Sample Answer for NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS Included After Question
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.
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.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
A Sample Answer For the Assignment: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Title: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Hey Anastasia thanks for sharing informative post, as we are aware Pharmacokinetic process includes four main steps such as absorption, distribution, metabolism, and excretion that explain movement of drug throughout the body. Applying detailed knowledge of these four steps to drug therapy will be beneficial in achieving maximum effects of drugs and minimize harm .IV hydralazine is usually used in the hospitalized patient with hypertensive emergency. The pattern of drug absorption such as rate and extent of absorption is unique and the route by which the drug is administered significantly affects both the onset and intensity of effects (Rosenthal and Burchum, 2021, p 13). However as mentioned in the scenario patient was given IV hydralazine hence the absorption phase is bypassed and absorption happens instantaneous with rapid onset, and precise control over drug levels can be maintained. It is very critical to dilute the IV hydralazine with 10cc of sodium chloride prior to its administration and should be injected slowly over 2 minutes to avoid precipitous decrease in arterial pressure with a critical reduction in cerebral and utero-placental perfusion.
This process or administration of 5-10 mg of IV hydralazine can be repeated every 20-30 minutes until the desired effect is achieved however the blood pressure and heart rate of patient should be monitored entire time. Hypotensive effects occur 5-30 minutes after an IV dose. The antihypertensive effects of an IV dose last 2-6 hours on average, although the effects of a parenteral dose can last up to 12 hours; the affinity of hydralazine for arterial walls may partially explain the prolonged effect. The patient here in the scenario is admitted with hypertension and acute kidney failure so it is also critical to consider pharmacokinetic parameters such as drug excretion as the majority of the drug excretion occurs via kidneys and in the case of acute renal failure both the duration and intensity of drug responses may increase. Hence it is important to check on creatinine clearance levels and adjust the dose based on its function.
References
hydralazine hydrochloride – Drug Summary. PDR.net. (n.d.). Retrieved December 2, 2022, from https://www.pdr.net/drug-summary/Hydralazine-Hydrochloride-Tablets-hydralazine-hydrochloride-738
Hydralazine 20mg Powder for Concentrate for Solution for Injection/Infusion. ADVANZ PHARMA. (2022, August 8). Retrieved from https://www.medicines.org.uk/emc/product/6710/smpc#gref Rosenthal, L. D., & Bur
A Sample Answer 2 For the Assignment: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Title: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Pharmacokinetics involves sequential processes, including absorption, distribution, metabolism, and excretion that occur in the body following drug administration (Arcangelo & Peterson, 2018). On the other hand, pharmacodynamics is the effect of a particular drug on the body. It includes side effects, physiological processes, and drug reactions. Unique patient features, including sex, age, and health condition, influence the two processes. My focus for this discussion purpose from my experience will be a 48-year-old male with diabetes mellitus Type 2.
Scenario: 48-year-old male with diabetes type 2 who was diagnosed with diabetes since the age of 20 but recently started going into diabetic ketoacidosis frequently. Patients presents with blood glucose of 690. Patient takes multiple medications including Lyrica, Metformin, Atorvastatin, and Lisinopril for hypertension, renal disease, gout, coronary artery disease, and neuropathy. I do not recall all the medications he was on.
Due to the complications of diabetes, these patients are usually prone to cardiovascular diseases, stroke, kidney diseases, vision alterations, among other diseases. Therefore, these patients are usually on many other drugs apart from the ones specified for diabetes mellitus.
Factors affecting pharmacokinetics
Liver metabolizes many drugs but with diabetic there is a decreased CYP 3A4 which is hepatic enzymatic activity and protein levels due to taking other medications for other complications brought about by diabetes (Uehara et al 2017). More often, these patients also experience an increase in glomerular infiltration rate causing excretion concerns related to micro vascular and macro vascular changes and renal function loss (Trevisan & Dodesini, 2017). There is also the effect of distribution due to the process of glycation where albumin has decreased affinity for some fatty acids decreasing efficiency of fatty acid grafted drugs (Gajahi Soudahome et al., 2018). Due to the different drugs that this patient was taking, there was the effect of decreased membrane permeability influenced by insulin induced capillary perfusion affecting absorption (McConell et al., 2020)
Pharmacodynamics
Metformin activates the enzyme adenosine monophosphate kinase (AMPK) which inhibits enzymes involved in gluconeogenesis and glycogen synthesis in the liver blocking the enzyme pyruvate carboxylase, while stimulating insulin signaling and glucose transport in muscles (Hunter et al., 2018). By blocking this enzyme, lactic acid accumulates causing lactic acidosis. This could happen with high doses of metformin or with patient with decreased renal clearance. This patient takes Lisinopril, ACE inhibitor, which lowers blood pressure by inhibiting the enzymes Angiotensin I and II which constricts blood vessels. Renal function can be decreased with chronic use of ACE inhibitors thus renal dosing is highly advised.
Personalized Care
This patient was seeing different doctors for diabetes, renal disease, and hypertension. Her medications were not revised by these providers hence the complications due to polypharmacy. For her personalized care, I would recommend her medications to be revised by the providers, a goal placed to focus on decreasing A1C, avoiding sedentary lifestyle including diet change, at home glycemic control, improved physical activity, and regular follow ups.
References
Uehara, S., Uno, Y., Nakanishi, K., Ishii, S., Inoue, T., Sasaki, E., & Yamazaki, H. (2017). Marmoset Cytochrome P450 3A4 Ortholog Expressed in Liver and Small-Intestine Tissues Efficiently Metabolizes Midazolam, Alprazolam, Nifedipine, and Testosterone. Drug Metabolism and Disposition, 45(5), 457–467. https://doi.org/10.1124/dmd.116.074898
McConell, G. K., Sjøberg, K. A., Ceutz, F., Gliemann, L., Nyberg, M., Hellsten, Y., Frøsig, C., Kiens, B., Wojtaszewski, J. F. P., & Richter, E. A. (2020). Insulin‐induced membrane permeability to glucose in human muscles at rest and following exercise. The Journal of Physiology, 598(2), 303–315. https://doi.org/10.1113/jp278600
Trevisan, R., & Dodesini, A. R. (2017). The Hyperfiltering Kidney in Diabetes. Nephron, 136(4), 277–280. https://doi.org/10.1159/000448183
Gajahi Soudahome, A., Catan, A., Giraud, P., Assouan Kouao, S., Guerin-Dubourg, A., Debussche, X., le Moullec, N., Bourdon, E., Bravo, S. B., Paradela-Dobarro, B., Álvarez, E., Meilhac, O., Rondeau, P., & Couprie, J. (2018). Glycation of human serum albumin impairs binding to the glucagon-like peptide-1 analogue liraglutide. Journal of Biological Chemistry, 293(13), 4778–4791. https://doi.org/10.1074/jbc.m117.815274
Hunter, R. W., Hughey, C. C., Lantier, L., Sundelin, E. I., Peggie, M., Zeqiraj, E., Sicheri, F., Jessen, N., Wasserman, D. H., & Sakamoto, K. (2018). Metformin reduces liver glucose production by inhibition of fructose-1-6-bisphosphatase. Nature Medicine, 24(9), 1395–1406. https://doi.org/10.1038/s41591-018
A Sample Answer 3 For the Assignment: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Title: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
COVID-19 Patient
In March 2020 Arkansas began to see the first surge of patients with coronavirus (COVID-19). In the beginning, treatment for the virus was based on oxygen saturation, and symptom management. By August 2021 monoclonal antibodies, Regen-Cov, casirivimab and imdevimab given together became the treatment of choice for the Delta strain of the virus under Emergency Use Authorization by the Food and Drug Administration (FDA.gov).
A 50 y/o male patient with moderate obesity and high blood pressure presented with cough, tachypnea and fever. He reported onset of symptoms eight days prior to seeking treatment and tested positive for COVID-19 using a rapid antigen test. His temperature was 102 degrees, heart rate 124, BP (Blood Pressure) 147/92 and oxygen saturation was 87%. The patient had no known drug allergies. He did not meet inclusion criteria due to his oxygen saturation but after doing some deep breathing, coughing, and sitting upright rather than lying down his oxygen saturation increased to 94% and remained there. The decision was made to give him Regen-COV. The patient was not vaccinated against COVID-19.
Individualized Plan of Care
Regen-COV 1200mg (casirivimab 600mg and imdevimab 600mg) was given subcutaneously using four injection sites and administering 2.5 ml per site. The patient was asked to remain in a supine position for 10 minutes post injection to decrease the amount of irritation to the injection sites. He was monitored for one hour post injection with no change in vital signs or evidence of any adverse reaction to treatment. The patient was sent home with his wife, an oxygen saturation monitor and educational materials. He was instructed to do his deep breathing exercises every hour while awake.
The following afternoon I called the patient to reassess. He reported that his fever was resolving and had been no higher than 100 degrees since that morning. He reported feeling weak but not short of breath. His oxygen saturation was 94%. He felt like he was improving.
The patient was also called 48 hours after receiving monoclonal antibody treatment and reported, ¨I am sure you saved my life with that medicine. ¨ He was afebrile, and his oxygen saturation was 97%. He reported fatigue but his malaise was resolved. He reported no irritation at the injection sites and was instructed to follow up with his physician if his symptoms returned or worsened. I spoke to him one week post injection and he reported a full recovery and returned to work.
Pharmacokinetics
Pharmacokinetics explain what the body does to the drug in terms of absorption, distribution, metabolism and excretion. (Rosenthal and Burchum, 2018). Regen-Cov is lab-created human antibodies given in combination (Food and Drug Administration, 2021).
Regen-COV has a half-life of 26-30 days and is degraded into small peptides and amino acids in the body. It is not metabolized by the liver or kidneys. Because of this, patient weight, hepatic or renal impairment do not affect exposure of the drug or require dose modification. It is also very unlikely that Regen-COV will interact with other medications (Deeks, 2021).
Pharmacodynamics
Pharmacodynamics is the study of the effects of the drug on the body and how the effects are produced (Rosenthal and Burchum, 2018. pp 22-23). Regen-COV antibodies have a high affinity for the spike protein of the COVID-19 virus. The antibody binds to the spike protein and prevents the virus from binding to human cells. This reduces the viral replication in the lungs and other body tissues (Deeks, 2021).
References
Deeks, E.D. (2021, October 30). Casirivimab/Imdevimab: First Approval. Nature Public Health Emergency Collection, 81(17), 2047-2055. doi:10.1007/s40265-021-01620-z.
Food and Drug Administration. (2021). U.S. Food & Drug Administration. Retrieved from FDA.gov:
FDA.gov/drugs/drug-safety-and-availability/fda-authorizes-regen-cov-monoclonal-antibody-
Therapy.
Rosenthal, L.D., & Burchum, J.R. (2021). Lehneś Pharmacotherapeutics for Advanced Practice Nurses
And Physician Assistants. St. Louis: Elsevier.
A Sample Answer 4 For the Assignment: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Title: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Thank you for sharing your experience. As I start this class, I want to learn more about the subjects at-hand, so I paid attention and further researched some points of discussion from your writing to increase my knowledge. Two points of your discussion that I further researched to help me understand the information is about the drug’s no effect of liver and kidney and the half-life of the drug. You talked about Regen-Cov not being metabolized by the liver or kidneys and that it was administered subcutaneously. Subcutaneous injections are absorbed by the fatty tissue with less blood vessels under the skin and metabolized into the circulatory system after reaching the blood vessels (Kim, Park, & Lee, 2017). This tissue/blood vessel absorption and direct circulatory system metabolizes explains the lack of use of the liver and kidney. Next, you mentioned about half-life of Regen-Cov. Medication half-life has significant implications for dosing regimen and peak-to-trough ratio at the balanced state (Smith, Beaumont, Maurer, & Di, 2017). After understanding the importance of half-life, I can relate the information to the use of the drug with the patient. Moving forward, I look forward to learning more about pharmacokentics and pharmacodynamics of medications and how they are implemented into treatment. Thank you, again.
References
Kim, H., Park, H., & Lee, S. J. (2017). Effective method for drug injection into subcutaneous tissue. Scientific reports, 7(1), 1-11.
Smith, D. A., Beaumont, K., Maurer, T. S., & Di, L. (2017). Relevance of half-life in drug design: Miniperspective. Journal of medicinal chemistry, 61(10), 4273-4282.
A Sample Answer 5 For the Assignment: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Title: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
I appreciate your very thoughtful response and your interest in monoclonal antibodies. It is amazing that the body absorbs these into the bloodstream where they are metabolized and attach to specific viruses to do their work or stopping replication and reducing viral load. The science behind creating/cloning tissues in a lab that were once only produced and replicated in a healthy human body is amazing to me.
I appreciate the study you did and included in your response. You are obviously a great student and member of the nursing profession. Thank you again, Tracey
Good morning, Tracey. The past two years have been trying times for many of us as bedside nurses. As a progressive care telemetry nurse, myself, I spend many shifts on our covid units during the initial outbreak. It was interesting seeing drugs repurposed to help fight the outbreak. In the beginning there was some question about the pharmacokinetics of certain medications and whether or not dose adjustments would be vital in medication therapy for patients based on age, race, and comorbidities (Reddy et al., 2020).
One repurposed drug that has found a key role in combatting the virus has been Pepcid. Pepcid has become a common drug that give our patients in the inpatient setting. The idea behind repurposing this medication is it’s use as an antagonist in histamine signaling thus reducing severity of symptoms (Malone, 2021).
The first week of this course has already piqued my curiosity about some of the off-label uses for some covid treatments that we have been using. It will be interesting when we look back to see what had a certain positive effect and what did not based on the data. Thank you for your post and have a great morning.
References:
Malone, R. (2021). More than just heartburn: does famotidine effectively treat patients with
covid-19? Digestive Diseases and Sciences, 66, 3672-3673.
https://link.springer.com/article/10.1007/s10620-021-06875-w
Reddy V. P., Khateeb, E., Jo, H., Giovino, N., Lythgoe, E., Sharma, S., Tang, W., Jamei, M.,
& Hodjegan, A. (2020). Pharmacokinetics under covid-19 storm. British Journal of
Clinical Pharmacology, 1-29. DOI: 10.1111/bcp.14668
A Sample Answer 6 For the Assignment: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Title: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
When prescribing medication, it is crucial to consider several individual patient factors that might affect the pharmacokinetic and pharmacodynamic process (Reeve et al., 2017). For instance, while working with the geriatric population, I encountered an 85-year-old female patient with a history of atrial fibrillation and serum creatine of 1.8mg/dl. The patient was prescribed digoxin to help manage the rapid heart rate. A maintenance dose of 125mcg tabs once a day was decided based on the patient’s pharmacodynamic and pharmacokinetic processes.
Advanced age is characterized by reduced functionality of several regular body processes responsible for functional integration between different cells and organs. The 85-year-old patient displayed several pharmacokinetic changes, with the main ones being a reduction in hepatic and renal clearance and decreased distribution volume of water-soluble drugs leading to higher serum levels (Drenth‐van Maanen et al., 2019). Consequently, some of the pharmacokinetic changes associated with the patient’s advanced age include increased sensitivity to drugs like digoxin.
Serum creatine of 1.8mg/dl is quite high indicating that the patient’s kidneys are not functioning properly. However, since approximately 67% of digoxin undergoes renal clearance, it was necessary to calculate the standard renal clearance of the drug, which is 6 liters per hour per 70 kg body weight, with a creatinine clearance of 100 mL/min (Holford, 2017). The patient’s creatinine clearance is however reduced hence the need to administer a lower dose of the drug. A once-daily dosing frequency is thus recommended with a bioavailability of 0.7 that requires 127 mcg/day as the daily maintenance dose. The dose should however be monitored closely for further changes.
References
Drenth‐van Maanen, A. C., Wilting, I., & Jansen, P. A. F. (2019). Prescribing medicines to older people—How to consider the impact of aging on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921–1930. https://doi.org/10.1111/bcp.14094
Holford N.G. (2017). Pharmacokinetics & pharmacodynamics: rational dosing & the time course of drug action. Katzung B.G.(Ed.), Basic & Clinical Pharmacology, 14e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2249§ionid=175215748
Reeve, E., Trenaman, S. C., Rockwood, K., & Hilmer, S. N. (2017). Pharmacokinetic and pharmacodynamic alterations in older people with dementia. Expert Opinion on Drug Metabolism & Toxicology, 13(6), 651–668. https://doi.org/10.1080/17425255.2017.1325873
A Sample Answer 7 For the Assignment: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Title: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics PEER POSTS
Case of a dialysis patient who has atrial fibrillation, irregular rhythm, increased heart rate, and CHF. Patient has been fluid overload, no leg edema but with crackles on both lungs. Hemoglobin and hematocrit level are within normal limits. She went to the hospital for SOB. Initial treatment was dialysis to relieve SOB. Orders were Amiodarone IV drip, and oxygen.
Atrial fibrillation (AF) is a dangerous heart condition where there is an irregular and rapid heart rate. The heart beats out of coordination with the ventricles. People with AF have a four to fivefold increased risk of stroke and a two to threefold increased risk of heart failure (McCance, & Huether, 2019).
Amiodarone, a potent antiarrhythmic medication is used in treatment of irregular heart rate, such as atrial fibrillation, supraventricular and ventricular tachyarrhythmia. It is used to restore normal heart rhythm and maintain regular heart rate. This medication stays in the body for weeks to months, even after taking it.
Pharmacokinetics of Amiodarone
Pharmacokinetics is divided into four phases which are absorption, distribution, metabolism and excretion. Amiodarone has oral and IV medications. Oral amiodarone has a slow and variable absorption of about 40 % in the body. IV Amiodarone begins to act within one hour, with rapid onset of action within minutes after an infusion. The bioavailability may be influenced by age, liver disease, and interactions with other drugs or substances that inhibit or induce cytochrome (CYP) 450, thus affecting efficacy) (Biancatelli, et al, 2019). Amiodarone is a lipophilic drug, which absorption is enhanced if taken with foods high in fat content, and has a large but variable volume distribution (66 L/kg of body weight) (Biancatelli, et al, 2019).My patient weighs 70 kg and there is good volume distribution of the medication. She is below 65, so there is less likely of a adverse effects due to age. There is no information as to gender issue problems with Amiodarone.
Pharmacodynamics
She was given an IV dose of Amniodarone and according to hospital report she converted from atrial fibrillation to normal sinus rhythm. Pharmacodynamics is the study of the biochemical and physiologic effects of drugs on the body and the molecular mechanism by which those effects are produced (Rosenthal, & Burchum, 2021).
The short half-life for disappearance of amiodarone from plasma after intravenous administration is likely a measure of drug redistribution from vascular space into tissue and not body elimination. Amiodarone is metabolized by eliminated by hepatic metabolism and biliary excretion, so it is very beneficial for my patient. About less than 1% of the dose is excreted unchanged in the urine. Biliary excretion may have a role in the overall elimination of the drug
Evidence from literature suggests that dronedarone (amiodarone derived) causes a specific partial inhibition of tubular organic cation transporters leading to a limited increase in serum creatinine not related with a decline in renal function (Conti, et al, 2015).
References
Conti, V., Biagi, C., Melis, M., Fortino, I., Donati, M., Vaccheri, A., Venegoni, M., Motola, D. (2015). Acute renal failure in patients treated with dronedarone or amiodarone: a large population-based cohort study in Italy. European Journal of Clinical Pharmacology, Vol. 71(9). ISSN: 0031-6970. DOI 10.1007/s00228-015-1903-2
Biancatelli, R.M., Congedo, V., Calvosa, L., Ciacciarelli, M., Polidoro, A., Iuliano, L. Adverse reactions of Amniodarone. Journal of geriatric cardiology, (JGC) Vol. 16 (7) ISSN: 1671-5411. doi: 10.11909/j.issn.1671-5411.2019.07.004
McCance, K.L. and Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby Elsevier.
Rosenthal, L.D., and Burchum, J.R., 2021. Lehne’s pharmacotherapeutics for advanced practice nurses and physicians assistants (2nd ed.) St. Louis, MO: Elsevier
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