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Pharmacokinetics (PK) and pharmacodynamics (PD) are two main branches of pharmacology that are essential for optimizing drug therapy and ensuring patient safety. PK studies the journey of a drug through the body, including its absorption, distribution, metabolism, and elimination while on the other hand, PD examines how a medication affects the physiological and biochemical functions of the body (Ernstmeyer & Christman, 2023). This paper explores the relationship of these principles with my real-world clinical experiences, emphasizing the importance of considering individualized factors that influence drug response.
During my clinical experience, I came across a 65-year-old male patient with a history of chronic heart failure presented with worsening symptoms of dyspnea, fatigue, and edema. His current medications included furosemide, an aldosterone antagonist, and enalapril, an ACE inhibitor. Upon evaluation, the patient’s serum potassium level was found to be elevated, indicating potential hyperkalemia, which is a known adverse effect of aldosterone antagonists.
Several factors influenced the PK and PD processes in this patient, contributing to the development of hyperkalemia. According to Rosenthal and Burchum (2019), an advanced patient’s age increases the risk of impaired renal function. The patient’s age, being over 60 years old, could have slowed down the elimination of potassium from the body. Secondly, the patient’s concurrent use of enalapril, an ACE inhibitor, can further enhance potassium retention due to its mechanism of action. Additionally, the patient’s reduced physical activity may have contributed to decreased potassium excretion through sweat.
Based on the influencing factors and patient history, a personalized plan of care was developed to address the hyperkalemia and optimize drug therapy. The aldosterone antagonist dosage was reduced to minimize potassium retention (American Geriatrics Society, 2019). Additionally, the patient was advised to monitor his potassium levels regularly and maintain a low-potassium diet. Furthermore, regular monitoring of renal function was recommended to ensure adequate potassium excretion.
This case study highlights the importance of considering PK and PD principles in patient care. Understanding these factors that influence drug absorption, distribution, metabolism, and elimination enables healthcare professionals to tailor drug regimens to individual patients, minimizing the risk of adverse effects and maximizing therapeutic efficacy.
American Geriatrics Society. (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://doi.org/10.1111/jgs.15767
Ernstmeyer, K., & Christman, E. (2023). Chapter 1 pharmacokinetics & pharmacodynamics. Www.ncbi.nlm.nih.gov; Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK595006/
Rosenthal, L. D. R., & Burchum, J. R. (2019). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants: Laura Rosenthal DNP ACNP, Jacqueline Burchum dnsc APRN BC: 9780323554954: Amazon.com: Books. Amazon.com. https://www.amazon.com/Pharmacotherapeutics-Advanced-Practice-Physician-Assistants/dp/0323554954
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.
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.
The human body and pharmacological agents interact in various fashions to cause desired pharmacological effects and adverse outcomes in undesired situations. I encountered a patient named Mrs. B (not her actual name) who was being treated for congestive heart failure in my training. Mrs. B is a 78-year-old black female who had been on treatment for heart failure two months ago. During that admission, she had been brought in because she had bilateral lower limb edema.
Mrs. B was put on furosemide for his edema and heart failure. She was ambulant and reported no leg pain. During the second day on furosemide, she started reporting dizziness. Her blood pressure measured that day was within the normal limits but borderline low. Her physician reassured her that her vitals were fine but there needed some adjustments in the doses of her medications. Her physician was also worried about her kidney function due to her conditions. Therefore, he ordered that Mrs. B be evaluated for serum creatinine, urea levels, and serum potassium and sodium levels.
Mrs. B’s body ad furosemide reacted in various ways to cause the improvement of the edema and the dizziness with lowered blood pressure. Furosemide is the commonest prescribed diuretic and has indications in cardiac, hepatic, pulmonary, and renal diseases (Rosenthal & Burchum, 2020). It has well documented pharmacokinetic profile and pharmacodynamics properties. The route of administration can be parenteral or enteral. Oral administration is usually through oral uncoated tablets or oral disintegrating films (Koh et al., 2021).
The route determines its bioavailability and onset of action after administration. The absorption happens in the gut after oral administration, and metabolism occurs in the liver, after which elimination will take place in the kidneys. This explains the physicians’ concerns about kidney functions. Poor elimination in kidney injury would lead to toxicity of this drug and more adverse events. Furosemide acts in the loop of Henle to promote the excretion of water and potassium.
Therefore, it reduces fluid overload and reduces cardiac output. In so doing, it can lower blood pressure and cause hypotension and dizziness. This explains the phenomenon that Mrs. B was experiencing on the second day of therapy (Khan et al., 2022). Therefore, the pharmacokinetics and pharmacodynamics of furosemide explain the entire phenomena Mrs. B had. This understanding provides the basis for the care plan for this patient.
Mrs. would require rehydration despite still having fluid overload. This would prevent acute kidney injury and furosemide toxicity. Mrs. B is an elderly patient, and the administration of furosemide would require monitoring of sodium levels for this particular population, according to the American Geriatric Society (American Geriatrics Society, 2019). Decreased kidney function among the elderly population would lead to decreased drug elimination and thus toxicity. This plan would also include blood pressure monitoring to prevent orthostatic hypotension and dizziness.
The personalized plan for Mrs. B is based on what furosemide does to the body (pharmacodynamics) and what the body does to furosemide (pharmacokinetics) and the factors influencing these interactions. Age has stood out as a key factor in the pharmacodynamics and pharmacokinetics of furosemide. The diminished physiological capacity of the body in adults influences how they eliminate and metabolize medications. Therefore, nursing interventional adjustments and physical intervention adjustments would be justified in this case.
American Geriatrics Society. (2019). American geriatrics society 2019 updated AGS beers criteria® for potentially inappropriate medication use in older adults: 2019 Ags beers criteria® update expert panel. Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767
Khan, T. M., Patel, R., & Siddiqui, A. H. (2022). Furosemide. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499921/
Koh, S.-K., Jeong, J.-W., Choi, S.-I., Kim, R. M., Koo, T.-S., Cho, K. H., & Seo, K.-W. (2021). Pharmacokinetics and diuretic effect of furosemide after the single intravenous, oral tablet, and newly developed oral disintegrating film administration in healthy beagle dogs. BMC Veterinary Research, 17(1), 295. https://doi.org/10.1186/s12917-021-02998-4
Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders. https://evolve.elsevier.com/cs/product/9780323554954
The patient case that I recall from my past experiences is about a 40-year-old male patient who was admitted following an amputation. The patient transferred to rehab just days after the surgery and was not medically stable to endure 3 hours of therapy. Some comorbidities include a kidney transplant, ESRD on peritoneal dialysis, hypertension, and diabetes. The patient was chronically hypotensive, with normal systolic blood pressures in the 80s. Current medications included anti-hypertensives and alpha-adrenergic agonists. During therapy, the patient would experience orthostatic hypotension dropping down to the 60’s.
Some factors might have influenced pharmacokinetic and pharmacodynamic processes in this patient. Pharmacokinetics involves absorption, distribution, metabolism and excretion. After the medication is ingested, it gets absorbed into the bloodstream, which moves from the blood into the cell.
The drug is then metabolized by the liver and excreted primarily by the kidneys. Drugs and their metabolites can exit the body in urine, bile, sweat, saliva, breast milk, and expired air (Rosenthal, 2021). Patients with chronic kidney disease will respond to drugs differently than patients with normal kidney function. In patients with healthy kidneys, small molecules and drugs get filtered through the glomerulus. In the tubules, lipid-soluble drugs undergo passive reabsorption. Lastly, active transport systems can pump drugs into the tubule to be excreted with urine.
For patients who have ESRD, the excretion of drugs is affected tremendously. Whether kidney disease is acute or chronic, drug clearance decreases, and the volume of distribution may remain unchanged or increase” (Roberts, et.al., 2018). Duration and intensity are factors to consider in these patients due to the increased number of free drugs in the blood. With patients who are taking multiple drugs, there is a delayed excretion of drugs if they use the same transport system, and the medication effects can be delayed. According to Sommer, Seeling, and Rupprecht, “70.4% of the residents with an estimated glomerular filtration rate (eGFR) < 60 mL/min take at least five drugs, with 17.7% of them taking > 10 drugs as long-term medication” (2020).
The personalized care plan that I would implement for this patient included taking a full history of medications including herbal and over-the-counter drugs. Accurate documentation of medications prevents adverse drug-to-drug interactions, medication replication, and dosage errors. As the provider, we can adjust the dosage of medications accordingly. In the case of this patient, a decrease in the dosage of antihypertensive medications should be considered because the patient continues to have hypotension.
Renal dosage of these medications also must be taken into consideration, are these medications appropriate for patients with chronic kidney disease? I would monitor for signs and symptoms of toxicity including low blood pressure, dizziness, headaches, and feeling tired. Monitor blood pressure throughout the day, especially before and after taking blood pressure medications and when the patient reports symptoms of hypotension. The patient would benefit from education about the medications and what signs and symptoms to monitor for.
My patient is an incarcerated 43-year-old Hispanic male with schizophrenia, currently being treated with 20mg of olanzapine once at nighttime. This treatment has effectively treated the positive and negative symptoms of his mental health illness. However, his blood sugar levels have become elevated lately He has no reported history of diabetes nor other known medical conditions. He has a history of methamphetamine and alcohol use. He has gained approximately twenty pounds over the past three months while incarcerated.
It is well documented that patients undergoing treatment with antipsychotics are at an increased risk of gaining weight and developing diabetes mellitus (DM) in comparison to the general population, an approximate eight to ten-fold increased risk according to Jaworski et al. (2021). Holt (2019) noted that among atypical (second generation) antipsychotics, olanzapine has been associated with the highest rate of weight gain and DM (71%) when compared to first generation antipsychotics (p.4).
Among the atypicals, olanzapine is closely followed by risperidone and quetiapine in causing these adverse effects, with the least likely being ziprasidone and aripiprazole (Khandker et al., 2022, p.2). However, the possible causational mechanism of developing DM associated with initiating antipsychotics is still being studied. There is the general belief that it correlates with weight gain, but there is also evidence that suggests that it may be due to a direct decrease in insulin sensitivity and insulin secretory capacity (Holt, 2019, p. 5).
To determine the best course of treatment to take with this patient, it is important to review and balance the control of symptoms, risk of side effects, and the risk of relapse (Khandker et al., 2022, p. 9). Our patient has a history of taking other antipsychotics including Haldol and risperidone, but the patient experienced most benefit of his symptoms with olanzapine. He does not recall having received treatment with either ziprasidone or aripiprazole.
In this case, I would recommend that we adjust his antipsychotic medication to aripiprazole, monitor for therapeutic response, and continue monitoring his blood sugars. We want to avoid having to treat another disease process if it can be avoided which might be accomplished with this adjustment. It is also important to note that it may be necessary to treat him with olanzapine if it is discovered that he is not responded favorably to other treatments or if the patient wishes to continue with his current treatment after being given the risks of benefits of his options.
Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?
These are some of the questions you might consider when selecting a treatment plan for a patient.
Photo Credit: Getty Images/Caiaimage
As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to do no harm. It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority.
Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.
To Prepare
Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
Review the scenario assigned by your Instructor for this Assignment.
Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.
By Day 7 of Week 1
Write a 2- to 3-page paper that addresses the following:
You see another nurse practitioner writing a prescription for her husband, who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.
Give examples. For example, say it was Dilaudid (hydromorphone) tablets. Talk about the drugs effects on patient (kinetics & dynamics briefly), use highest level pharmacological information, since you are doing advanced pharmacology. Talk about Ethical Moral & Legal aspects of this error & how you will rectify the issue. Talk about long term consequences of opioid prescriptions. Give information as short paragraphs, not big blobs.
NOTE:
PLEASE INCLUDE A TITLE PAGE, INTRODUCTION AND SUMMARY.
MY STATE IS PENNSYLVANIA.
Use peer reviewed scholarly reference articles, provider/clinician based, not patient based, from peer reviewed, current US based journals. Within 5 years.
Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 33, Review of Hemodynamics (pp. 285-289)
Chapter 37, Diuretics (pp. 290-296)
Chapter 38, Drugs Acting on the Renin-Angiotensin-Aldosterone System (pp. 297-307)
Chapter 39, Calcium Channel Blockers (pp. 308-312)
Chapter 40, Vasodilators (pp. 313-317)
Chapter 41, Drugs for Hypertension (pp. 316-324)
Chapter 42, Drugs for Heart Failure (pp. 325-336)
Chapter 43, Antidysrhythmic Drugs (pp. 337-348)
Chapter 44, Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels (pp. 349-363)
Chapter 45, Drugs for Angina Pectoris (pp. 364-371)
Chapter 46, Anticoagulant and Antiplatelet Drugs (pp. 372-388)
…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke some of the leading risk factors for heart disease
Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.
Photo Credit: Getty Images/Science Photo Library RF
As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.
Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm
To Prepare
Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
Review the case study assigned by your Instructor for this Assignment.
Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
Write a 2- to 3-page paper that addresses the following:
Here is the Case for your Study!
Patient JJ has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia.
Drugs currently prescribed include the following:
Glipizide 10 mg po daily
Metformin 500 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily
Facilitator/Professor help:
INFORMATION AS SHORT PARAGRAPHS, READABLE. All information & presentation have to be at advanced clinician level.
Example, here are some questions you may want to address in your assignment:
Does this patient need both verapamil & atenolol at the same time, since both have similar actions?
Recent guidelines do not recommend beta blockers for hypertension. But it was possibly added for the best therapeutic outcome? Why beta blockers? (example, he had strokes?).
Is there a drug to be added for stroke prevention?
What are the major adverse effects of Statins (muscle related), Hydralazine (many, lupus like syndrome), glipizide (hypoglycemia) HCTZ (hypokalemia) etc.
Why can’t this patient be a candidate for metformin, the best used diabetes drug, efficacious, no hypoglycemic attacks etc.?
Please include a title page, an introduction with a purpose statement, and a summary.
Please be mindful of plagiarism and APA format, I have included the rubric and a template. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.
Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.
Photo Credit: Photo Library / Getty Images
One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.
To Prepare
Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.
Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:
PLEASE USE THE TEMPLATE
5-6 SLIDES
QUESTION 1
CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”
HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.
Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
Question:
Which cholesterol is considered the “good” cholesterol and what does it do?
CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”
HPI: Patie
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