAMICS NURS 6521
PHARMACOKINETICS AND PHARMACODYNAMICS NURS 6521
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
PHARMACOKINETICS AND PHARMACODYNAMICS NURS 6521
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.
16 year old African American male, came into clinic for a routine physical. The adolescent urine screen revealed a positive screening for gonorrhea. The patient was contacted via telephone and asked to return to clinic for nurse visit to receive adequate treatment of 500mg Ceftriaxone IM. Upon arrival to the clinic the patient was pressed for time due to other plans he had made, it was explained to him that due to the new use this antibiotic, with IM administration he needed to remain in clinic for observation for 30 minutes post dose.
The patient then became agitated and slightly unruly, It was explained to him that this introducing any antibiotic carried a risk of allergic reaction like all other medications and post exposure assessment was necessary to get this treatment. The patient threatened leaving as it was explained to him that this infection will not clear on its own, and has the potential to be transmitted if he is not treated and abstinent for sexual activity. After providing all education the patient finally consented for treatment.
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Factors influencing Pharmacokinetic and Pharmacodynamics
Upon assessment this gentleman did not have allergies to medications, or severe underlying illnesses. Medication delivery was parental According to Burchum et. al. (22021)IM administration is rapid delivery of water soluble drugs with the disadvantage of causing discomfort, while the capillary wall is easy to pass for absorption. Pain, inconvenience, injury and bleeding are all disadvantages of IM administration, however the ability to give medication that is not very soluble or depot drugs are the advantages according to Burchum et. al. (2021)
This patient had no issues with renal or hepatic system so there were no concerns related to drug excretion. The dose was correct for this patient and standard treatment is a one time IM antibiotic treating the partner and not engaging in intercourse. Clearly there is risk of reinfection which would pose a issue as this can lead to untreatable forms of STDs. Monitoring response was a big part of why this patients presentation was important for me, as it is unknown how the patient will act, according to Ball et. al (Burchum et al. (2021)
Care
Much of what occurred in office is what I would have done myself. The patient was screened for the urine at a PE then called to inform him of the positive test. The patient was then given a large amount of information and data regarding his diagnosis and his treatment . This is very urgent to make sure the family is on board. Making sure the kidney and liver is functioning well prior to give these medications is important for renal excretion
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier..
Nice Post! According to St Cyr et al. (2020), the Centers for Disease Control recommends a single 500 mg IM dose of ceftriaxone for uncomplicated gonorrhea. It is also essential to continue to monitor for ceftriaxone resistance. It is recommended that patients be retested three months after treatment (St Cyr et al., 2020). Some other considerations when prescribing this medication would be if the patient has a penicillin allergy or is pregnant (when working with female patients, not pertaining to your case study). According to UpToDate (2022), using ceftriaxone would be safe if the patient only has a history of rash without any IgE manifestations. Pregnant women with uncomplicated gonorrhea can be treated the same as the general population (UpToDate, 2022).
References
St Cyr, S., Barbee, L., Workowski, K. A., Bachmann, L. H., Pham, C., Schlanger, K., Torrone, E., Weinstock, H., Kersh, E. N., & Thorpe, P. (2020). Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Morbidity and mortality weekly report, 69(50), 1911–1916. https://doi.org/10.15585/mmwr.mm6950a6Links to an external site.
UpToDate. (2022). Evidence-Based Clinical Decision Support System| UpToDate | Wolters Kluwer. https://www.uptodate.com/contents/treatment-of-uncomplicated-neisseria- Links to an external site.gonorrhoeae-infections?search=ceftriaxone-drug- &source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H2 79612
Great post, It is very important that as practitioners we ensure that patients are apart of the plan in terms of medications they will take. Once we educate and allow patients to share in their care and the benefits of treatment, they become more compliant with their care. (Nobuyuki et.al, 2022) Notes that when in their case, pharmacist do a good job of educating patients on medication and benefits it decreases the rate of non compliance. This would be an affecting factor of the pharmacokinetic and pharmacodynamic process.
Reference
Nobuyuki Wakui, Mizue Ozawa, Takahiro Yanagiya, Saki Endo, Chikako Togawa, Raini Matsuoka, Shunsuke Shirozu, Yoshiaki Machida, & Mayumi Kikuchi. (2022). Factors Associated With Medication Compliance in Elderly Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.771593
Thank you for this post. As indicated in the post, comorbidities have a substantial impact on the pharmacodynamics and pharmacokinetic processes of medications. The low clearance of medications because of kidney disease increases the risk of adverse effects. The patient’s advanced age also influences pharmacokinetics and pharmacodynamics. Aging is related to the reduction in drug metabolism because of reduced liver mass (Rosenthal & Burchum, 2020).
Consequently, the patient can experience severe adverse effects from ibuprofen, including stomach ulcers. Age is a key consideration when formulating a care plan. For a young adult patient, the care plan should be changed to include ibuprofen because of the reduced risk of stomach ulcers. Nurse practitioners must identify the efficacy and tolerability of medications in relation to patients’ age and social factors (Visovsky et al., 2022). Decisions about pharmacological interventions should be led by an assessment of the patient for comorbidities and drug interactions.
References
Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier Health Sciences.
Visovsky, C. G., Zambroski, C. H., & Lutz, R. M. (2022). Edmunds’ pharmacology for the primary care provider. Elsevier Health Sciences.
Thank you for this post. As indicated in the post, comorbidities have a substantial impact on the pharmacodynamics and pharmacokinetic processes of medications. The low clearance of medications because of kidney disease increases the risk of adverse effects. The patient’s advanced age also influences pharmacokinetics and pharmacodynamics. Aging is related to the reduction in drug metabolism because of reduced liver mass (Rosenthal & Burchum, 2020).
Consequently, the patient can experience severe adverse effects from ibuprofen, including stomach ulcers. Age is a key consideration when formulating a care plan. For a young adult patient, the care plan should be changed to include ibuprofen because of the reduced risk of stomach ulcers. Nurse practitioners must identify the efficacy and tolerability of medications in relation to patients’ age and social factors (Visovsky et al., 2022). Decisions about pharmacological interventions should be led by an assessment of the patient for comorbidities and drug interactions.
References
Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier Health Sciences.
Visovsky, C. G., Zambroski, C. H., & Lutz, R. M. (2022). Edmunds’ pharmacology for the primary care provider. Elsevier Health Sciences.
I agree that Pharmacokinetics plays a huge role on the effects of pain medication. I just have a recent experience where a patient was admitted to my floor and was later sent to surgery to receive split thickness graft to her BLE. The patient blood pressure began to slowly drop, and respirations became shallow after the administration of versed. The patient was 78 years old and was 78kg. The patient had to receive Narcan because of the medication. Later it was found that the patient had a Hydromorphone pump and was receiving Hydromorphone and sedatives while in surgery. Sedates are usually given based off the patients age and weight. Pharmacokinetics and pharmacodynamics occur differently in older adults. Older adults typically have decreased gastric acid production and decreased gastric mobility which causes impaired drug dissolution (Rosenthal et al.,2021,p.60). This can cause decrease bioavailability of drugs. Decreased gastric mobility in adults increases the effects of medications (British Pharmacological Society, 2022, p.4).
British Pharmacological Society | Journals – Wiley Online Library. (n.d.). Retrieved December 4, 2022, from https://bpspubs.onlinelibrary.wiley.com/
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Some factors affect the dosage prescribed to a patient, and one of the factors includes their age. A patient’s age determines their drug administration since the absorption, distribution, metabolism, and administration rate differs between different ages (American Geriatrics Society 2019 Beers Criteria Update Expert Panel et al., 2019). Furthermore, other elements, such as the patient’s response to medication and the side effects one can experience, are determined by age. Therefore, giving a five-year-old patient with high blood pressure the dosage of an adult instead of a child can affect the patient regarding pharmacokinetics and pharmacodynamics.
Pharmacokinetics
The patient is five years old and has high blood pressure. She was supposed to receive a slow dosage of labetalol with nicardipine, administered intravenously during the first minutes of the encounter. After the pressure was under control, the patient was to switch to oral medication and receive it in minimal amounts. Instead, they got a high dosage of Angiotensin II Receptor Blockers (ARBs) after the nurse made an error, which affected the pharmacokinetics and pharmacodynamics of the patient.
The absorption rate took longer because of the patient’s gastrointestinal conditions. They are young, and the functioning of their digestive system is not equipped for the high dosage. Therefore, the absorption was incomplete, and some drugs remained in the gastrointestinal system (Ferguson & Stein, 2023). Another issue with pharmacokinetics is the risk of toxicity during distribution because of the high levels of the drugs in crucial organs such as the liver and kidneys. The young patient has a small liver and kidney and low body weight, meaning they are not equipped to handle high amounts of drug administration and distribution that an adult can handle (American Geriatrics Society 2019 Beers Criteria Update Expert Panel et al., 2019). In addition, the metabolism rate of the drug would happen slower, which increases the chance of severe side effects. The slow metabolism comes from the immature enzymes in the liver of a five-year-old. Furthermore, the elimination process will likely take longer and incomplete because of the underdeveloped excretion system. These factors may lead to high levels of drug toxins in the body and prolonged side effects.
Pharmacodynamics
According to the child’s age and the dosage they have received, the patient can respond differently to the drug and its side effects. At the age of five, a patient’s physiology is not equipped to handle high doses of ARBs, and exposure to such can lead to lower blood pressure than expected, fatigue, drowsiness, and dizziness. Moreover, the patient can be exposed to other risk factors such as stomach discomfort, headaches, and nausea. The elevated side effects come from the inability of the body to absorb, distribute, metabolize, and excrete the drugs administered.
Personalized Plan of Care
The personalized care plan should start with understanding the patient’s history and outline any pre-existing conditions that can worsen the situation. The nurse should focus on preventing complications by recognizing the error, discontinuing the administration, and allowing the drugs in the system to clear out (Rosenthal & Burchum, 2020). Furthermore, the patient should be monitored for changes in their cardiac output, side effects prevalence, and blood pressure changes for the next 48 to 72 hours. The patient should be kept in a stress-free environment where they should receive regular observation to establish a difference and respond accordingly (Ferguson & Stein, 2023). The nurse should ensure the patient does not engage in strenuous activities to prevent energy expenditure and manage their oxygen intake capacity.
Conclusion
Patient care involves ensuring that the patient’s pharmacokinetics and pharmacodynamics are considered during treatment. Dealing with a five-year-old patient with high blood pressure requires careful consideration of the medication they receive to prevent instances of overdosing the patient. Nonetheless, in the case of an error where they receive an adult dosage, the patient should be given optimal care with a personalized plan to ensure the changes they experience are noted and considered during the rectification of the error. On the other hand, nurses should take the necessary precautions when handling patients to prevent severe side effects and more harm to the patient.
References
American Geriatrics Society 2019 Beers Criteria Update Expert Panel, Fick, D. M., Semla, T. P., Steinman, M., Beizer, J., Brandt, N., … & Sandhu, S. (2019). American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/JGS.15767
Ferguson, M. A., & Stein, D. R. (2023). Pharmacologic Treatment of Pediatric Hypertension. In Pediatric Hypertension (pp. 857–881). Cham: Springer International Publishing.
Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants-E-Book. Elsevier Health Sciences.
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