Age along with pathophysiologic changes related to disease are huge factors that can affect pharmacokinetics and pharmacodynamic processes. According to Rodrigues, Herdeiro, Figueiras, Coutinho, and Roque (2020), ageing is a process that inevitable resulting in a decline in functioning and increased susceptibility to certain diseases, requiring the use of an increased amount of medication. Ageing can affect the distribution, metabolism, and excretion in the process of pharmacokinetics. Changes in body mass and protein synthesis can affect distribution of a drug and nutritional status can affect the rate of metabolism of a drug in an ageing patient (Rodrigues et. al, 2020). Most drugs are eliminated through kidneys. In the ageing patient, there is a decline in renal function related to a decrease in the glomerular filtration rate and renal blood flow, which makes it difficult for drugs to be excreted through the kidneys. This, in turn, puts the patient at risk for adverse drug reactions. According to Ponticelli, Sala, and Glassock (2015), older patients who have kidney disease are most at risk for adverse drug reactions. The process of pharmacodynamics affected by ageing can cause drug sensitivity and impaired homeostasis.
The patient K.S. has several medical conditions, resulting in a numerous amount of prescribed medications. She is frail in statue and
has a lean body mass, which can affect the distribution of the medications prescribed. She, also, has poor nutritional status, which can affect the metabolism of the medications prescribed. She has been recently diagnosed with chronic kidney disease, which can affect elimination of the medications prescribed. She is prescribed warfarin, in which the response can be increased due to drug sensitivity leading to an adverse event. Also, due to impaired homeostasis, blood pressure regulation could be affected. NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics
In developing a personalized plan of care for patient K.S., one has to take into consideration the patient’s age and medical history. One would review the drug therapy with the patient and discontinue any medications that are not necessary, have drug interactions, or put the patient at risk for an adverse drug reaction. One would ensure that current laboratory testing has been completed and review the laboratory results with the patient. Based on these results, one would consider medications that are safer for the patient and has the lowest effective dose possible. One would provide education to the patient on disease processes, purpose of medications prescribed, checking blood pressure and parameters to follow. One would stress the adherence to medication regimen and the importance of laboratory testing.
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.
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 2 For the Assignment: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics
Title: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics
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
A Sample Answer 3 For the Assignment: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics
Title: NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics
For this week’s discussion, we are to post about a patient case from our experiences, observations, and/or clinical practice from the last 5 years. We are then to describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient that is identified. We are then to explain details of the personalized plan of care that would be developed based on influencing factors and patient history.
The first case that comes to mind is that of a current patient whom I will refer to as Mr. X, who is a resident at the long-term care facility where I work. He is a an 85 year old gentlemen, who has diagnoses of PTSD, depression, hypertension, and dementia. His medications include Depakote, Quetiapine Fumerate, Sertraline, Donepezil, Amantadine, Nifedipine, and Lithium.
According to Mangoni and Jackson (2004), there are pharmacodynamic changes a person of advanced age undergoes, including a reduction in renal and hepatic clearance and increases in the volume of distribution of lipid soluble drugs. This results in an increased sensitivity to particular drugs such as anticoagulants, cardiovascular and psychotropic drugs as clearance of these drugs is longer than most. Mr. X is on cardiovascular and psychotropic drugs.
Recently, he had a change in Quetiapine due to an increase in hallucinations. This drug is an atypical antipsychotic that is indicated for hallucinations, depression, and anxiety disorders (Duncan et. al). His doses of this drug are 25 mg in the morning, and 300 mg at bedtime. This drug was increased slowly with an effectiveness measure of decreased (or no) hallucinations. Lithium is given as a dose of 300 mg at bedtime. Again, this drug was increased slowly with a measured effectiveness of no hallucinations, as well as decreases in behaviors such as angry outbursts. Nifedipine extended release is 90 mg in the morning. The effectiveness of Nifedipine was a decrease in blood pressure.
Mr. X has his blood levels of Lithium checked monthly at this time after it was checked every 7 days for a month, which I believe is appropriate given the alterations in clearance of this drug. He is also checked monthly by psychiatry in my facility. I also agree with this. His blood pressure is monitored before administration of his cardiovascular drug. I believe it is also pertinent to check his Lithium levels if he begins to hallucinate as this is a side effect of Lithium. Furthermore, his sodium is 140, potassium is 4.1, BUN is 18, Creatinine is 1.0. These are within normal limits.
For his care plan, he will be free from medication side effects, he will be able to verbalize feelings of safety within the building, he will receive the least dosage of the prescribed psychotropic drug to achieve maximum functional ability both mentally and physically. Additionally, there will be a decrease in behaviors and Mr. X will be able to verbalize his feelings. Finally, he will also have a blood pressure with a systolic no greater than 140, and a diastolic no greater than 80 for two readings or more.
Grading Rubric Guidelines DQ
| Performance Category |
10 |
9 |
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4 |
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| 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
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- 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.
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- 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.
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- 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
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- No evidence of the use of scholarly inquiry to inform or change professional or academic decisions.
- Information is not valid, relevant, or reliable
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| 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.
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- 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
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- 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
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- 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
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- 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
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| 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.
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- 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
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- 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
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- Does not post to the thread
- No connections are made to the topic
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| 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.
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- 4-5 errors in APA format.
- Writing responses have 4-5 grammatical, spelling and punctuation errors.
- Writing style is somewhat focused.
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- 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.
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- 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.
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- 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
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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. |
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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. |
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The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT. |
NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics References
Ponticelli, C., Sala, G., and Glassock, R. (2015). Drug management in the elderly adult with
chronic kidney disease: a review for the primary care physician. Mayo Clinic Proc., 90
(5). Doi.org/10.1016/j.mayocp.2015.01.016.
Rodrigues, D., Herdeiro, M., Coutinho, P., and Roque, F. (2020). Elderly and polypharmacy:
physiological and cognitive changes. Frailty in the Elderly.
Doi:10.5772/intecopen.92122.
Rosenthal, L.D. and Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice
nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.
NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics RE: NURS 6521- Week 1 Discussion Board
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Hello Robin,
Great discussion post, I really enjoyed reading your discussion. I’ve worked in a hospital for five years and one of the main reason for readmission is patients not taking medications, due to not understanding why they are taking them, not to mention over taking medications that cause a whole new list of issues. Medications like midodrine and coumadin are very sensitive medications that need to be closely monitored. For a patient taking midodrine, the patient needs to understand that this medication is very influential peripheral acting aplpha-1 agonist that is mostly used for patients with hypotension (Wong, Wong, Robertson, Burns, Roberts and Isbister, 2017). The mechanism of action of Midodrine is to make an increase in peripheral venous resistance and then to decline venous capacity, with the goal being to increase laying and standing blood pressure ( Wong, Wong, Robertson, Burns, Roberts and Isbister, 2017). With midodrine the patient needs to educate on heart rate to make sure they don’t become bradycardic; the patient needs to be educated on how to check pulse and blood pressure before medication administration and there needs to be an order for parameters for the patient, for when the patient should and should not take the medication ( Wong, Wong, Robertson, Burns, Roberts and Isbister, 2017).
With coumadin the patient needs to have their INR checked frequently to make sure it’s within a therapeutic range, and to also make sure the patients’ blood is not too thin. Anticoagulation drugs have a risk for bleeding due to their complexity (Bajorek,2011). For this patient you stated in this scenario she was on several other medications as well, and when patients are on several medications, the risk of them being misused is even higher (Bajorek,2011). When a patient is unable to take medications as prescribed, there current health care issues aren’t being treated, which is why a lot of times they end up being readmitted with the same problem they were previously in the hospital for. Kymes, Sullivan, Jackson & Raj (2020), note that a patient not being able to comply with their medications is a very huge public health problem, that affects a lot of comorbidities that a person has. I agree with your plan of care and discontinuing any medications that aren’t necessary, as more medications add to more adverse reactions that could happen and to monitor blood pressure and pulse before administration of midodrine. The patient also needs to be following the orders for her coumadin and to have her INR checked as frequent as the physician wants. The patient can have her INR checked at home with a home health nurse. I would also suggest this patient to keep a log of her blood pressure and pulse to show her provider, so they can adjust as needed to keep her as safe as possible. NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics
Heather
NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics References:
Bajorek B. (2011). A review of the safety of anticoagulants in older people using the medicines management pathway: weighing the benefits against the risks. Therapeutic advances in drug safety, 2(2), 45–58. https://doi.org/10.1177/2042098611400495
Kymes, S. M., Sullivan, C., Jackson, K., & Raj, S. R. (2020). Real-world droxidopa or midodrine treatment persistence in patients with neurogenic orthostatic hypotension or orthostatic hypotension. Autonomic Neuroscience: Basic and Clinical, 225. https://doi-org.ezp.waldenulibrary.org/10.1016/j.autneu.2020.102659
Wong, L. Y., Wong, A., Robertson, T., Burns, K., Roberts, M., & Isbister, G. K. (2017). Severe Hypertension and Bradycardia Secondary to Midodrine Overdose. Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology, 13(1), 88–90. https://doi-org.ezp.waldenulibrary.org/10.1007/s13181-016-0574-4
Week 1: Basic Pharmacotherapeutic Concepts/Ethical and Legal Aspects of Prescribing
How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?
Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.
This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.
Learning Objectives
Students will:
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients
Assess patient factors and history to develop personalized plans of care
Evaluate ethical and legal implications related to prescribing drugs
Analyze ethical and legal practices of prescribing drugs
Analyze strategies to address disclosure and nondisclosure
Justify advanced practice nurse strategies to guide prescription drug decision-making
Analyze the process of writing prescriptions to avoid medication errors
Learning Resources
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 1, “Prescriptive Authority” (pp. 1–3)
Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)
American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (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. doi:10.1111/jgs.15767
American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.
This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.
Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm
This website outlines the code of federal regulations for prescription drugs.
Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.
Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.
Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html
This website details key aspects of drug registration.
Fowler, M. D. M., & American Nurses Association. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application (2nd ed.). American Nurses Association.
This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.
Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list
This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.
Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17
This article provides NPs with information regarding state-based laws for NP prescribing.
Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446
The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.
Required Media (click to expand/reduce)
Introduction to Advanced Pharmacology
Meet Dr. Terry Buttaro, associate professor of practice at Simmons College of Nursing and Health Sciences as she discusses the importance of pharmacology for the advanced practice nurse. (8m)
Accessible player
Nature Video. (2016). The evolution of oral anticoagulants [Video]. https://www.youtube.com/watch?v=Gp-ucDRiaUA
Note: This media program is approximately 5 minutes.
Speed Pharmacology. (2015). Pharmacology – Pharmocokinetics (Made Easy) [Video]. https://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s
Note: This media program is approximately 14 minutes.
Speed Pharmacology. (2017). Pharmacology – Diuretics (Made Easy) [Video]. https://www.youtube.com/watch?v=9OBvNpnS0h4&t=664s
Note: This media program is approximately 18 minutes.
Speed Pharmacology. (2017). Pharmacology – Antiarrhythmic Drugs (Made easy) [Video]. https://www.youtube.com/watch?v=9xSqezCMHnw&t=1205s
Note: This media program is approximately 23 minutes.
Speed Pharmacology. (2015). Pharmacology – Pharmocokinetics (Made Easy) [Video]. https://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s
Note: This media program is approximately 14 minutes.
Speed Pharmacology. (2016). Pharmacology – Adrenergic receptors & agonists (MADE EASY) [Video]. https://www.youtube.com/watch?v=KtmV-yMDYPI&t=372s
Note: This media program is approximately 18 minutes.
Speed Pharmacology. (2017). Drugs for Hyperlipidemia (Made Easy) [Video]. https://www.youtube.com/watch?v=Of1Aewx-zRM&t=24s
Note: This media program is approximately 14 minutes.
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.
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.
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
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Week 1 Discussion Rubric
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Discussion Main Post: Pharmacokinetics and Pharmacodynamics
For an advanced practice nurse, advanced knowledge of pharmacotherapeutics is important. A few factors that affect how the patient can react to the medication are the age, genetics, and metabolism of the patient. Understanding pharmacokinetics and pharmacodynamics is a vital component in successfully designing a patient-focused drug treatment strategy while preparing care for any patient population. Pharmacokinetics is the study of the movement of drugs in the body, and this involves the ingestion, metabolization, delivery, and excretion of the drug. Pharmacodynamics is how the body reacts to the drug and its action mechanisms (Rosenthal & Burchum, 2018).
Description of the Patient Case
A 66-year-old female was admitted to our nursing facility with Major depression with psychosis. This patient was discharged from another sister nursing facility for aggressive, combative and refusing care. This patient was brought to us because our sister facility was not equip to handle this type of patients. The physician ordered Haldol, and Benadryl. After receiving the IM injection, the patient calmed down and was drowsy which increased her risk for fall and injury.
The majority of drugs are excreted by the kidneys; pharmacokinetics in patients sixty-five or older are affected by loss of kidney function (Aymanns, Keller, Maus, Hartman & Czock, 2010; Rosenthal & Burchum, 2018). Pharmacotherapy is difficult because of the complexities of comorbidities, polypharmacy and age-related liver/kidney changes, and drug interactions or toxicity may occur.( Boparai & Korc-Grodzicki, 2011).
The personalized plan of care for this 66 years old patient would be a modified confusion assessment method (mCAM-ED) and a reality orientation. Behavioral symptoms change and evolve throughout dementia; agitation, restlessness, and hallucinations are frequent in these patients, reduction in agitation rather than sedation is a goal of treatment in most cases ( Casey, 2015). The first drug of choice would be Haldol, which has a shorter half-life, causes less sedation, respiratory depression, and has minimal effects on BP (Calver & Isbister, 2013).
NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics Reference
Aymanns, C., Keller, F., Maus, S., Hartman, B., & Czock, D. (2010). Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clinical Journal of American Society of Nephrology, 5(2). doi: 10.2215/CJN.03960609
Boparai, M., & Korc-Grodzicki, B. (2011). Prescribing for older adults. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 78(4), 613–626. doi: 10.1002/msj.20278
Calver, L., & Isbister, G. K. (2013). Parenteral sedation of elderly patients with acute behavioral disturbance in the ED. The American Journal of Emergency Medicine, 31(6), 970-3. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.ajem.2013.03.026
Casey D. A. (2015). Pharmacotherapy of neuropsychiatric symptoms of dementia. P & T: a peer-reviewed journal for formulary management, 40(4), 284–287.
Hasemann, W., Grossmann, F. F., Stadler, R., Bingisser, R., Breil, D., Hafner, M., & Kressig, R. W. (2018). Screening and detection of delirium in older ED patients: performance of the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). A two-step tool. Internal and Emergency Medicine, (6), 915. https://doi-org.ezp.waldenulibrary.org/10.1007/s11739-017-1781-y
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Response 1
Hello Noah
Thanks for sharing your post. Because of the physiologic changes that come with aging, such as decreased renal and liver function, practitioners have to fully understand the possible adverse effects medication can have on elderly patients. As you stated, understanding pharmacokinetics and pharmacodynamics is a vital component in successfully designing patient-focused treatment strategies. Physiological changes with age may alter absorption, distribution, metabolism, and excretion of drugs in the elderly population. “Reduced elimination and prolonged half-life are most commonly observed pharmacokinetic changes in older patients whereas altered sensitivity to drugs and change in receptor affinity are major pharmacodynamic changes” (Mukker et al., 2016, para.1).
In response to your scenario, I have to question if the primary care provider ruled out a urinary tract infection. Did he/she order lab work before administering Haldol (Haloperidol) to check the patient’s renal and liver function? Did the patient begin a new medication, which could have caused a drug-drug interaction, causing the behaviors? What other comorbidities did the patient have? A thorough medication review should be considered when administering new medications to patients, particularly in children and older adults. Drug dosing for older adults should be reduced or started at a very low dose due to decreased renal and liver function (Rosenthal & Burchum, 2021). Haldol (Haloperidol) is considered a typical antipsychotic and is not recommended to treat patients with dementia-related psychosis (Drugs.com, 2020). If the patient has a diagnosis of Dementia, administering Haldol (Haloperidol) can lead to detrimental outcomes.
NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics References
Drugs.com. (2020).Haldol side effects.https://www.drugs.com/sfx/haldol-side-effects.html
Mukker, J., Singh, R., & Derendorf, H. (2016).Pharmacokinetic and pharmacodynamic considerations in elderly population.https://doi.org/10.1007/978-3-319-43099-7_10
Rosenthal, L., & Burchum, J. (2021).Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants(2nd ed.).
