NUR 6521 Discussion: Pharmacokinetics and Pharmacodynamics

NUR 6521 Discussion Pharmacokinetics and Pharmacodynamics

For few years that I worked at long term care facility, there were constant cases of urinary tract infections. These infections became so high that many of our patients required admission into acute care setting. According to (Wesolek, et, al, 202) UTI is the most common bacterial infection especially in women and it accounts for as high as three million emergency department visits annually. Understanding what urinary tract infection and teaching it to the patients were some of the strategies that we used in order to overcome the so many cases that we had. According to (Rosenthal, et al,2021) explains that pharmacokinetics is the study of drug movement throughout the body which involves processes of absorption, distribution, metabolism and excretion. While pharmacodynamic is understanding what the drug does to the body which are influenced by gender, ethnicity age and so on. This aspect is very essential in explaining to a patient what the antibiotics that has been prescribed does to the body as well as what to do in terms of adverse reaction and finally why the prescriber ordered the antibiotics for a duration of time. With our patients understanding the basic knowledge of the drug as well as practicing personal hygiene is when we saw the cases of urinary tract infections decrease at our facility. The cases were not 100 percent due to other factors like weak immunity among some patients as well as glitches when it comes to practicing the best hand hygiene possible.

Nurses played a role in understanding themselves on how the drug works which included monitoring the drugs concentration which were seen when the patient started to see improvement on their symptoms which were achieved by monitoring their vital signs as well as drug concentration in patients’ blood. Also, informing patients’ providers if the route of administration needs changed due to patients’ intolerance to the ordered route of administration. With these plans being put in place with a dedicated nursing staff is when we saw patient’s urinary tract infections cases decrease with patients and nurses understanding more on pharmacokinetics and pharmacodynamics of the drugs being at their disposal.

discussion

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. 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 pharamcodynamic 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.
In this Discussion, you reflect on a case from your past clinical experiences
and consider how a particular patient’s pharmacokinetic and pharmacodynamic
processes altered his or her response to a drug.

To prepare:

Review this week’s media presentation with Dr. Terry
Buttaro, as well as Chapter 2 of the Arcangelo and Peterson text, and the Scott
article in the Learning Resources. Consider the principles of pharmacokinetics
and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical
practices from the last five years. Select a case from the last five years that
involves a patient whose individual differences in pharmacokinetic and
pharmacodynamic factors altered his or her anticipated response to a drug. When
referring to your patient, make sure to use a pseudonym or other false form of
identification. This is to ensure the privacy and protection of the patient.

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.

With these thoughts in mind:

By Day 3

Post a description of the case you selected. Then, describe
factors that might have influenced pharmacokinetic and pharmacodynamic
processes of the patient from the case you selected. Finally, explain details
of the personalized plan of care that you would develop based on influencing
factors and patient history in your case.

By Day 6

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 pharmadynamic processes of the patients in their case studies. In addition,
suggest how the personal care plan might change if the age of the patient were
different and if the patient had a comorbid condition such as renal failure,
heart failure, or liver failure.

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Pharmacokinetics and Pharmacodynamics

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.

NUR 6521 Discussion: Pharmacokinetics and Pharmacodynamics 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&sectionid=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

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).

NUR 6521 Discussion: Pharmacokinetics and Pharmacodynamics 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

NUR 6521 Discussion: Pharmacokinetics and Pharmacodynamics Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.