NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521 Week 1 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. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics ORDER NOW FOR CUSTOMIZED AND ORIGINAL NURSING PAPERS 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. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics 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! Submission and Grading Information Grading Criteria To access your rubric: Week 1 Discussion Rubric Post by Day 3 of Week 1 and Respond by Day 6 of Week 1 To Participate in this Discussion: Week 1 Discussion Samples 66-year-old female with end stage renal disease, diabetes, and breast cancer. The patient has edema of lower extremities and has been placed on 2L oxygen as needed. The MD orders two units of blood to be administered. Although patient has long history of renal disease, she has never received hemodialysis. Administering medication intravenously to a patient with end stage renal disease can become problematic. Kidney dysfunction affects the way the body excretes urine which is how the body eliminates medication. Studies have shown that 57% of those in end stage renal disease contain issues with pharmacokinetics with medication (Nyman, 2015). Furthermore, kidney dysfunction affects absorption, elimination, and distribution of medication in the body. Patients with chronic kidney disease generally display changes in the gastrointestinal tract that impacts medication absorption. During the process of absorption, medication undergoes active transport across the intestinal barrier (Nolin, 2015). Those gastrointestinal changes alter drug absorption and decreases bioavailability. The elimination of medication is known as total systemic clearance which occurs through renal excretion (Nolin, 2015). Distribution refers to the amount of medication being distributed throughout the body. Distribution is affected when physiological variables such as plasma protein or total body water are affected by chronic kidney disease (Selewski & Goldstein, 2018). Because these changes have occurred to the patient’s kidney function, the main concern would be fluid overload as the patient is unable to distribute the fluid properly. The plan of care would contain interventions that focus on excess fluid volume. I would assess for shortness of breath or rales in the lungs. I would monitor for increase in edema, distended jugular vein and weight gain. The patient should be weighed daily. Elevate the head of the bed to improve airway as well as continue with 2L oxygen. Infuse blood slowly and monitor vitals closely to decrease chance of fluid overload. References Nolin, T. D. (2015). A Synopsis of Clinical Pharmacokinetic Alterations in Advanced CKD. Seminars in Dialysis , 28 (4), 325–329. Nyman, H. A. (2015). Renal Dosing in High-Risk Populations. Journal of Infusion Nursing, 38(3), 210–215. T Selewski, D., & L Goldstein, S. (2018). The role of fluid overload in the prediction of outcome in acute kidney injury. Pediatric Nephrology , 33 (1), 13. 2 An 85 years old woman gets admitted to the hospital with the problem of progressive dyspnea with swelling of the leg for the last four months. The woman is a retired schoolteacher and had lost her husband. The woman denied doing any physical activity, and even for her daily meal, she depends on meal services. With dyspnea, she also has the problem of orthopnea, which increased from the last two weeks and led her to sleep in a recliner chair for the last seven days. The woman has a history of hypertension, obesity, and hospital admission for a heart-related problem. She was taking furosemide in a dose of 160 mg/day every day though her problem of hypertension was controlled by losing weight (Huang et al., 2016). The influencing factor in this case study is her age, medical history, inactive life, and poor eating habit of the women. The age-related pharmacodynamics and pharmacokinetic changes serve as a major contributor in her condition, making her more prone to chronic heart diseases. As a nurse, I observed that the woman was ordered apixaban for preventing stroke rather than warfarin, which is the most commonly used stroke inhibitor applied in the general population (Frost et al., 2015). The antiarrhythmic drugs are also not administered frequently, keeping in mind the change in pharmacokinetics, including the absorption and distribution of the drugs. I observed the treatment plan for the woman and the considerable difference with the medications administered in the general population. As the pharmacokinetics and the pharmacodynamics change with age, the creatinine clearance decreases with age making the apixaban more potent and non-inferior as stroke inhibitor than warfarin. The mechanism of intracranial bleeding also changes in the elder population making the apixaban a more reliable drug on older people. Metabolism, absorption, distribution, and clearance for antiarrhythmic medicines also decrease in the older population making the choice of rhythm control limited (Frost et al., 2015). Care plan: Keeping in mind the age of the patient it is essential to treat the dyspnea and give instant relief by moderating the position to maximize the respiratory air of the patient. The patient will be given oxygen therapy and inhaled bronchodilators to get immediate assistance. The stopped of the frusemide or decreased working with aging due to lower tubular clearance. The clearance reduced due to reduced plasma flow and result in delayed distribution and absorption of the drug. The alternative of the diuretic medication will be administrated for the patient with appropriate pharmacokinetics. The dose of ACE inhibitor needs to be altered in the case of older adults as the plasma concentration increases with age as an alteration of pharmacokinetics with aging, and the creatinine clearance must be checked when its value is lower than 30 ml min?1. Some modern drugs, like benazepril, spirapril, and fosinopril, are potentially compensating due to their biliary route clearance in older adults (Powers et al., 2012). Isoprenaline related chronotropic effect is less sensitive for older adults due to the pharmacodynamics changes, and alternative of the drug will be given for better result (Dai et al., 2015). References: Dai, X., Hummel, S. L., Salazar, J. B., Taffet, G. E., Zieman, S., & Schwartz, J. B. (2015). Cardiovascular physiology in the older adults. Journal of geriatric cardiology: JGC , 12 (3), 196–201. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics Frost, C. E., Song, Y., Shenker, A., Wang, J., Barrett, Y. C., Schuster, A., … & LaCreta, F. (2015). Effects of age and sex on the single-dose pharmacokinetics and pharmacodynamics of apixaban. Clinical pharmacokinetics , 54 (6), 651-662. Huang, X., Dorhout Mees, E., Vos, P., Hamza, S., & Braam, B. (2016). Everything we always wanted to know about furosemide but were afraid to ask. American journal of physiology. Renal physiology , 310 (10), F958–F971. Mangoni, A. A., & Jackson, S. H. (2004). Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. British journal of clinical pharmacology , 57 (1), 6–14. Powers, B. J., Coeytaux, R. R., Dolor, R. J., Hasselblad, V., Patel, U. D., Yancy, W. S., Jr, Gray, R. N., Irvine, R. J., Kendrick, A. S., & Sanders, G. D. (2012). Updated report on comparative effectiveness of ACE inhibitors, ARBs, and direct renin inhibitors for patients with essential hypertension: much more data, little new information. Journal of general internal medicine , 27 (6), 716–729. 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