Sample Answer for NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts 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 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 Weitzel et al (2014) 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.
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
In 2011, more than 3.7 billion drug prescriptions were filled at pharmacies in the United States (The Kaiser Family Foundation, 2011). With billions of drugs prescribed each year for the treatment and management of various disorders, it is essential for advanced practice nurses to familiarize themselves with common drug treatments and effects of these treatments on patients. When prescribing drugs, ensuring patient safety is the major concern. In many clinical settings, nurses work more closely with patients than any other health care provider, making it their responsibility to assist physicians with this task. As an advanced practice nurse maintaining patient safety, you must consider the many patient factors that impact pharmacotherapeutics.
This week you explore factors that influence pharmacokinetic and pharmacodynamic processes in patients. You also examine patient factors that advanced practice nurses must consider when developing drug therapy plans.
Learning Objectives
By the end of this week, students will:
- Analyze factors that influence pharmacokinetic and pharmacodynamics processes in patients
- Assess patient factors and history to develop personalized plans of care
- Understand and apply key terms, concepts, and principles related to pharmacotherapeutics
- Understand and apply key terms, concepts, and principles related to prescribing drugs to treat geriatric patients
Photo Credit: Daniel Kaesler/EyeEm/EyeEm/Getty Images
Learning Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
- Chapter 2, “Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles” (pp. 17-31)
This chapter examines concepts related to pharmacokinetics and pharmacodynamics. It also explores patient factors that health care providers consider when prescribing drug therapy to patients.
A Sample Answer For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
The patient scenario to be discussed for the purpose of this discussion post is a patient being treated with intravenousvancomycin for a Methicillin Resistant Staphylococcus Aureus (MRSA) infection in a spinal surgical incision. The patient had multiple comorbidities; however, the most pertinent comorbidity is end-stage chronic renal disease. Common practice in this setting is to order pharmacokinetic services to monitor and assist with management of vancomycin administration. The monitoring includes laboratory studies including blood chemistries and vancomycin levels. During the monitoring, it was discovered the patient had an extremely high level of vancomycin in the blood which required holding the next scheduled dose, and changing the amount of Vancomycin provided in the next dose.
Factors Influencing Pharmacokinetics and Pharmacodynamics
Vancomycin is a glycopeptide antibiotic that is hydrophilic and cannot pass through the cells membranes through simple diffusion resulting in a need to be administered intravenously to achieve a systemic result (Zaric, et al., 2018). Vancomycin reaches a peak level, which is 63 mcg/mL, in the blood and falls to about 23 mcg/mL in about two hours after the infusion, and then continues to decrease to 8mcg/mL about 11 hours after the end of the infusion in an individual without any renal impairment (Connective Rx, 2018). The concentration of vancomycin in the blood is also impacted by the degree of inflammation (Connective Rx, 2018). The pharmacokinetics factors, which is what the body does with the drug (Arcanfelo, Peterson, & Reinhold, 2017), influencing the patient’s response to the medication are influenced by the impaired kidney function. Approximately 80%-90% of vancomycin is excreted in the urine (Zaric, et al., 2018).
Review of the pharmacodynamics, the way the drug impacts the body (Arcanfelo, Peterson, & Reinhold, 2017), reveals vancomycin inhibiting bacterial synthesis through binding to the precursor on bacterial cell walls (Connective Rx, 2018). Through the binding of vancomycin to the precursor unit of the bacterial cell wall, the outcome is RNA synthesis inhibition, alteration of the bacterial cell wall permeability, and bacterial cell death (Connective Rx, 2018). Severe adverse reactions related to the renal function include renal failure, azotemia, and interstitial nephritis (Connective Rx, 2018). Moderate adverse reactions include hypokalemia and hypotension (Connective Rx, 2018). Vertigo and dizziness are mild symptoms that can be related to kidney function (Connective Rx, 2018). In renal patients the doses have to be adjusted due to the possibility of accumulation of the medication causing nephrotoxicity (Connective Rx, 2018). Nephrotoxicity occurring as a result of monotherapy is usually reversible (Connective Rx, 2018).
Personalized Plan of Care
The plan of care for this patient was for him to have vancomycin on the days he would have dialysis to assist with the excretion of the medication. Labs were drawn frequently to monitor the kidney function and vancomycin trough levels and dose adjustments were made accordingly. Collaboration with the pharmacokinetics pharmacist and the provider was also crucial to the management of the outcome of the patient.
Conclusion
In conclusion, the above-mentioned patient was given vancomycin for a MRSA infection and he had a co-morbidity of ESRD. The ESRD impacted the excretion of the vancomycin resulting in toxic levels of vancomycin in the patient’s blood. The pharmacokinetics and pharmacodynamics significantly impact the action of the medication and magnitude of the impact on the body. The individualized plan of care for the specified patient created the possibility to limit any further renal impairment.
References
Arcanfelo, V. P., Peterson, A. M., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Ambler, PA: Lippincott Williams & Wilkins.
Connective Rx. (2018). Vancomycin Hydrochloride. Retrieved from PDR.net: https://www.pdr.net/drug-information/vancomycin-hydrochloride-for-injection?druglabelid=3535
Zaric, R. Z., Milovanovic, J., Rosic, N., Milovanovic, D., Zecevic, D. R., Folic, M., & Jankovic, S. (2018). Pharmacokinetics of vancomycin in patients with different renal function levels. Open Medicine, 512-519.
A Sample Answer 2 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
I had a family member with a history of CAD, and IDDM, who was in need of an aortic valve replacement. The TAVR procedure was completed successfully and was sent home on a regimen of Coumadin/Warfarin for anticoagulant therapy. This person had other underlying health problems (one of which was a herniated disc) of which he was unaware which resulted in weakness and frequent falling. His falls resulted in multiple skin tears and bruising, bleeding was always present and he related that to the warfarin. Upon speaking to him one day when he had a question about his meds, I noticed a bottle of Ibuprofen with his prescriptions. He stated he had been taking Ibuprofen for the pain in his back. I did explain that the Ibuprofen affected his Coumadin/Warfarin, and to speak with his PCP about an alternative.
Pharmacokinetics /Pharmacodynamics
In a study completed by Juel, Pedersen, Langfrits & Jensen, 2013, it was determined that there is a pharmacokinetic interaction between Coumadin/Warfarin and Ibuprofen which causes and inhibition of Coumadin/Warfarin metabolism. The level of anticoagulation with warfarin is usually monitored with international normalized ratio (INR), every one-point increase, increases bleeding risk by 54% (Choi, Kim, Son, Kim, Kim, Ahn, & Lee, 2010). According to Choi et al., 2010, and Juel, et al., 2013 both medications are metabolized by cytochrome P450.
Personalized Plan of Care
For initial Coumadin/warfarin therapy the INR must be checked routinely and monitored closely, as this was not the case with my family member. Perhaps an alternate anticoagulant should have been introduced. There are many other oral anticoagulants that are utilized, which would have been more beneficial to this individual. According to Arcangelo, Peterson, Wilbur & Reinhold (2017), direct-acting oral coagulants (DOACs) have a faster onset of action, have fewer drug-drug interactions, and have a predictable anticoagulant response. Along with any anticoagulant therapy, patient teaching explaining the effects of OTC medication. This family member was unaware at the time, that he also had pancreatic cancer, which would have also affected the pharmaceutical plan.
References:
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins
Choi, K. H., Kim, A. J., Son, I. J., Kim, K. H., Kim, K. B., Ahn, H., & Lee, E. B. (2010). Risk factors of drug interaction between warfarin and nonsteroidal anti-inflammatory drugs in practical setting. Journal of Korean medical science, 25(3), 337-41.
Juel, J., Pedersen, T., Langfrits, C., & Jensen, S. (2013). Administration of tramadol or ibuprofen increases the INR level in patients on warfarin. European Journal of Clinical Pharmacology, 69(2), 291–292. https://doi-org.ezp.waldenulibrary.org/10.1007/s00228-012-1325-3
A Sample Answer 3 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Case Scenario
Over the years working as a nurse I have encountered many patients who state that sleep aids do not work for them. They often complain that the treatment for insomnia has the opposite effect for them. People who use these medications and fall fast asleep without difficulty would probably question how is this possible. The first time I had someone tell me that sleep aids did not work for them I to in the back of my mind questioned why. For the sake of privacy, I will call the patient that I am referring to Sam.
Sam was a male Caucasian patient in his mid-60’s who was brought into the ED by his wife for new onset of confusion. Sam’s wife stated that he had been very forgetful lately doing things like driving to the store and not remembering the trip there, or where he parked, he seemed to have an increase in anxiety, and he was not sleeping many hours at all. Being that this behavior was out of the patient’s norm and recently started, she was concerned enough to convince him to come to the Emergency room.
A neurologic workup was completed on Sam. He had a minor health history, and he was a social drinker. A week before the ED visit he functioned normal going to work, shopping, and driving without any issues. Although a medication list was collected at the beginning of the visit new information came to light. The patient told his wife that he was had been taking his Ambien in the morning with his other medications. The patient was unaware that the Ambien was intended for sleep. The ED physician contributed the patient’s new confusion to the Ambien that he just started taking before the confusion started.
Pharmacokinetics and Pharmacodynamics
When prescribing medication, I understand that it is important to know how the drug works in the body and what effect it achieves. Pharmacokinetics is defined as “how the drug is absorbed, distributed and eliminated from the body” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p.17). Ambien is rapidly absorbed through the GI tract which means that taking the medication with food or while the stomach is full can slow down the onset of the medication. The medication is distributed throughout the body by binding to protein carriers at 92% (Kizior, 2018). Different medications are metabolized in different ways. When it comes to how the Ambien is broken down, it is metabolized by the liver and eliminated through urination (Kizior, 2018). The effectiveness of how the body receives the Ambien will determine how well it works for the Sam. Also, the overall health, gender, and age of the patient can play a role in how well the medication is excreted by the body. Sam is in his late 60’s, “older adults undergo physiologic changes that affect the absorption, distribution, and elimination of many agents” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p.30).
Pharmacodynamics is defined as “the set of processes by which drugs produce specific biochemical or physiologic changes in the body” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p. 27). Many factors can play a factor in how a drug will affect a person such as age, race, gender, and genetics. Due to Sam’s age and the fact that he is a drinker it is possible that the effect of the medication was intensified causing his confusion.
Personalized Plan
When prescribing for Sam, I would take his not only his health history and social history into account but also his age. From the beginning, it is clear to see that Sam did not understand why he was taking Ambien because he was taking it at the wrong time of day. Thorough patient teaching would be performed so that Sam would understand to take the medication at night for his insomnia and not to drink while taking the medication. Also, I would have him take it on an empty stomach. I would decrease Sam’s dose if possible and include his wife in the education because he would need to be monitored while taking a hypnotic such as Ambien, “consistent monitoring of the elderly is needed when taking a long-acting hypnotic due to accumulation in the renal or hepatic system” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p.732). I would suggest other options for relaxation prior to medication. As a prescriber, I would take into consideration Sam’s age even if he seems healthy the body changes as it ages, “when prescribing you must be focused and attentive because every patient is different” (Laureate Education, 2012).
Reference:
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Kizior, R. (2018). Saunders Nursing Drug Handbook 2019. Elsevier – Health Sciences Division.
Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology.
A Sample Answer 4 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
While working for surgeons who exclusively perform outpatient parathyroidectomies for patients with primary hyperparathyroid
disease, calcium regulation in the immediate post-operative period is a standard part of patient care. It is essential that the serum
calcium remains in range for the body to function normally (Ross, Taylor, Yaktine, & Del Valle, 2011). For most patients, a daily loading
dose of calcium supplementation for one week followed by a gradual titration is enough to maintain healthy calcium serum levels
during this period, and this is part of standard post-operative care and discharge instructions. Rarely, patients will experience
hypocalcemia. The following presents a brief explanation of the role of parathyroid hormone and calcium supplementation after
parathyroidectomy, the pharmacokinetic and pharmacodynamic factors related to over the counter calcium supplementation, and a
case of hypocalcemia which resulted in hospitalization.
Parathyroidectomy patients present postoperatively with dormant remaining parathyroid glands evidenced by parathyroid
hormone (PTH) levels taken immediately after surgery. Because PTH is essential to calcium homeostasis by regulating resorption of
bone, stimulating production of calcitriol by the kidneys, and affecting renal excretion of calcium (Ross et al., 2011) the anticipated
drop in this hormone post-operatively also results in a decrease in serum calcium levels and dictates that calcium must be taken
parenterally until the remaining glands wake-up and function regularly. Taken orally, calcium supplementation corrects
deficiencies within minutes (Huether & McCance, 2017).
Even though the per os (PO) calcium supplementation recommended to patients is over the counter, it is imperative the nurse and
practitioner taking care of post-parathyroidectomy patients understand the pharmacokinetics and pharmacodynamics of calcium
supplementation; principles of recommending or managing a dietary supplement include knowing the efficacy, safety, dosage,
indications, potential side effects, and expected therapeutic benefit (Bonakdar, 2010). Arcangelo, Peterson, Wilbur, and Reinhold
(2017) define pharmacokinetics as how a “drug is administered, absorbed, distributed, and…eliminated from the body” (p. 17).
Calcium regulation in the body is a complex process; a simple explanation of pharmacokinetics of calcium is that one-fifth to one-third
of PO administration is absorbed in the small intestines through passive and active transport, the remainder is excreted in the stool,
and the portion absorbed in the intestines is either reabsorbed or excreted by the kidneys (O’Toole, 2010 & Ross et al., 2011)). Any
disease process that affects the absorption potential of the small intestines or kidney function has a potential to cause a change in
the pharmacodynamics of supplemental calcium (Houillier, Froissart, Maruani, & Blanchard, 2006)
Calcium is essential to nerve and muscle function on the cellular level (Huether & McCance, 2017), vascular contraction and dilation
(Ross et al., 2011), and even plays a significant role in cell proliferation and death (Wang, Yang, & Shen, 2015). The therapeutic effect,
or purpose, of calcium administration in postoperative parathyroidectomy patients, is to prevent complications caused by
hypocalcemia.
Sue (name changed for privacy), a postoperative patient in her seventies who had suffered from hyperparathyroid disease for
many years, presented three days postoperatively with vague symptoms of malaise, fatigue, and dizziness. Traditionally the first signs
of low calcium are tingling or numbness in the hands, feet, and lips (Huether & McCance, 2017), but experience has shown that
atypical symptoms occasionally present first. This patient was treated with increased calcium supplementation at the
recommendations of her surgeon and developed an allergic reaction in the form of an all-over body rash to over-the-counter (OTC)
Citracal Max (calcium citrate plus D, manganese, copper, and zinc). Treatment was focused on finding a form of calcium that relieved
her symptoms and did not cause stomach upset (for this patient some forms of calcium caused loose stools, which may also have
affected absorption). When the patient did not respond to increased calcium supplementation as anticipated (therapeutic response)
she was sent for labs and found to have a serum calcium level in the low sevens; she was subsequently sent to the hospital for
intravenous calcium administration. She was discharged from the hospital almost a week later with a stabilized serum calcium level, a
prescription for calcitriol (activated Vitamin D) and increased amounts of daily calcium supplementation.
Pharmacogenetics, demonstrated by this patient’s allergic response to the standard OTC calcium supplementations, was a factor in
this incidence of hypocalcemia. The patient did not immediately inform the surgeon of her response to the supplementation regimen.
Also, after a form of calcium tolerated by the patient was identified, her symptoms did not improve. She told me after her discharge
that the endocrinologist caring for her in the hospital told her that a few things decreased her body’s ability to absorb the calcium she
was taking: coffee (caffeine) consumption, and administration of torsemide and PreserVision. This would account for behavioral and
pharmacodynamic elements that affected therapeutic response, but another factor for this patient is age. Aging is correlated with
decreased vitamin D receptor (VDR) resulting in decreased calcium absorption in the small intestine (Lieben et al., 2015).
In summary, the metabolism and effect of calcium supplementation in the human is a complex process that can be altered by
many factors including genetic response (allergic reaction), behavior, and age. The practitioner caring for patients prescribed this
supplement are responsible for understanding its pharmacokinetics and pharmacodynamics to ensure positive patient outcomes.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice a practical
approach (4th ed.). Philadelphia, PA: Wolters Kluwer.
Bonakdar, R. A. (2010). The H.E.R.B.A.L. guide. Dietary supplement resources for the clinician. Philadelphia, PA: Wolters Kluwer| Lippincott
Williams & Wilkins.
Drugs.com. (n.d.). Calcium citrate disease interactions. Retrieved November 27, 2018, from https://www.drugs.com/disease-
interactions/calcium-citrate.html#Phosphate_Calcifications
Houillier, P., Froissart, M., Maruani, G., & Blanchard, A. (2006). What serum calcium can tell us and what it can’t. Nephrology Dialysis
Transplantation, 21(1), 29-32. https://doi.org/10.1093/ndt/gfi268
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Elsevier.
Lieben, L., Verlinden, L., Masuyama, R., Torrekens, S., Moermans, K., Schoonjans, L., … Carmeliet, G. (2015). Extra-intestinal calcium
handling contributes to normal serum calium levels when intestinal calcium absorption is suboptimal. Bone, 2015(81), 502-512.
https://doi.org/10.1016/j.bone.2015.08.023
O’Toole, J. F. (2010). Disorders of calcium metabolism. Nephron Physiology, 2018(118), 22-27. https://doi.org/10.1159/000320884
Ross, A. C., Taylor, C. L., Yaktine, A. L., & Del Valle, H. B. (Eds.). (2011). Overview of Calcium. Dietary reference intakes for calcium and
vitamin D. https://doi.org/ 10.17226/13050
Wang, L., Yang, X., & Shen, Y. (2015). Molecular mechanism of mitochondrial calcium uptake. Cellular and Molecular Life Sciences,
2015(72), 1489-1498. https://doi.org/10.1007/s00018-014-1810-1
A Sample Answer 5 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
A.J., a 68-year-old white male with occasional alcohol use and a history of impaired kidney function was recently treated for peptic ulcers related to excessive use of NSAIDs. The patient did report dark stools, nausea at times with blood-tinged emesis, and lab values showed decreased hemoglobin and hematocrit. The diagnosis of H. pylori was ruled out through the breath test (Prabhu & Shivani, 2014).
Pharmacodynamics
The best choice for treatment for this particular patient was to terminate the patient’s use of NSAIDs and encourage cessation of alcohol use. Use of one over the counter medication and one prescription medication was effective in treatment. Aluminum hydroxide dosed at thirty ml. pc as an adjunct therapy to neutralize gastric acid and to inactivate pepsin. Additionally, Cytotec (misoprostol) 100 mcg TID with meals and at HS was prescribed as an antiulcer agent indicated for the prevention of gastric mucosal injury (Vallerand & Sanoski, 2018).
Aluminum hydroxide contributes to misoprostol induced diarrhea. Therefore concomitant use is avoided, and the misoprostol is taken with each meal, and the aluminum hydroxide is taken two hours after the meal (Prabhu & Shivani, 2014). The adverse reactions of misoprostol are head ache, abdominal pain, diarrhea, constipation, dyspepsia, flatulence, nausea and vomiting (Vallerand & Sanoski, 2018).
Pharmacokinetics
Aluminum hydroxide has a toxic potential as it binds to phosphate in the intestines and becomes insoluble and unabsorbable aluminum phosphate and calcium increases from the decreased phosphate absorption which is excreted in the stool. This patient, because of his age may have the pharmacogenetic disposition of a higher risk of aluminum toxicity related to impaired renal function (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Misoprostol is rapidly absorbed and creates an appropriate high plasma level over a forty-eight hour time frame (FDA, 2018). Misoprostol is excreted through the urine (Vallerand & Sanoski, 2018).
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics
for advanced practice: a practical approach. Philadelphia: Wolters Kluwer.
FDA. (2018). Cytotec dosage and administration. Retrieved from:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2002/19268slr037.pdf.
Prabhu, V., & Shivani, A. (2014). An overview of history, pathogenesis, and treatment of
perforated peptic ulcer disease and evaluation of prognostic scoring in adults. Annals of
Medical and Health Sciences Research, 4(1): 22-29 , doi: 10.4103/2141-9248.126604.
Vallerand, A. H., & Sanoski, C. A. (2018). Davis’s Drug Guide for Nurses. Philadelphia: F.A.
Davis Company.
A Sample Answer 6 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
In 2013, a 46-year-old African American female arrived at the emergency room with a complaint of swelling to lips 20 mins before arrival. Vitals were stable, airways secured, she denied swelling and itching of the throat. The patient denied allergies to food or medications. When asked for medication list, Lisinopril was listed for hypertension. Lisinopril is an ace inhibitor to treat high blood pressure and heart failure. Common names include Zestril and Prinival. The patient was given epinephrine 0.3mg, Benadryl 50mg, Solumedrol 125mg, and famotidine 20mg, then placed in our 24-hour observation unit.
Pharmacokinetics refers to how the drug is absorbed distributed and eliminated from the body (Arcangelo, Peterson, Wilbur, Reinhold, 2017). Pharmacodynamic is how the medication affects the body and the therapeutic or toxic effects (Arcangelo, Peterson, Wilbur, Reinhold, 2017). There is a significant variation of ace inhibitors causing angioedema among different races. Ace inhibitors induce angioedema to have several risk factor including over the age of 65, females, Africans American, prior angioedema, smoking, and history of ace inhibitor-associated cough (Guyer, A., Banerji, A. 2017). There’s a 3 to 5 fold increase risk of angioedema in African American vs. White Americans (Guyer, A., Banerji, A. 2017).
Personalized plan for the 46-year-old African American ace-inhibitor angioedema patient would consist of discontinuation of the Lisinopril. Change the ace inhibitor to a potential beta blocker or another antihypertensive medication. Give the patient a healthcare literature handout on hypertension with changes in lifestyle and diet.
Reference
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Guyer, A., Banerji, A. (2017). Ace inhibitor-induced angioedema. Retrieved from https://www.uptodate.com/contents/ace-inhibitor-induced-angioedema.
Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology. Baltimore, MD
A Sample Answer 7 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Prescribing medication as an advanced practice nurse is a huge responsibility it necessitated knowledge and understanding to ascertaining an appropriate dose for your patients. Furthermore, certain factors such as the genetics, sex, ethnicity, age, and behavior must be taken into consideration due to the patient’s pharmacokinetic and pharmacodynamics processes (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Advanced practice nurses are not only prescribing medication but also monitoring result. It is a necessity to understand how medications work, and the practitioner’s intention for the use and result (Laureate Education, 2012). The patient’s pharmacokinetic and pharmacodynamics reaction may alter their response to a medication. Pharmacokinetics is well-defined as the study of the time course of drug absorption, distribution, metabolism, and excretion. Pharmacodynamics refers to the relationship between drug strength at the site of action and the effect, involving the time course and greatness of therapeutic and adverse effects (Brooke, 2018).
Case Scenario
I am a mental health nurse working in the emergency department (ED) in Florida. A not long time ago, Broward Sheriff Officers (BSO) accompanied with a well know ambulance company brought to the ED a seventy-four-year-old African American female under a baker act status with a medical history of high blood pressure and diabetes. She has a mental health history of dementia, major depressive disorders, anxiety, and agitation. She functions better when she is compliant with her psychotropic medications. While the nurse is changing patient to two gowns, she became agitated, labile, aggressive and combative Upon arrival to the ED patient was agitated, anxious. She presented a danger to herself, and another patient in the room. The Ed physician ordered Ativan 0.5 mg intramuscular (IM) stat for the anxiety and agitation. After the administration of the first drug, the patient became delirium which resulted in a fall and sustaining a left leg fracture. Thus, the patient’s age was a factor which altered her anticipated response to the drug. The pharmacokinetics that influenced the adverse effects in the patient was due to the normal aging process (Daly, Bay, Levy, & Carnahan, 2015).
Patient Factor – Age
In the geriatric population, benzodiazepines are often prescribed for patients in low dosage for anxiety and agitation. However, benzodiazepines in the elderly are known to cause delirium which may result in falls and fractures. According to Pasina et al., (2014) the most significant risk for this drug within the first few weeks of administration is a fracture of the extremities. Hence, due to physiologic changes associated with aging, use of certain medications can increase the risks of fall incident among the elderly population.
The elderly population is at a higher risk of experiencing unfavorable side effects from certain drugs as their aging physiology alters the rate of absorption, distribution, metabolism, and excretion of these substances which thereby impacts the overall pharmacokinetics and pharmacodynamics (Scott, Schmitt, & Livingston, 2016). The elderly population is particularly at risk to delirium than those younger due to changes in brain function, multiple general medical problems, polypharmacy, reduced hepatic metabolism of medications, multisensory declines. Lastly, brain disorders such as dementia that the patient diagnosed with. Alteration of polypharmacy is very common among the elderly, and the possibility of drug interactions must be well-thought-out as a cause of agitation. Medications such as benzodiazepines, beta-blockers, selective serotonin reuptake inhibitors (SSRIs), neuroleptics and diphenhydramine can cause more problems (Weitzel et al., 2014). Pharmacodynamics of benzodiazepines is thought to utilize their anxiolytic effect by increasing the action of GABA. Several reasons exaggerate the effect of benzodiazepines including age, female gender, genetics, and nutritional status (Arcangelo et al., 2017).
Plan of Care
The plan of care for the patient will focus on closed monitoring for mental, physical, the efficacy of the psychotropic medications (Arcangelo et al., 2017). A geriatric psychiatrist should reexamine the patient medication reconciliation profile since they are vulnerable to neuropsychiatric symptoms especially with dementia (Daly, Bay, Levy, & Carnahan, 2015). In the geriatric population, psychotropic medications used to control anxiety and agitation should use with caution. Usually, medication should be the last resort when dealing with elderly, nonpharmacological methods such as keeping any noise down, decrease light in the room, and assign the caregivers that the patient gets alone to assist patient (Arcangelo et al., 2017). The staff should ensure that her needs have been met such as hunger, toileting, pain, and proper room temperature. Also, monitor for triggers to prevent outbursts for the safety of the patient and others are essential. Close monitoring after administering medication to a patient for adverse effects is imperative.
Buspar can be an alternative drug to be given. Trazodone, a second drug of choice but in low dosage might be given if the patient is anxious, agitated, and depressed. The drug of choice to treat agitation in the elderly with dementia is Haldol starting with the lowest dose, which should be preferable in treating delirium and agitation (Brooke, 2018). Antipsychotics are the medication of choice in the treatment of delirium but in the treatment of dementia and geriatric patient close monitoring is essential. It will save lives and times with all other complication that could come with corrective of action and more. Series of controlled trials also showed that antipsychotic medications could be used to treat agitation and psychotic symptoms in medically ill and geriatric patient populations and it demonstrated the clinical superiority of antipsychotic drugs over benzodiazepines in delirium treatment (Pasina et al., 2014).
Conclusion
Knowledge and understanding of antipsychotic medications are essential for safe care. The main primary goal of the advanced practice nurse is stabilization of their patient for a safe environment to get the best response they can from the medication without adverse effects or negative outcomes. However, every patient is different. Adverse reactions can still happen no matter how cautious the prescriber is (Laureate Education, 2012). Furthermore, prescribed medication for a mental health geriatric patient should always be the first choice of action.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins
Brooke, J. (2018). Differentiation of delirium, dementia and delirium superimposed on dementia in the older person. British Journal of Nursing, 27(7), 363–367. https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2018.27.7.363
Daly, J. M., Bay, C. P., Levy, B. T., & Carnahan, R. M. (2015). Caring for people with dementia and challenging behaviors in nursing homes: A needs assessment geriatric nursing. Geriatric Nursing, 36(3), 182-191. doi: 10.1016/j.gerinurse.2015.01.001
Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology. Baltimore, MD: Author
Pasina, L., Djade, C. D., Tettamanti, M., Franchi, C., Salerno, F., Corrao, S., … Nobili, A. (2014). Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: results from the REPOSI Study. Journal of Clinical Pharmacy And Therapeutics, 39(5), 511–515. https://doi-org.ezp.waldenulibrary.org/10.1111/jcpt.12178
Scott, B. M., Schmitt, A. L., & Livingston, R. B. (2016). Neuropsychological performance of a patient suspected of dementia taking lorazepam and retested 1 year later following titration. Applied Neuropsychology, Adult, 23(3), 167-171. doi:10.1080/23279095.2015.1030017
Weitzel, K. W., Elsey, A. R., Langaee, T. Y., Burkley, B., Nessl, D. R., Obeng, A. O., Staley, B. J., Dong, H. J., Allan, R. W., Liu, J. F., Cooper-Die-off, R. M., Anderson, R. D., Conlon, M., Clare-Salzler, M. J., Nelson, D. R., … Johnson, J. A. (2014). Clinical pharmacogenetics implementation: approaches, successes, and challenges. American journal of medical genetics. Part C, Seminars in medical genetics, 166C (1), 56-67.
A Sample Answer 8 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Introduction
The primary priority of nurse practitioners in the provision of healthcare is in prescribing power that ascertains the safety of their patients. We are living in a world full of medical advancement and scientific discovery and therefore, staying grounded in the current research and information on drugs impedes patient safety. In most cases, prescribers fail to consider individual co-morbidities or patient physiological factors during the process of prescribing sedation, resulting in potential medication overdose. In this discussion, I will highlight some key pharmacokinetic and pharmacodynamics principles that likely caused the respiratory collapse of a patient in a Texas hospital in the event of a simple outpatient procedure. Also, the discussion will base on patient factors that could have changed the interaction of their bodies with medication hence providing nursing professionals with a better understanding of future patient interactions to some drugs. Lastly, I will propose a personalized plan of care for the patient based on history and influencing factors that will be safe for him.
Description of a patient case
A majority of people who visit a public Texas hospital for routine examinations usually assume that their care is personalized to their condition by the personnel and that the providers will highly comply with the safety regulations. It was not the case for one elderly individual. After the patient was given two milligrams of midazolam through his IV (a frequently used sedation dose), he immediately became apneic and unresponsive. It required manual ventilation and the administration of flumazenil to reverse the sedation. In the readings of this week’s text, there exist several patient conditions and factors that suggest that this particular sedation dosage was not appropriate for the patient. After the reversal medication, the patient quickly regained consciousness and spontaneous respiratory drive. However, the medical team would have still implemented a safer approach to the patient’s care (Scott, 2011).
Patient factors influencing Pharmacokinetics and Pharmacodynamics
This week’s resources provide basic principles that highlight factors that may affect the patient in this situation. One element of consideration was the advanced age of the patient since he was above eighty years old (Kirwan, MacPhee, Lee, Holt & Philips, 2012). Elderly patients have a minimal physiological ability to absorb, distributing and eliminating drugs. Therefore, acute illness severely affects the patient’s condition. Another factor that affects the pharmacokinetics of medication is the patient behavior such as nutrition and habits of diet. Since the patient was highly emaciated, it is believed to have contributed to the overdosing effect of midazolam. Sometimes, a decreased intake of calories from different sources interferes with the pharmacokinetics to the administered medication (Laureate Education, Inc.). Also, the patient was undergoing a renal biopsy that affected his pathophysiological renal process hence resulting in a predisposition that changed the concentration of midazolam in the blood. Patients admitted in ICU with acute renal failure experience a decrease in hepatic processing ability towards versed (Kirwan, MacPhee, Lee, Holt & Philips, 2012). This is because of a reduction of CYP3A4 and other enzymes. This is an excellent example of a patient factor that represents an alteration in pharmacodynamics. In this case, there was an alteration on the way the drug was interacting with the enzymes. Evaluation of the overall condition of the patient to underlying acute illness indicates that the man was predisposed to adverse effects in the process of medication.
Personalized Plan of Care
The patient had presented a pre-renal biopsy hence the need for a safer plan of care. The nurses would have orally administered benzodiazepine which was a bit safer. As described in the text, intravenous routes of medication bypass the first-pass effect of the liver and therefore high peaks of drugs can be disastrous. In the case the prescription of Midazolam was desirable; nurses should consider the dosage parameters (Peterson, 2013). For elderly patients above sixty years, 1mg of intravenous versed every two minutes is enough to achieve light sedation and a quarter of the sedation dosage is adequate for maintenance. Also, the nurses would have considered the malnourished state of the patient thus avoid giving strong medication (Peterson, 2013). In the future, healthcare will be efficient because studies have confirmed the presence of pharmacogenetic testing that would deal with risk-benefits for patients thus getting rid of adverse medical events. However, the interventions are costly, and reimbursement is not yet supported.
Conclusion
Apart from new medications, there exist a plethora of elements that influence the response of patients or appropriateness of new prescriptions. After the above analysis and examination of the case in Texas hospital, there are some warnings that doctors should have identified. Nurses should learn pre-disposing factors to adverse conditions for various patients thus providing safe healthcare (Arcangelo & Peterson, 2013). The knowledge of this case makes clinicians to embrace safety measures in the field.
References
Kirwan, C. J., MacPhee, I., Lee, T., Holt, D. W., & Philips, B. J. (2012, January). Acute kidney injury reduces the hepatic metabolism of midazolam in critically ill patients. INTENSIVE CARE MEDICINE, 38(1), 76-84. http://dx.doi.org/ 10.1007/s00134-011-2360-8
Peterson, A. M. (2013). Pharmacotherapeutics for Advanced Practice A Practical Approach (3rd ed.). V. P. Arcangelo & A. M. Peterson (Eds.). Ambler, PA: Lippincott Williams & Wilkins.
Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology. Baltimore, MD: Author.
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Scott, S. A. (2011). Personalizing medicine with clinical pharmacogenetics. Genetics in Medicine, 13(12), 987–995. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290900/
A Sample Answer 9 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Absorption of a drug along with its distribution in the body and elimination by the body is related to pharmacokinetics. The physiological and biochemical changes that a drug makes on the body is related to pharmacodynamics. These changes occur predominantly due to the interaction of a drug with a receptor (Arcangelo et al, 2017). Each patient you prescribe medications to will have their own reaction to medications. Not all medications will work for each individual. Constant monitoring of medications that are prescribed will be an important part of helping patients to manage their conditions. Having an understanding of how medications are absorbed and the factors that may affect how the medication is absorbed will be influential in the administration of medications.
In my experience with renal patients, I have learned of medications that are nephrotoxic that patients with kidney conditions should not take. Many patients with transplanted kidneys are educated not to take NSAIDS. Many patients understand that they should not be taking ibuprofen, asprin, or aleve (Harisingani et al, 2013). The issue with this is that many cold medications and common migraine medications contain these ingredients and patients do not fully understand that they need to be reading the ingredients more closely. I recently had a kidney transplant patient who frequently had migraines. They were on their third transplant and had gone into rejection. During this stay, they developed a headache and asked for Excedrin. This medication contains acetaminophen, caffeine and asprin (n.a., 2018). I advised the patient that due to the contents of this medication, we would likely not be able to administer this medication to her. They seemed confused, so I provided education on the contents of the medication. They became very concerned and informed me that prior to their creatinine levels beginning to increase they had been taking a cold medication for an illness they developed for nearly 2 weeks.
We looked up the medication and they had been taking the form that contained ibuprofen. During that time, they had also run out of some of their antirejection medications and had forgotten to contact the transplant coordinator to have the prescription refilled. They stated that they were without the antirejection medication for about a week while taking the cold medication. They also indicated that they thought their illness would go away faster if they were not taking their antirejection medication for a short time. The assumption that just because a medication is available over the counter that it is safe for consumption by everyone is a concern I see many times with patients. After learning this information, the physician and transplant team were informed. The patient was re-educated on the importance of understanding their medications and taking them as prescribed. The patient was also given extensive education on the types of medications they can use and what medications to avoid. The patient’s impaired renal function caused them to be susceptible to the nephrotoxic nature of the medications (Arcangelo et al, 2017).
The misuse of the antirejection drugs caused damage to the transplanted kidney as well as their body began to create antibodies to the new kidney and attack it as foreign invading body (Heuther and McCance, 2018). Ultimately, the kidney was not able to be saved and the patient had to resume hemodialysis. Patient education was given but not evaluated well enough to ascertain that the patient did not have an adequate understanding of their medications and what was safe for them to take. This may have been related to the education level of the patient and their capacity to understand the information given to them. They appeared to have a lower level of education and did not seem to have a reading level higher than that of an elementary age child. They also had the propensity to appear to understand information because they did not wish to “look stupid” to the transplant team. Each patient should be approached at their level of understanding rather than providing a standardized education especially when it comes to medications designed to regulate their conditions.
Arcangelo, V., Peterson, A., Wilbur, V., and Reinhold, J. (2017). Pharmacotherapeutics for advanced practice: A practical approach. (4th edition). Philadelphia, PA: Wolters Kluwer
Harisingani, R., Saad, M., and Cassangnol, M. (2013). How to managed pain in patients with renal insufficiency or end-stage renal disease on dialysis?. The Hospitalist. Retrieved from: https://www.the-hospitalist.org/hospitalist/article/125688/how-manage-pain-patients-renal-insufficiency-or-end-stage-renal-disease
Huether, S. and McCance, K. (2017). Understanding pathophysiology. (6th ed.) St. Louis, MO: Elsevier, Inc.
- a. (2018). Excedrin migraine. Excedrin. Retrieved from: https://www.excedrin.com/products/migraine/
A Sample Answer 10 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Pharmacokinetics is important because it enables clinicians to safely administer medications in a therapeutical manner to individual patients. Pharmacokinetics increase efficacy and decrease adverse effects of patient’s drug therapy. While pharmacodynamics focus on how the concentration of the drug interacts at a receptor site and how the time, course and intensity of the drugs can therapeutically or adversely affect the body (Downes, Hahn, Wiles, Courter, andVinks (2014). The individual that is going to be discussed in this case is a ten-year female.
This ten- year old female is an African American who was diagnosed with Disruptive Mood Dysregulation Disorder and was prescribed Lamotrigine because she could not be diagnosed with Bipolar Disorder due to her age, although there was a strong family history of bipolar on both sides of the family. The ten-year-old female in question (A.J) was displaying labile mood (moments of sadness and then moments of extreme excitement), increase aggression, temper tantrums and pressured speech, irritability, which all can be classic signs of bipolar. Lamotrigine was started at the recommended 25 mg by mouth daily dose. Some of the common side effects from Lamotrigine are; drowsiness, nausea, dizziness, fatigue, diarrhea, headaches and nonserious rash (National Alliance on Mental Illness, 2018). A.J behaviors did not change after being on the medication for three days, she was being placed in four-point restraints daily for being physically aggressive, combative and needed additional medication such as Benadryl and Haldol intramuscularly to prevent her from hurting herself and others.
The decision was made to increase Lamotrigine to 25 mg by mouth twice a day because the A.J’s behaviors and mother expressing concerns over her aggression and mood swings. After being on the increased dose of the medication for three additional days A.J began to show improvement with her behaviors and was discharged from the behavioral health unit and mother was informed and educated about all the possible side effects from the increased dose of the Lamotrigine including severe rashes. Further, if rashes should develop to stop the Lamotrigine immediately and seek immediate medical attention. Several days after being home, A.J’s mother called to state that she had developed a severe rash over her entire body and was not showing any improvements despite treating the rash with Calamine topically. A.J’s mother was informed to bring her back immediately to the hospital because she was having an adverse reaction from the Lamotrigine known as Stevens-Johnson Syndrome which can be potentially fatal if not treated immediately. A.J was admitted to the floor once more and placed on Benadryl 25 mg by mouth three times daily to decreasing the itching that she was experiencing and prevention of skin breakage which has the potential to lead to skin infection. After being in the hospital for one week with no complications from the rashes which were resolving, A.J was discharged back home, with a prescription for Benadryl which is to be taken until the rashes are completely resolved.
Factors that Impact Pharmacokinetics and Pharmacodynamics Response to Lamotrigine
According to, Milosheska, Lorber, Vovk, Kastelic, Dolžan, and Grabnar (2016) Lamotrigine is a second generation anti-epileptic drug that is also used for other disorders such as bipolar. Lamotrigine exhibits first order linear pharmacokinetics. Following oral administration it is rapidly and completely absorbed into the systemic circulation with a maximum concentration in plasma after 1–3 hrs (Milosheska, et al., 2016). The predominant route of Lamotrigine elimination is hepatic metabolism. The main metabolite of Lamotrigine is excreted in the urine. According to Milosheska, et al. (2016) studies have shown that “Lamotrigine metabolism and distribution is mediated also with some transporter proteins such as ATP-binding cassette protein B1 (ABCB1)”, p.400. Genetics and ethnicity also play a role in how Lamotrigine is excreted and metabolized by the body. According to Milosheska, et al. (2016) there is a large inter-individual variability in the pharmacokinetics of Lamotrigine which is influenced by patient’s age, weight, co-medications, gender, liver, and renal function. According to Milosheska, et al, a 100 kg patient would require a 40% larger dose to achieve similar steady-state Lamotrigine concentrations found in a 70 kg patient, while in a lean 45 kg patient Lamotrigine dose should be reduced by 34%( p.408). According to the Food and Drug Administration Lamotrigine should be increased by 25 mg between one to two weeks when being used for bipolar in mono-therapy.
Personalized Plan of Care
Considering that Lamotrigine has not been approved for treatment of Bipolar in children, the treatment plan would consist of slowly titrate the medication to decrease the risk of developing Stevens-Johnson syndrome. According to (Aniken, 2018) Lamotrigine is not approved for Bipolar and that slow titration is recommended for children under 16 years old. Since A.J was just ten-years-old, the titration rate would be similar to the one that is used for children who takes Lamotrigine for seizure prevention. The titration would be as follow; weeks 1-2: 0.3 mg/kg/d; weeks 3-4: 0.6 mg/kg/d; weeks 5 and onward: increase the daily dose by 0.6 mg/kg every 1 to 2 weeks. Always round down to the nearest whole tablet. Adolescents have the same target dose as adults, but it is lower for children under 12 (around 150 mg/d). There would be weekly weighing to determine if titration of Lamotrigine should be done for that week. There would be a thorough assessment of the A.J’s history to see if she had any medical history of skin problems which would more than likely increased her risk of developing a rash from Lamotrigine.
Metabolic labs would be drawn prior to the starting the medication and six months after initiating the Lamotrigine. This is done in order to establish baseline results of A.J’s renal function, liver, and other vital organs. Plus what impact starting the medication is going to have on her body. A.J mother would also be educated on the importance of ensuring that A.J is using sunscreen while outside or wear protective clothing seeing that Lamotrigine increase the risk of obtaining sunburn. The next step that the student would take is to ensure that careful records are being kept of when Lamotrigine was increased and how A.J is tolerating the titration and continuing education of both patient and mother of what side effects should be immediately reported to the healthcare provider.
Pharmacokinetic differences may play a part in the age‐related differences in the incidence of adverse effects, therefore careful assessments must be done prior to starting any medication in any patient.
References
Aiken, C. (2018). How to minimize lamotrigine’s adverse effects. Retrieved from
http://www.psychiatrictimes.com/bipolar-disorder/how-minimize-lamotrigines-adverse-
effects
Downes, K. J., Hahn, A., Wiles, J., Courter, J.D., and Vinks, A.A. (2014). Review: Dose
optimization of antibiotics in children: application of pharmacokinetics/pharmacodynamics in pediatrics. Internal Journal of Antimicrobial Agents, 43(3), 223-230.doi: 10.1016/j.ijantimicag.2013.11.006
Milosheska, D., Lorber, B., Vovk, T., Kastelic, M., Dolžan, V. and Grabnar, T. (2016)
Pharmacokinetics of lamotrigine and its metabolite N-2-glucuronide: Influence of polymorphism of UDP-glucuronosyltransferases and drug transporters. British Journal of Clinical Pharmacology, 82, 399-411. doi: 10.1111/bcp.12984
National Alliance on Mental Illness –NAMI, (2018). Lamotrigine. Retrieved from