NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Sample Answer for NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion 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 Discussion

Title: NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Patient Case

As a psychiatric nurse with several years of experience, I have worked with several patients especially adults to assist in diagnosis and treatment care. As a nurse, I understand that the way our bodies interact with drugs is individually different as people have personal factors which affect how the drug interacts with their body and vice versa. This means that when describing drugs, the nurse should also take these factors into consideration factors such as ethnicity, age, gender, and even nutrition to avoid putting the patient’s life at risk. In my patient case scenario, I will use my latest patient who comes to the clinic every month for a check-up since she has been diagnosed with hypertension (Van et al., 2018). When the patient come into the hospital, she said she has several medical conditions such as lower back aches, ulcers, and anxiety. When she came to my clinic she was complaining of acute heartburn and a burning sensation in the upper stomach. She had been prescribed valium and clonazepam which she has taken for two weeks. The patient reported that since she started taking the drugs, she feels constantly sick though the symptoms have reduced.

Factors that might have interfered with the pharmacokinetic and pharmacodynamic processes

I realized that several factors might have influenced the patient’s pharmacodynamics and pharmacokinetics of drugs. I believe her pharmacodynamics and pharmacokinetics might have been influenced by her behavior such as alcohol consumption mostly on weekends and environmental exposures such as pesticides can alter drug-metabolizing enzymes, as well as pharmacokinetics of drug metabolism (Rosenthal & Burchum, 2021). Besides, another factor is her body size, as an overweight patient, the way the drug is absorbed might have an impact on the pharmacokinetic implications.

An individualized Plan of Care

Having the full details of this patient’s case would be beneficial in determining a full treatment plan. I would recommend a change of drugs by replacing them with benzodiazepine, a change of nutrition, and intense physiotherapy. The patient can come for follow-ups and another check-up as scheduled.

References

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. Louis, MO: Elsevier.

Van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58(10),

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To Prepare

NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics
NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics
  • 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.

A Sample Answer 2 For the Assignment: NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Title: NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Pharmacokinetics (PK) is the study of medication movement within the patient’s body. At the same time, pharmacodynamics (PD) studies the physiological and biochemical effects of a particular medication in the body (Rosenthal & Burchum, 2021). In this discussion, I reflect on a previous patient that I took care of in my current workplace and explore the PK and PD effects concerning various factors affecting these processes. I currently work in an outpatient research unit where we give chemotherapy, biotherapy, trial vaccines, immunotherapies, and other phase one to phase three clinical trials. I once took care of a 65-year-old Caucasian male who was diagnosed with Mantle Cell Lymphoma (MCL). MCL is a rare type of B-cell non-Hodgkin lymphoma (NHL) with a case incidence of one per 200,000 people and is more common in males with ages ranging from 60 to 70 years old (Lynch & Acharya, 2020). In my case experience, the patient was cleared to receive his first round of immunotherapy that day, and the patient’s treatment plan order was to pre-medicate with Acetaminophen (Tylenol) 650 mg orally and Diphenhydramine (Benadryl) 25 mg intravenously 30 minutes before Rituximab (Rituxan) infusion. Then, infuse Rituxan at a starting rate of 50 ml/hr and increase the rate of 50 ml every 30 minutes (max 400 ml/hr) until infusion completion. The vital sign orders were to monitor every 15 minutes during the infusion, one hour after the end of infusion, and just before discharge.

The factors that may influence the PK and PD processes are genetics, gender, ethnicity, age, and lifestyle/behavior of the patient. Genes may play a role in the PK and PD process. Pharmacogenetics is the study of how a patient’s genes affect how they respond to certain drugs (National Institute of General Medical Sciences, 2020). Patients diagnosed with Mantle Cell Lymphoma (MCL) involve the protein CD20 attached to the cancer cells. In combination with Rituximab infusions, clinical trials are being developed to disrupt these B-cell gene pathways involved in MCL. Although men and women may respond differently to the same drug, gender, race, and ethnicity in general, are not a very helpful basis for anticipating drug responses (Rosenthal & Burchum, 2021).

The elderly population’s ability to metabolize medications is commonly decreased (Rosenthal & Burchum, 2021). Those over the age of 60 are more likely to develop kidney disease (National Kidney Foundation, 2020). Furthermore, renal function often declines in old age (Rosenthal & Burchum, 2021). The kidneys also play a role in drug excretion and serve to limit the duration of action of medications (Rosenthal & Burchum, 2021). Therefore, particular drugs may need to be reduced to prevent drug toxicity or overdose. It is also imperative to check the renal function of patients before giving medications.

Certain medications, such as acetaminophen, may increase the risk of hepatotoxicity. Furthermore, Benadryl undergoes first-pass metabolism in the liver before reaching the systemic circulation, increasing the risk for liver injury (Schneider et al., 2017). Therefore, it is critical to check the patient’s hepatic function levels before administering this kind of medication.

A personalized treatment plan is essential. An understanding of each medication mechanism of action and side effects will help equip the advanced practitioner to provide better care and education to the patient. In our case, the common infusion side effects of Rituximab are chills, rigors, and fever. Patients who receive Rituximab infusions are usually pre-medicated with Acetaminophen and Benadryl to help counter these adverse effects. Furthermore, antihypertensive medications may enhance Rituximab’s hypotensive effect (Provincial Health Cervices Authority, 2020). Therefore, it is advised to hold antihypertensive drugs during the infusion, monitor frequent vital signs, and educate the patient about this side effect and the importance of blood pressure monitoring at home. Since we have an elderly patient, determining the right dosage of medications is essential. For example, a half dose of Benadryl 25 mg IV push is recommended in the elderly patient as pre-medication instead of the full amount of 50 mg. In this case, maximal efficacy can still be achieved with a lower dosage of this medication while considering the patient’s age, renal, and liver functions. 

Good patient education is imperative in providing treatment with medication function and side effects. It is important to remember patient safety is always paramount in delivering care. Educating the patient on what to expect ahead of time, such as the potential side effects of each medication during treatment and after discharge, will increase medication compliance and better management of symptoms.

References

Lynch, D., & Acharya, U. (2020). Mantle Cell Lymphoma. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK536985/

National Institute of General Medical Sciences. (2020). Pharmacogenomics. What is pharmacogenomics?https://www.nigms.nih.gov/education/fact-sheets/Pages/pharmacogenomics.aspx

National Kidney Foundation. (2020). Aging and kidney disease. https://www.kidney.org/news/monthly/wkd_aging

Provincial Health Services Authority. (2020). Rituximab. BC Cancer Drug Manual. http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Rituximab_monograph.pdf

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Schneider, Y., Cui, I., & Jesudian, A. (2017). Diphenhydramine as a cause of drug-induced liver injury. Case Reports in Hepatology. https://doi.org/doi.org/10.1155/2017/3864236

A Sample Answer 3 For the Assignment: NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Title: NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

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&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

A Sample Answer 4 For the Assignment: NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Title: NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

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

Grading Rubric Guidelines

Performance Category 10 9 8 4 0
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic decisions.
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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
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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)
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Summarizes what was learned from the lesson, readings, and other student posts for the week.
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Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition
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  • 8-10 errors in APA format.
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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.