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\u2019s 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\u2019s pharmacokinetic and pharmacodynamic processes altered his or her response to a drug.<\/span>\u00a0<\/span><\/p>\n With these thoughts in mind:<\/span>\u00a0<\/span><\/p>\n Post<\/span><\/b> 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.<\/span>\u00a0<\/span><\/p>\n Read<\/span><\/b> a selection of your colleagues\u2019 responses and <\/span>respond <\/span><\/b>to <\/span>at least two<\/span><\/b> of your colleagues on <\/span>two different days<\/span><\/b> 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.<\/span>\u00a0<\/span><\/p>\n Note:<\/span><\/b> For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues\u2019 postings. Begin by clicking on the \u201cPost to Discussion Question\u201d link and then select \u201cCreate Thread\u201d 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 <\/span>Submit!<\/span><\/b>\u00a0<\/span><\/p>\n 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.<\/span>\u00a0<\/span><\/p>\n 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.<\/span>\u00a0<\/span><\/p>\n By the end of this week, students will:<\/span><\/b>\u00a0<\/span><\/p>\n Photo Credit: Daniel Kaesler\/EyeEm\/EyeEm\/Getty Images<\/span>\u00a0<\/span><\/p>\n 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.<\/span>\u00a0<\/span><\/p>\n Arcangelo, V. P.,\u202fPeterson, A. M., Wilbur, V., & Reinhold, J. A.\u202f(Eds.). (2017). <\/span>Pharmacotherapeutics for advanced practice: A practical approach<\/span><\/i> (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.<\/span>\u00a0<\/span><\/p>\n \u200bThe 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.\u00a0<\/span>\u00a0<\/span><\/p>\n \u00a0<\/span><\/p>\n \u00a0<\/span>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\u2019s 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).\u00a0<\/span>\u00a0<\/span><\/p>\n \u00a0<\/span>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).\u00a0<\/span>\u00a0<\/span><\/p>\n \u00a0<\/span><\/p>\n \u00a0<\/span>\u200bThe 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.<\/span>\u00a0<\/span><\/p>\n \u00a0<\/span><\/p>\n \u00a0<\/span>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\u2019s 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. <\/span>\u00a0<\/span><\/p>\nTo prepare:<\/span><\/b>\u00a0<\/span><\/h2>\n
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\nThis chapter examines concepts related to pharmacokinetics and pharmacodynamics. It also explores patient factors that health care providers consider when prescribing drug therapy to patients.\u00a0<\/span>\u00a0<\/span><\/li>\n<\/ul>\nA Sample Answer For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts<\/strong><\/h2>\n
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts<\/strong><\/h2>\n
Factors Influencing Pharmacokinetics and Pharmacodynamics<\/span>\u00a0<\/span><\/h2>\n
Personalized Plan of Care<\/span>\u00a0<\/span><\/h2>\n
Conclusion<\/span>\u00a0<\/span><\/h2>\n
\u00a0<\/span>References<\/span>\u00a0<\/span><\/h2>\n