NURS 6521 Pharmacokinetics and Pharmacodynamics
Sample Answer for NURS 6521 Pharmacokinetics and Pharmacodynamics 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 Pharmacokinetics and Pharmacodynamics
Title: NURS 6521 Pharmacokinetics and Pharmacodynamics
Working in an intermediate care unit, I get to see patients from all races with different healthcare needs and conditions. One obvious thing observed from the so many patients that come into the facility is the prevalence of diabetes, hypertension and chronic obstructive pulmonary disease (COPD) in patients ages 20 years and above. Though the diseases are common, the types of medications used in treating them may differ in dose, brand, and pricing. When prescribing medications for an individual patient, the physician considers the effects of the drugs and the mechanism of their action on that particular patient.
Let us consider a 75-year-old male patient who is admitted for uncontrolled Diabetes. The patient has a past medical history of Diabetes type II and takes metformin to control his glucose but had not been able to afford the refills for his medication. On admission the patient presented with a blood glucose of 288 mg/dl and was ordered Lispro on a low dose sliding scale with blood glucose monitoring before meals and at bedtime. The patient was assigned to a young nurse who had recently just started working on the unit. Just before the lunch trays came in, the nurse went to review the patients’ blood glucose levels the nurse tech had checked. Without paying much attention, the nurse drew up 8 units of lispro insulin and administered it to the patient for what she thought was a blood sugar of 288mg/dl. After about 20 minutes the nurse discovered that the patient was sweating a lot and had an increased heart rate with slight shivers. The young nurse called the attention of an older nurse and explained all the care she had provided to the patient prior to discovering his current state. The two nurses reviewed the documentation on the computer and saw that the patients’ last blood glucose check was 98mg/dl and not 288mg/dl as the young nurse had thought it was. The older nurse immediately got a glucometer and checked the patients’ blood glucose which was now 52mg/dl, and also discovered that the patient had not eaten anything. The older nurse immediately followed the establishment’s protocol and administered 1 gram of glucagon to the patient, checked his blood glucose which had gone up slightly and then administered another gram, checked his blood glucose again, and then provided the patient with a small cup of orange juice and a cracker.
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As nurse practitioners, it is important to know and understand the pharmacokinetics and pharmacodynamic processes. Pharmacokinetics is the process of a drug being absorbed, distributed, metabolized, and excreted from the body (Rosenthal and Burchum, 2021). Pharmacodynamics is the relationship between drug concentration at the site of action and the resulting effects which include the time and severity of therapeutic and adverse effects (DiPiro, 2008).
Lispro Insulin is a rapid-acting insulin that has a short duration of action which is used to improve blood glucose management in patients with diabetes (Rosenthal and Burchum, 2021). It is more effective than the normal human insulin in improving and helping to maintain blood glucose control (Campbell et al., 1996). Factors that might influence the pharmacokinetics and pharmacodynamics of insulin are the size of the dose, the injected volume and the insulin concentration, vigorously rubbing the site of the injection, increase in temperature which increases absorption rate, site of the injection (absorption is faster when administered in the abdomen), and exercising of extremity within an hour of injection can speed up absorption (Donner and Sarkar, 2019). The patient received a large dose of insulin for an inaccurate blood glucose reading and presented with a hypoglycemic reaction due to the large amount of insulin that was administered.
A personalized care plan for the patient based on influencing factors and the patients history would be to set goals for the patient that include effective treatments to normalize and manage blood glucose levels, decrease the risk for hypoglycemic or hyperglycemic events using insulin medication, diet, and exercise, informing and educating the patient on the importance of compliance with medication regimen and importance of monitoring blood glucose, providing the patient with prescription savings or discount cards like Good Rx, and providing the patient with location to local community clinics that help with providing low-cost prescription medications.
Ensuring that the patient is properly educated and provided with the necessary resources to provide for his medication will promote his participation in self-care and ensure his compliance with monitoring and maintaining manageable blood glucose levels.
References:
Campbell, R. K., Campbell, L. K., & White, J. R. (1996, November). Insulin lispro: its role in the treatment of diabetes mellitus. The Annals of pharmacotherapy. https://pubmed.ncbi.nlm.nih.gov/8913409/.
Donner, T., & Sarkar, S. (2019). Insulin – Pharmacology, Therapeutic Regimens, and Principles of Intensive Insulin Therapy. Endotext [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK278938/.
DiPiro, J. T. (2008). Pharmacotherapy: A pathophysiologic approach. McGraw-Hill Medical.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) Elsevier.
A Sample Answer 2 For the Assignment: NURS 6521 Pharmacokinetics and Pharmacodynamics
Title: NURS 6521 Pharmacokinetics and Pharmacodynamics
Patient Scenario
Jane Doe is a 32-year-old G4P4 who vaginally delivered a viable female infant at 0804 this morning. Two hours post-delivery the patient comes over to the postpartum unit, and report is obtained from the labor & delivery (L&D) nurse. This same nurse attended her delivery and cared for her throughout her recovery. She reported that the patient had an uncomplicated delivery, infant weighed 3573 grams, a first-degree perineal laceration was noted and repaired, her quantitative blood loss was 250 milliliters. The patient has an 18 gauge IV in her left hand. Her fundus is noted to be firm, midline, and at the level of the umbilicus. The patient is planning to breastfeed her infant. The L&D nurse states that the patient attempted but was unable to void after the delivery prior to transferring to postpartum. The patient denies any pain currently. Jane Doe had an adequate and uncomplicated course of prenatal care. Her medical history includes gestational hypertension for which she has been taking Labetalol 200mg twice daily during her pregnancy, lupus, anxiety, and depression. She is unmedicated for the latter diagnoses.
Her blood pressures have been closely monitored and have been under control in the 130s/70s-80s throughout her pregnancy. She does admit to smoking 1/2 pack per day for the last 15 years but has no history of drinking alcohol. Her BMI is within normal range, and she has no family history of hypertension. Her vital signs upon admission to postpartum are T:98.3, P:110, BP:165/93, RR:20, SpO2:99% on room air. The patient’s vital signs were stable during her labor, delivery, and recovery with only slightly elevated blood pressure but nothing of concern. The patient’s lab work and urinalysis that was obtained prior to delivery was all within normal limits. Jane Doe is given her morning dose of Labetalol 200mg at the time of admission. The nurse will reassess her blood pressure 1 hour after administration and report to the doctor.
Factors Influencing Pharmacokinetics
The antihypertensive drug Labetalol is an alpha-beta blocker. Its use is recommended for treating gestational hypertension as it is safe for pregnant women and their unborn child. It is also safe for breastfeeding mothers. Labetalol relaxes blood vessels leading to a decrease in blood pressure and heart rate (Khan, 2020). The extent of decrease in blood pressure depends on the route of administration of Labetalol. In oral administration, a drop in blood pressure can be seen 20 minutes to 1 hour after administration, while effects from IV administration can be seen in just minutes. Labetalol is absorbed rapidly via first pass metabolism into the blood plasm through the liver or gastrointestinal tract. The highest concentration levels are seen at around 1-2 hours post administration. Labetalol’s half-life is approximately 3-3.5 hours after administration. The bioavailability is shown to correlate with the age of the patient with values of only 30% seen in patients aged 30-40. My patient falls in this age range at 32 years old. The bioavailability is noted at higher levels in older patients doubling to 60% at the age of 80. This percentage is also noted to increase when the medication is taken with food. The liver is responsible for excretion of Labetalol. After a dose of Labetalol is administered to a patient, the hepatic system rids the blood stream of approximately 85% of the medication. Excretion of Labetalol is dependent on the quality of hepatic blood flow. Labetalol is metabolized through conjugation to glucuronide metabolites and is excreted via urine and bile in feces (Abdullah & Yusof, 2019).
Factors Influencing Pharmacodynamics
Labetalol is a dual action medication. It is both an alpha1-adrenergic antagonist and a beta-adrenergic antagonist. Labetalol selectively antagonizes alpha1-adrenergic receptors and non-selectively antagonizes beta-adrenergic receptors, therefore the activity ratio of alpha to beta blockage when administered via the oral route is 1 to 3. When administering via the intravenous route the ratio is 1 to 7 (Miller et al., 2022). When Labetalol is administered, alpha1-adrenergic antagonism occurs which lowers blood pressure by vasodilation and a decrease in vascular resistance. Continued vasodilation from Labetalol use will not decrease stroke volume or cardiac output. Beta-adrenergic antagonism causes a decrease in the patient’s heart rate. Labetalol stops adrenergic stimulation of β-receptors in the smooth muscles, cardiac muscles, and bronchial muscles. This blockade is what causes a decrease in systemic blood pressure. This process also elicits some of the side effects caused by Labetalol such as bronchospasms. For this reason, Labetalol is contraindicated in patients with asthma (Abdullah & Yusof, 2019).
Personalized Plan of Care
The plan moving forward for Jane Doe was to recheck her blood pressure 1 hour after administration of Labetalol 200mg. Her blood pressure remained elevated at 160/99. I notified the provider who increased her Labetalol dose to 300mg three times daily. At this time, I administered the extra dose of 100mg of Labetalol to equal the newly ordered dosage, and her blood pressure was rechecked again in 1 hour. The patient’s blood pressure did respond to the extra dose of Labetalol, and her blood pressure dropped to 135/80. Increasing the strength and frequency of the medication kept the concentration levels in her body at a higher percentage throughout the day to control her blood pressure. Going forward, her blood pressures were checked every four hours or more frequently as needed throughout her stay. The nurses on each shift assessed for edema, changes in vision, and daily weight checks were performed. Gestational hypertension is high blood pressure that develops after 20 weeks gestation, and it usually subsides after delivery of the infant. In this patient’s case, the blood pressure did not immediately return to normal range. She will likely have to remain on the Labetalol for the next couple weeks. She will follow up in the office with her OBGYN in 1 week for a blood pressure check.
There are a few factors that could have caused this. The patient could have an overabundance of fluid onboard from receiving intravenous fluids before, during, and after her delivery. The patient also has a history of lupus which puts her at greater risk for gestational hypertension. Gestational hypertension also makes this patient more susceptible for developing chronic hypertension later in life. The patient’s history of smoking for the past 15 years is a major factor that can contribute to hypertension. I educated her on smoking cessation. If this patient’s blood pressure had not decreased our next plan of action would have been to transfer her back to Labor & Delivery and begin a magnesium drip to control her blood pressure. This is recommended for emergency treatment to reduce the risk of preeclampsia induced seizures (Morgan, 2021).
References
Abdullah, A., & Yusof, M. (2019). Labetalol: A brief current review. Pharmacophore. https://pharmacophorejournal.com/article/labetalol-a-brief-current-review
Gestational hypertension: Causes, symptoms & treatment. (2022). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4497-gestational-hypertension
Hypertension during pregnancy and after delivery: Management, cardiovascular outcomes and future directions. (2018, September 28). American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2018/09/28/08/08/hypertension-during-pregnancy-and-after-delivery
Khan, A. (2020, April 10). Taking Labetalol in pregnancy: Is it safe, risks & side effects. FirstCry Parenting. https://parenting.firstcry.com/articles/taking-labetalol-in-pregnancy-is-it-safe/
Miller, M., Kerndt, C. C., & Maani, C. V. (2022, July 12). Labetalol – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK534787/
Morgan, J. (2021, February 23). Postpartum hypertension: When a new mom’s blood pressure is too high | Heart | Your pregnancy matters | UT southwestern Medical Center. UT Southwestern Medical Center | The #1 Best Hospital in DFW. https://utswmed.org/medblog/postpartum-high-blood-pressure/
A Sample Answer 3 For the Assignment: NURS 6521 Pharmacokinetics and Pharmacodynamics
Title: NURS 6521 Pharmacokinetics and Pharmacodynamics
Patient Care Scenario
The patient under review is a 78-year-old African American male. The patient has a history of CHF, CKD, HTN, obesity, dementia, and falls. The patient reports intermittent alcohol use and denies tobacco use. The patient arrives at the facility and is diagnosed with cellulitis. The patient reports a history of renal complications secondary to IV antibiotics.
This patient has multiple variables such as obesity, age, comorbidities, and cognitive concerns that may impact pharmacokinetics and pharmacodynamics. Research suggests that infection promotes inflammation and has procoagulant properties that can negatively impact cardiovascular disease processes (Ng et al., 2022). This patient, having an infectious process, is at an increased risk for heart failure exacerbation. The presence of CKD poses a concern in this case due to antibiotic treatments used to manage infection being nephrotoxic, increasing the patient’s risk of developing ESRD (Ishigami et al., 2020). It is critical to be mindful of these concepts when prescribing medications and managing care to prevent further harm to the patient.
While managing this patient’s care, it is vital to consider obesity as a pharmacokinetic principle when dosing medications. For example, vancomycin may appear low initially (especially within the first ten days of treatment) in the serum while accumulating in adipose tissue, causing overdose over time (Assadoon et al., 2022). Treating an obese patient with vancomycin should prompt clinicians to frequently monitor levels, especially in early treatment, to prevent damage to the kidneys while managing infection. It is prudent to implement frequent follow-up appointments following discharge for this patient. Lastly, the clinician should consider the patient’s cognitive status and ability to provide self-care. If the patient cannot appropriately manage his care, the treatment team should involve family or community resources to help improve the patient’s outcome.
References
Assadoon, M. S., Pearson, J. C., Kubiak, D. W., Kovacevic, M. P., & Dionne, B. W. (2022). Evaluation of Vancomycin Accumulation in Patients With Obesity. Open Forum Infectious Diseases, 9(10), 1–5. https://doi.org/10.1093/ofid/ofac491
Ishigami, J., Cowan, L. T., Demmer, R. T., Grams, M. E., Lutsey, P. L., Coresh, J., & Matsushita, K. (2020). Hospitalization With Major Infection and Incidence of End-Stage Renal Disease: The Atherosclerosis Risk in Communities (ARIC) Study. Mayo Clinic Proceedings, 95(9), 1928–1939. https://doi.org/10.1016/j.mayocp.2020.02.026
Tien M. H. Ng, Esther E. Oh, Yuna H. Bae-Shaaw, Emi Minejima, & Geoffrey Joyce. (2022). Acute Bacterial Infections and Longitudinal Risk of Readmissions and Mortality in Patients Hospitalized with Heart Failure. Journal of Clinical Medicine, 11(740), 740. https://doi.org/10.3390/jcm11030740