NURS 6521 Pharmacokinetics and Pharmacodynamics Sample Paper

NURS 6521 Week 1 Discussion – Pharmacokinetics and Pharmacodynamics Sample Paper

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NURS 6521 Week 1 Discussion

Pharmacokinetics and pharmacodynamics are important factors in the plan of care for any patient population. When taking care of elderly patients and prescribing medications, it is important for healthcare prescribers to know how medications will affect elderly patients. One example of the importance of pharmacokinetics and pharmacodynamics playing a factor in patient care was during the treatment of a 75-year-old white female. She was forgetful and lived alone will little outside help for daily task and healthcare. This patient used acetaminophen (Tylenol) for pain on a regular basis to treat her arthritis and generalized pain. During a detailed history, she reported that she was careful not to exceed the recommended daily dose of acetaminophen. Additional medications taken by this patient included digoxin for an apparent cardiac condition. The patient presented with nausea, vomiting and abdominal pain that was sudden in onset.  Acetaminophen, a safe and effective pain reliever, is one of the most popular OTC pain relivers in the U.S.  Elevated LFTs and renal function labs provided clues to the healthcare provider that drug toxicity may be present.

Pharmacokinetics is defined as the study of the time course of drug absorption, distribution, metabolism, and excretion (Spruill et al., 2014). Clinical pharmacokinetics is the application of pharmacokinetic principles to the safe and effective therapeutic management of drugs in an individual patient (Spruill et al., 2014). Pharmacodynamics refers to the relationship between drug concentration at the site of action and the resulting effect, including the time course and intensity of therapeutic and adverse effects (Pea, 2012). The effect of a drug present at the site of action is determined by that drug’s binding with a receptor.

Normal aging of organs and systems leads to diminished function in many areas including decreased neuromuscular strength and reaction time to losses in memory and cognition (Jankovic, Illic, Bukumiric & Jankovic, n.d.).  There is a decreasing trend in hepatic metabolizing capacity with advancing years that can affect the ability to clear therapeutic drugs and environmental chemicals. This factor, combined with decreased renal clearance, causes prolonged retention of numerous drugs in elderly individuals.  The elderly consume a disproportionate quantity of drugs, with those older than 65 taking, on average, two to six prescribed and one to three nonprescription drugs at any one time (Cecilia et al., 2018). About 70 to 80% of an oral dose of digoxin is absorbed, mainly in the proximal part of the small intestine (Martin-Suarez et al., n.d.). The degree of binding to serum albumin is 20 to 30% (Martin-Suarez et al., n.d.). Digoxin is extensively distributed in the tissues, as reflected by the large volume of distribution. High concentrations are found in the heart and kidneys, but the skeletal muscles form the largest digoxin storage.

Polypharmacy is the administration of numerous drugs, usually more than five medications, to a single patient (Jankovic, Illic, Bukumiric & Jankovic, n.d.). This practice is very common in elderly individuals and increases the risks for drug interaction and side effects. In addition, there are numerous pharmacodynamic factors in the CNS of elderly subjects that may affect sensitivity to neuroactive agents. Changes in central cholinergic pathways, including decreased number of brain acetylcholine postsynaptic receptors, have been demonstrated in rodent models of aging and may contribute to the progressive decline in memory and cognition in elderly individuals (Pea, 2012). Liver function is generally considered to be maintained well into old age. A variety of drugs can induce hepatotoxicity with the possibility that reduced cellular defenses and reserve capacity could make the elderly individuals’ liver more susceptible to medications.

Elderly individuals are at greater risk of drug interactions due to metabolic changes and decreased drug clearance associated with aging. This risk becomes compounded with each additional number of drugs used. Several factors in older individuals contribute to their increased risk for developing a drug-related problem. They include frailty, coexisting medical problems, memory issues, and use of multiple prescribed and non-prescribed medications (Cecilia et al., 2018).  A balance is required between over- and under-prescribing. Multiple medications are often required to manage clinically complex older adults. Clinicians are often challenged with the need to match the complex needs of their older patients with those of disease-specific clinical practice guidelines.

A stepwise approach to prescribing for older adults should include: periodic review of current drug therapy; discontinuing unnecessary medications; considering nonpharmacologic alternative strategies; considering safer alternative medications; using the lowest possible effective dose; including all necessary beneficial medications (Spruill et al., 2014). Primary goals of clinical pharmacokinetics include enhancing efficacy and decreasing toxicity of a patient’s drug therapy. The development of strong correlations between drug concentrations and their pharmacologic responses has enabled clinicians to apply pharmacokinetic principles to actual patient situations. A drug’s effect is often related to its concentration at the site of action, so it would be useful to monitor this concentration.

Phillip Comalander

References:

Cecilia, L., Åsa, B., Nina, V., Anders, B., & Patrik, M. (2018). Effects of medication reviews on use of potentially inappropriate medications in elderly patients; a cross-sectional study in Swedish primary care. BMC Health Services Research, Vol 18, Iss 1, Pp 1-9 (2018), (1), 1. doi:10.1186/s12913-018-3425-y

Jankovic, S., Illic, D., Bukumiric, Z., & Jankovic, S. (n.d). Impact of Educational Intervention on Prescribing Inappropriate Medication to Elderly Nursing Homes Residents. Srpski Arhiv Za Celokupno Lekarstvo, 143(3-4), 174-179.

Martin-Suarez, A., Calvo Hernandez, M. V., Garcia Gonzalez, D., Macias Nunez, J. F., & Ardanuy Albajar, R. (n.d). A New Method for Individualized Digoxin Dosing in Elderly Patients. Drugs & Aging, 33(4), 277-284.

Pea, F. (2012). Pharmacokinetics in everyday clinical practice. [electronic resource]. Torino: SEEd, 2012.

Spruill, W., Spruill, W. J., Wade, W. E., DiPiro, J. T., Coleman, R., Hershey, J., & Wade, D. (2014). Concepts in clinical pharmacokinetics. Bethesda, Maryland: American Society of Health-System Pharmacists, 2014.

Initial Post: Pharmacokinetics and Pharmacodynamics

Many different patient factors affect the pharmacokinetics and pharmacodynamics of medications. As providers, it is imperative to have a sound understanding of the pathophysiology of diseases and how they affect the body. According to Arcangelo and Petterson (2013), pharmacokinetics focuses on what the body does to the drug while pharmacodynamics concerns what the drug does to the body. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

Patient Scenario

Ms. J. is a 28-year-old gravida five para four, 38 weeks gestation admitted to labor and delivery with the complaint of spontaneous rupture of membranes. Ms. J. has limited prenatal care with a history of drug use. Upon examination, she does have rupture of membranes, and she is five centimeters dilated. Ms. J. is given Stadol 2mg IVP for pain, and 30 minutes to an hour later, she is requesting more pain medication. Ms. J. states she needs something stronger because the Stadol is not working. The physician ordered Stadol 1mg IVP every hour as needed. Ms. J. was still complaining of pain with the medication change and becomes very agitated, cursing staff, and uncooperative. The doctor was notified again of patient complaint of pain and behavior. The doctor was hesitant on prescribing anything else for pain but eventually ordered Demerol 25mg IVP which the patient only required one dose before delivery.

Factors Influencing the Pharmacokinetics and Pharmacodynamic Process

The patient’s history of drug use significantly impacts the body’s utilization of medications, and the effect medication has on the body. Patients with a history of substance abuse make up 14% of the admissions to acute care units (da Cunha, 2015). According to Dunn and Neuman (2012), tolerance to pain medication develops from chronic use of a controlled substance which leads to the patient requiring increased amount of the same drug to achieve the desired effect. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

Personalized Plan of Care

Individualized care for this patient was to control her pain while trying to avoid respiratory depression of the newborn after delivery. According to Dunn and Neuman (2012), providers must believe and accept a patient’s report of pain to successfully manage it. Undertreatment of a patient’s pain can cause pseudoaddiction in which the patient exhibit behaviors similar to addiction but is due to inadequate pain management (Dunn & Neuman, 2012). As a provider, it is important to have a pain management plan in place for patients with substance abuse and refer them to the appropriate agencies for treatment after delivery.

References

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3^rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

Da Cunha, B. F. (2015). Ethics and undertreatment of pain in patients with a history of drug abuse. MEDSURG Nursing, 4-16.

Dunn, D., & Neuman, J. (2012). How substance abuse impacts pain management in acute care. Nursing, 42(8), 66-68. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

NURS 6521: Advanced Pharmacology Week One: Basic Pharmacotherapeutic Concepts

Prescribing appropriate medications is an essential role of health care providers and practitioners in the treatment of medical conditions, preventing negative health status and promoting health. As advanced practice registered nurses (APRN), understanding the process of how drugs and human body interacts is critical in managing our patients properly. As stated by the National Council of State Boards of Nursing, APRNs are prepared by education and certification to assess, diagnose, and manage patient problems, order tests, and prescribe medications (n.d.). Competence in drug therapy is one of the fundamental functions of APRNs particularly, nurse practitioners. The purpose of this week’s discussion will analyze how patient factors influence the processes of pharmacokinetic and pharmacodynamics in individuals to develop an effective plan of care.

Pharmacokinetics and Pharmacodynamics

Pharmacokinetics refers to the movement of the drug through the body while pharmacodynamics indicates how the drug is affecting the body (Arcangelo, Peterson, Reinhold, & Wilbur, 2017, p. 17). Both processes involve the interaction of the medication and human body functions. Several factors such as age, gender, ethnicity, behavior, genetics, and pathophysiological conditions can influence the processes of pharmacokinetics and pharmacodynamics of an individual. An example is the physiologic changes that occur during the aging process which can lead to several alterations in the absorption, distribution, metabolism, including excretion of drugs and the modifications in pharmacokinetics often affect drug properties such as concentration or rate of clearance, deviations in pharmacodynamics resulting changes in drug’s magnitude of effects and subsequent likelihood of adverse consequences (Sera & Uritsky, 2016). Every individual can have different ways of processing drugs and unique means of getting the medication effects. Comprehensively understanding influences that can affect the drug-body interaction is crucial in achieving the desired outcome and preventing unwanted complications.

The Case of Age and Pathophysiological Changes Effects on Drug Interactions

Reduced muscle strength, increased inactivity, more severe chronic health conditions, and increased use of prescription medications are risk factors for falls among older Americans and fall injury rates are almost seven times higher for older adults with poor health than for those with excellent health (Centers for Disease Control and Prevention, 2016). Due to physiologic changes associated with aging, use of certain medications can increase the risks of fall incident among the elderly population. In the past years that I have worked as a registered nurse in long-term care facilities and acute hospitals, I have witnessed the prevalence of the negative consequences of fall incidents among the elderly population. Although age itself creates a risk for adverse drug reactions, polypharmacy and the multiplicity of drugs taken by older adults present the higher risk which can result in significant health outcomes, such as falls and fractures (Arcangelo, Peterson, Reinhold, & Wilbur, 2017, p. 77). Polypharmacy is defined as the use of multiple drugs by a patient, such as the use of more medications than indicated, the indication of inappropriate prescriptions, the use of two or more drugs to treat the same disease or same therapeutic class (Bellostas Muñoz, Caudevilla Martinez, Crespo Avellana, Diez-Manglano, Gomez Aguirre, & Velilla Marco, 2017). As older population may experience multiple complex conditions, they are at risks of taking various medications prescribed by different specialists, providers, and practitioners causing increased risks of adverse drug reactions from polypharmacy. Furthermore, many of the elderly population have been in various hospitals and transitional care facilities resulting to the accumulation of prescribed medications. As studied in an article, polypharmacy is independently associated with adverse outcomes in frailty particularly where there is a decline in nutritional status, functional ability, and cognitive capacity particularly, increasing the risk of falls in the elderly population (Heard, Jubraj, Marvin, Poots, Rajagopalan, & Ward, 2017). Due to the complexity of their medical condition and physiologic changes, multiple drug prescriptions can result in drug-body interaction causing adverse effects such as cognitive decline, behavioral changes, alterations in their activities of daily living and reduction in functional status.

Personalized Plan of Care

Proper prescribing consists of selecting drugs that have clear evidence for their indicated use, which is appropriate for the patient’s circumstances, are well tolerated and cost-effective and whose benefits outweigh the risks including periodic reviews of prescriptions, especially when the patient changes doctor and during health care transitions (Bellostas Muñoz, Caudevilla Martinez, Crespo Avellana, Diez-Manglano, Gomez Aguirre, & Velilla Marco, 2017). As advanced practice nurses, reviewing the medications prescribed to the patient before adding new prescriptions needs to be exercised to avoid unnecessary use of certain drugs. Also, educating patients and their caregivers to immediately report changes in signs and symptoms that can be related to drug interactions should be encouraged to evaluate the elderly’s medications timely before an adverse event can occur.

Reference

Arcangelo, V. P., Peterson, A. M., Reinhold, J. A., & Wilbur, V. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Bellostas Muñoz, L., Caudevilla Martinez, A., Crespo Avellana, M., Diez-Manglano, J., Gomez Aguirre, N., & Velilla Marco, J. (2017). Symposium. Polypathology: Polypathology, polypharmacy, medication regimen complexity and drug therapy appropriateness. Revista Clínica Española (English Edition), 217289-295. doi:10.1016/j.rceng.2016.12.008. Retrieved from /orders/www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S2254887417300115?

Centers for Disease Control and Prevention. (2016, September). Falls are leading cause of injury and death in older Americans. Retrieved from /orders/www.cdc.gov/media/releases/2016/p0922-older-adult-falls.html

Heard, K., Jubraj, B., Marvin, V., Poots, A. J., Rajagopalan, A., & Ward, E. (2017). Deprescribing medicines in the acute setting to reduce the risk of falls. European Journal of Hospital Pharmacy-Science and Practice, 24(1), 10-15. Retrieved from http://ejhp.bmj.com.ezp.waldenulibrary.org/content/24/1/10

National Council of State Boards of Nursing. (n.d.). APRNs in the U.S. Retrieved from /orders/ncsbn.org/aprn.htm

Sera, L., & Uritsky, T. (2016). Pharmacokinetic and pharmacodynamics changes in older adults and implications for palliative care. Progress in Palliative Care, 24(5), 255-261. doi:10.1080/09699260.2016.1192319. Retrieved from /orders/eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=6&sid=a5084331-cc2f-4444-b694-778f0a63d346%40sessionmgr4009