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.<\/span>\u00a0<\/span><\/p>\n 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.<\/span>\u00a0<\/span><\/p>\n When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient\u2019s 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.<\/span>\u00a0<\/span><\/p>\n For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient\u2019s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.\u202f<\/span>\u00a0<\/span><\/p>\n Be sure to review the Learning Resources before completing this activity.<\/span> Post<\/span><\/b>\u202fa 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.<\/span>\u00a0<\/span><\/p>\n Read<\/span><\/b>\u202fa selection of your colleagues\u2019 responses and\u202f<\/span>respond<\/span><\/b>\u202fto\u202f<\/span>at least two<\/span><\/b>\u202fof your colleagues on\u202f<\/span>two different days<\/span><\/b>\u202fby 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.<\/span>\u00a0<\/span><\/p>\n I had a recent clinical experience where a patient of mine was sensitive to medications. She had recently had high blood pressure in the 200\u2019s and acute kidney failure. She was given IV hydralazine and labetalol in the emergency room. She had a reaction to the medication and her heart rate dropped into the 20\u2019s and she became unresponsive. The emergency room staff performed chest compressions and administered to the patient, and she was transferred to the ICU.<\/span>\u00a0<\/span><\/p>\n A case study writes about adverse effects of hydralazine and notes \u201cHydralazine was chosen for its antihypertensive effect and 2 mg were administered intravenously (IV). Within a brief period of time (30-45 sec) the patient developed a profound bradycardia from 52-10 beats\/min occasioned by premature ventricular contractions (PVCs)\u201d (Wehner & Romanauskas, 1981). A different case study notes a similar adverse effect of labetalol, \u201cShe was thought to have an anaphylactoid reaction and was treated intravenously with fluids, diphenhydramine (50 mg), and methylprednisolone (250 mg), without initial improvement. While urinating in the bedpan, she developed bradycardia and hypotension, with a pulse of 30\/min and a blood pressure of 60\/40. Trendelenburg’s position and 2 L of normal saline were needed to restore her blood pressure to normal, although her bradycardia resolved spontaneously\u201d (Ferree, 1986).<\/span>\u00a0<\/span><\/p>\n This patient had orders to receive hydralazine IV to maintain a blood pressure of 140\/80 so that she could have a kidney biopsy. \u201cMost patients who undergo renal biopsy have hypertension, but hypertension is almost never considered a\u202fsingle or leading indication for biopsy\u201d (Stomp\u00f3r & Perkowska-Ptasi\u0144ska, 2020).<\/span>\u00a0<\/span><\/p>\n I diluted the hydralazine and pushed it over 10 minutes minimum and monitored the patient closely. I checked her blood pressure 15-30 minutes after administration and monitored her heart rate. She did not have any adverse reaction to the hydralazine when I administered it. I instructed the patient to use her call light button if she had any strange reactions or felt odd. I kept the physician updated on the patient\u2019s blood pressure and heart rate throughout the night. The patient was able to transfer to a medical-surgical floor for a lower level of care.<\/span>\u00a0<\/span><\/p>\n FERREE, C. E. (1986). Apparent Anaphylaxis from Labetalol.\u202f<\/span>Annals of Internal Medicine<\/span><\/i>,\u202f<\/span>104<\/span><\/i>(5), 729\u2013730.\u202f<\/span>https:\/\/doi-org.ezp.waldenulibrary.org\/10.1059\/0003-4819-104-5-729_2Links to an external site.<\/span><\/a>\u00a0<\/span><\/p>\n Stomp\u00f3r, T., & Perkowska-Ptasi\u0144ska, A. (2020). Hypertensive kidney disease: a true epidemic or rare disease?\u202f<\/span>Polish Archives of Internal Medicine<\/span><\/i>,\u202f<\/span>130<\/span><\/i>(2), 130\u2013139.\u202f<\/span>https:\/\/doi-org.ezp.waldenulibrary.org\/10.20452\/pamw.15150Links to an external site.<\/span><\/a>\u00a0<\/span><\/p>\n Wehner RJ, & Romanauskas VS. (1981). An adverse reaction with hydralazine: a case study.\u202f<\/span>AANA Journal<\/span><\/i>,\u202f<\/span>49<\/span><\/i>(3), 274\u2013276.<\/span>\u00a0<\/span><\/p>\n The patient was in her mid-40’s. Her renal function was impaired. BUN and creatine levels were high. She had no medical history but had presented to the ED after a routine visit with her PCP because her blood pressure was high, and her kidney markers were abnormally high. A research study states that hydralazine can cause reflex bradycardia, which is a paradoxical response that is not well understood (S\u00e1nchez-Salvatori, & Vidrio, 2003). Another possibility is that with the patient\u2019s impaired renal function, that her kidneys were not able to metabolize the drug properly, causing the half life of hydralazine to be increased. I was able to find a case study which states, \u201cFollowing a single 50 mg dose of hydralazine (Apresoline) in 13 patients with impaired renal function, a decrease in glomerular filtration rate (GFR) was correlated with an increase in serum half-life (T1\/2) of the drug (r=-0.69; p less than 0.01)\u201d (Talseth, p.1, 1976).<\/span>\u00a0<\/span><\/p>\n <\/p>\n \u202f<\/span>\u00a0<\/span>S\u00e1nchez-Salvatori, M. A., & Vidrio, H. (2003). Reflex bradycardia induced by hydralazine in sino-aortic deafferented conscious rats.\u202f<\/span>Autonomic & Autacoid Pharmacology<\/span><\/i>,\u202f<\/span>23<\/span><\/i>(1), 63\u201371.\u202f<\/span>https:\/\/doi.org\/10.1046\/j.1474-8673.2003.00278.xLinks to an external site.<\/span><\/a>\u00a0<\/span><\/p>\n \u202f<\/span>\u00a0<\/span>Talseth T. (1976). Studies on hydralazine. II. Elimination rate and steady-state concentration in patients with impaired renal function.\u202f<\/span>European journal of clinical pharmacology<\/span><\/i>,\u202f<\/span>10<\/span><\/i>(5), 311\u2013317. https:\/\/doi.org\/10.1007\/BF00565619<\/a><\/span>\u00a0<\/span><\/p>\n Hey Anastasia thanks for sharing informative post, as we are aware Pharmacokinetic process includes four main steps such as absorption, distribution, metabolism, and excretion that explain movement of drug throughout the body. Applying detailed knowledge of these four steps to drug therapy will be beneficial in achieving maximum effects of drugs and minimize harm .IV hydralazine is usually used in the hospitalized patient with hypertensive emergency. The pattern of drug absorption such as rate and extent of absorption is unique and the route by which the drug is administered significantly affects both the onset and intensity of effects (Rosenthal and Burchum, 2021, p 13). However as mentioned in the scenario patient was given IV hydralazine hence the absorption phase is bypassed and absorption happens instantaneous with rapid onset, and precise control over drug levels can be maintained. It is very critical to dilute the IV hydralazine with 10cc of sodium chloride prior to its administration and should be injected slowly over 2 minutes to avoid precipitous decrease in arterial pressure with a critical reduction in cerebral and utero-placental perfusion. <\/span><\/p>\n This process or administration of 5-10 mg of IV hydralazine can be repeated every 20-30 minutes until the desired effect is achieved however the blood pressure and heart rate of patient should be monitored entire time. Hypotensive effects occur 5-30 minutes after an IV dose. The antihypertensive effects of an IV dose last 2-6 hours on average, although the effects of a parenteral dose can last up to 12 hours; the affinity of hydralazine for arterial walls may partially explain the prolonged effect. The patient here in the scenario is admitted with hypertension and acute kidney failure so it is also critical to consider pharmacokinetic parameters such as drug excretion as the majority of the drug excretion occurs via kidneys and in the case of acute renal failure both the duration and intensity of drug responses may increase. Hence it is important to check on creatinine clearance levels and adjust the dose based on its function.<\/span>\u00a0<\/span><\/p>\n hydralazine hydrochloride – Drug Summary<\/span><\/i>. PDR.net. (n.d.). Retrieved December 2, 2022, from https:\/\/www.pdr.net\/drug-summary\/Hydralazine-Hydrochloride-Tablets-hydralazine-hydrochloride-738<\/a><\/span>\u00a0<\/span><\/p>\n Hydralazine 20mg Powder for Concentrate for Solution for Injection\/Infusion<\/span><\/i>. ADVANZ PHARMA. (2022, August 8). Retrieved from https:\/\/www.medicines.org.uk\/emc\/product\/6710\/smpc#gref<\/a><\/span>\u00a0<\/span><\/p>\n \u202f<\/span>\u00a0<\/span>Rosenthal, L. D., & Burchum, J. R. (2021).\u202f<\/span>Lehne\u2019s pharmacotherapeutics for advanced practice<\/span><\/i>\u202f<\/span>nurses and physician assistants\u202f<\/span><\/i>(2<\/span>nd<\/span>\u202fed.) St. Louis, MO: Elsevier.<\/span>\u00a0<\/span><\/p>\n Hello Anastacia! You have provided an insightful and impeccable post. Some patients tend to report insensitivity to medications prescribed. As a result, their health conditions remain undertreated because insensitivity to medications leads to medication non-compliance. These patients are usually frustrated by insignificant progress in their treatment outcomes and in turn ruin therapeutic relationship with healthcare providers and make them feel dissatisfied with the treatment process. Essentially, treatment should be guided by the aim to enhance the wellbeing of patient instead of arriving at a fixed therapeutic drug dose. One strategy to deal with issue is to begin slow and continue slow by beginning medication below the recommended beginning dose (Swanson et al., 2020). For example, consider starting on 1 mg of Hydralazine instead of the typical 2mg. Healthcare professionals should also try to understand dynamic factors that lead to the patient\u2019s insensitivity to medications. This can be achieved by calling allergist \/ immunologis to assess the patient. The evaluation is critical in identifying classes of medications that makes the patient insensitive and create a detailed personalized plan for future drug use.<\/span>\u00a0<\/span><\/p>\n Swanson, K. M., Zhu, Y., Rojas, R. L., St. Sauver, J. L., Bielinski, S. J., Jacobsen, D. J., … & Borah, B. J. (2020). Comparing outcomes and costs among warfarin-sensitive patients versus warfarin-insensitive patients using the right drug, right dose, right time: using genomic data to individualize treatment (RIGHT) 10K warfarin cohort.\u202f<\/span>PloS one<\/span><\/i>,\u202f<\/span>15<\/span><\/i>(5), e0233316. https:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0233316<\/a><\/span>\u00a0<\/span><\/p>\n As a preoperative nurse, nurses administer versed and fentanyl on a daily basis as directed by the anesthesiologist\u2019s orders. While other<\/span>\u00a0<\/span><\/p>\n drugs are given, this is primarily an orthopedic facility and these are the most commonly given pre-op drugs, especially for sedation for<\/span>\u00a0<\/span><\/p>\n nerve blocks. \u202fPatients\u2019 ages range from small children to elderly and medical history varies vastly among each patient. To establish<\/span>\u00a0<\/span><\/p>\n desired effect, but avoid causing harmful side effects, the appropriate dosage must be given. For patients with an intravenous (IV) access,<\/span>\u00a0<\/span><\/p>\n these drugs have instantaneous absorption with rapid onset (Rosenthal & Burchum, 2021). Dependent upon the patient\u2019s age, frequency<\/span>\u00a0<\/span><\/p>\n of use of analgesics, and size the anesthesiologist decides on the dosage to be given prior to initiation of a nerve block. Generally<\/span>\u00a0<\/span><\/p>\n speaking, most patients reach the desired pleasant state resulting in minimal discomfort during the short procedure. However, there are<\/span>\u00a0<\/span><\/p>\n two instances that come to mind and that is the patients that, for different reasons, have very high tolerance to some medications and<\/span>\u00a0<\/span><\/p>\n then those who are \u201clight weights\u201d as we tend to refer to them. However, older patients typically require smaller dosages of versed and<\/span>\u00a0<\/span><\/p>\n fentanyl. Sometimes the versed is even omitted and a lesser amount of fentanyl is given to avoid over sedation and confusion. Drug<\/span>\u00a0<\/span><\/p>\n sensitivity varies across the lifespan, but infants and elderly patients have increased sensitivity to drugs (Rosenthal & Burchum, 2021).<\/span>\u00a0<\/span><\/p>\n Usually, the anesthesiologists are great at judging what dosage is appropriate for each patient, but sometimes the tiny, elderly patients<\/span>RESOURCES<\/span>\u00a0<\/span><\/h2>\n
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