NURS 6521 Describe how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy

NURS 6521 Describe how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy

*** Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily

******Write a 3-page paper that addresses the following:

(Including the Introduction and conclusion)

Explain how the age factor might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case you were assigned.
Describe how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
Explain how you might improve the patient’s drug therapy plan by changing medications or provide an alternative treatment option for the patient.

and explain why you would make these recommended improvements.

Pharmacokinetics and pharmacodynamics determine the clinical effects of drug therapy. Pharmacokinetics (what the body does to the drug) is defined as the quantitative study of drug absorption, distribution, metabolism, and elimination (ADME). Pharmacodynamics is clinically more elusive and difficult to precisely quantify. Pharmacodynamics is the study of the biochemical and physiological effects of drugs in the body. Thus, pharmacodynamics can be thought of as “what the drug does to the body.” Despite being 2 distinct entities, there is substantial interplay between pharmacokinetics and the resultant pharmacodynamics. Understanding this can be challenging. The correlation between the dose administered and the resulting drug concentration at the site of action ultimately contributes to the pharmacodynamic response. Thus, pharmacodynamics describes the relationship between drug concentration and the desirable clinical effects of a medication as well as unwanted adverse effects. In addition, in pediatric patients, growth and development affect pharmacokinetics and pharmacodynamics. This article reviews the interplay between pharmacokinetics and pharmacodynamics (ie, dose-exposure-response relationships).
Pharmacokinetics
Pharmacokinetics (ADME) determines the concentration or amount of drug in the body that is available to have the desired effect. For a drug to have a positive or negative effect internally, the medication must first enter the body (eg, ingestion, dermal, rectal, submucosal) and be absorbed into the bloodstream. Once in the bloodstream, the drug can be distributed, ultimately reaching the site in the body where it may produce the desired effect at a receptor or drug target. After the drug-receptor interaction, the medication returns to the bloodstream and is taken to the liver, where it can be metabolized to substances that are more easily eliminated in the urine or feces.

Absorption
Absorption is the process by which a drug enters the bloodstream or another body compartment from the site of administration. Bioavailability is defined as the rate and extent to which the active drug is absorbed and becomes available at the site of drug action to produce a pharmacologic response. Drugs administered via the intravenous route are considered to be 100% bioavailable, meaning that the entire drug dose has reached the circulation. Routes that require absorption include oral, intramuscular, subcutaneous, and topical/transdermal and can result in adverse effects if given in sufficient quantities. Drug absorption plays a pivotal role in determining pharmacodynamic responses.

For a drug to be absorbed into the circulation, the active drug must first be liberated from the dosage form. Liberation depends on physiochemical factors of the drug, the dosage form, and the environment at the site of administration. There are multiple mechanisms by which drugs are absorbed into the circulation, including passive diffusion, convective transport, active transport, facilitated transport, ion pair transport, and pinocytosis. Except in the case of pinocytosis, a drug must be released into solution to be absorbed. NURS 6521 Describe how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy

Passive diffusion is one of the most important mechanisms of drug absorption; however, active transporters such as P-glycoprotein (P-gp) can be particularly important owing to drug-drug and drug-food interactions. P-glycoprotein is a transporter located in the endothelium of multiple organs, including the gastrointestinal tract lumen and the blood-brain barrier. This efflux transporter is responsible for pumping drugs back into the gut lumen and decreasing bioavailability. Digoxin is an example of a drug that is transported by P-gp. Inhibition of P-gp will increase the bioavailability of a P-gp substrate such as digoxin, and, conversely, induction of P-gp will reduce the bioavailability of digoxin and other P-gp substrates. This type of interaction has direct relevance to the clinical setting. For example, erythromycin, clarithromycin, and quinidine are P-gp inhibitors and, thus, when coadministered with digoxin, can result in an increased serum digoxin concentration. Grapefruit juice, guava, and mango also inhibit P-gp and can similarly affect the bioavailability of P-gp substrates. In addition to P-gp, other patient-specific factors, such as age, sex, body weight, gastric emptying rate, intestinal motility, gastric pH, blood flow, liver function, length of the intestines (short gut syndrome), type of diet, and presence/absence of food, can modify the efficiency and rate of absorption.

Nurs6521 Describe how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy

Absorption of a drug and the resulting serum concentration can depend on food intake and the time to medication exposure (Table 1). Medications are weak acids or weak bases that become ionized or un-ionized depending on the pH in the environment in which absorption takes place. Consuming a medication in the presence or absence of food can change the ionization state of the medication and affect absorption. Some medications are destroyed by stomach acid and should be taken on an empty stomach because food increases acid secretion. In addition, foods such as grapefruit juice can inhibit the intestinal enzyme cytochrome P450 (CYP) 3A4, resulting in increased drug absorption and higher serum concentrations. Insulin and oral antidiabetic agents are generally recommended to be administered with food to prevent hypoglycemia. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be administered with food to prevent local gastric irritation and ulceration.

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ASSIGNMENT RUBRIC

Grading Rubric

Performance Category	100% or highest level of performance 100% 16 points	Very good or high level of performance 88% 14 points	Acceptable level of performance 81% 13 points	Inadequate demonstration of expectations 68% 11 points	Deficient level of performance 56% 9 points	Failing level of performance 55% or less 0 points
Total Points Possible= 50	16 Points	14 Points	13 Points	11 Points	9 Points	0 Points
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic topics.	Presentation of information was exceptional and included all of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information was good, but was superficial in places and included all of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information was minimally demonstrated in all of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information is unsatisfactory in one of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information is unsatisfactory in two of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information is unsatisfactory in three or more of the following elements Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information
	16 Points	14 Points	13 Points	11 Points	9 Points	0 Points
Application of Course Knowledge Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations	Presentation of information was exceptional and included all of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information was good, but was superficial in places and included all of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information was minimally demonstrated in the all of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information is unsatisfactory in one of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from and scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information is unsatisfactory in two of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information is unsatisfactory in three of the following elements Applies principles, knowledge and information and scholarly resources to the required topic. Applies facts, principles or concepts learned scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.
	10 Points	9 Points			6 Points	0 Points
Interactive Dialogue Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic.	Demonstrated all of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.	Demonstrated 3 of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.			Demonstrated 2 of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.	Demonstrated 1 or less of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.
	8 Points	7 Points	6 Points	5 Points	4 Points	0 Points
Grammar, Syntax, APA Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error.	The following was present: 0-3 errors in APA format AND Responses have 0-3 grammatical, spelling or punctuation errors AND Writing style is generally clear, focused on topic,and facilitates communication.	The following was present: 4-6 errors in APA format. AND/OR Responses have 4-5 grammatical, spelling or punctuation errors AND/OR Writing style is somewhat focused on topic.	The following was present: 7-9 errors in APA format. AND/OR Responses have 6-7 grammatical, spelling or punctuation errors AND/OR Writing style is slightly focused on topic making discussion difficult to understand.	The following was present: 10- 12 errors in APA format AND/OR Responses have 8-9 grammatical, spelling and punctuation errors AND/OR Writing style is not focused on topic, making discussion difficult to understand.	The following was present: 13 – 15 errors in APA format AND/OR Responses have 8-10 grammatical, spelling or punctuation errors AND/OR Writing style is not focused on topic, making discussion difficult to understand. AND/OR The student continues to make repeated mistakes in any of the above areas after written correction by the instructor.	The following was present: 16 to greater errors in APA format. AND/OR Responses have more than 10 grammatical, spelling or punctuation errors. AND/OR Writing style does not facilitate communication
	0 Points Deducted					5 Points Lost
Participation Requirements	Demonstrated the following: Initial, peer, and faculty postings were made on 3 separate days					Failed to demonstrate the following: Initial, peer, and faculty postings were made on 3 separate days
	0 Points Lost					5 Points Lost
Due Date Requirements	Demonstrated all of the following: The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT. A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.					Demonstrates one or less of the following. The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT. A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.