Ideal Property Acquisition
As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.
Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.
When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.
prepare:
Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history in your case study.
By Day 3 of Week 1
Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.
By Day 6 of Week 1
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.
1st response Courtney …An 18-month- old patient was admitted to the hospital after losing 6 lbs and exhibiting signs of pain by screaming. The child was found to have severe blockages and impaction throughout his GI system. The parents have religious beliefs that prevent treatment and are instead opting to have the boy’s grandfather, an elder at their church, to come and heal the patient through prayer. In this discussion, I will be discussing how pharmacokinetics and pharmacodynamics affects a patient in their decision making process.
Pharmacokinetics refer to how the body absorbs, distributes, metabolizes and excretes drugs (Gorgan & Preuss, 2023). Pharmacodynamics are how the drug interacts with a target receptor to create a therapeutic response (Gorgan & Preuss, 2023).
In my own personal clinical experience, I have had patients refuse treatment for personal beliefs. One example I can think of is when I had a police officer that refused fentanyl after a crush injury because of his own personal observations with his job. He believed that fentanyl causes addiction in every person who takes it and therefore he did not want it. The patient also had a family history of substance abuse so he was fearful of the pharmacodynamics he could possibly experience because of his family history. Genetic predispositions may affect how a patient responds to fentanyl. The patient also seems fearful of the pharmacokinetics of fentanyl after seeing patients fall into respiratory depression caused by fentanyl.
My personalized plan of care for this patient would be to provide education for the parents on the importance of nutrition and treatment for a patient with a bowel impaction that is losing weight. Failure to thrive is diagnosed when a pediatric patient’s weight and development are below what is expected for their age and gender. (Smith & Badireddy, 2022). I would want to start this patient on IV fluids containing dextrose and also try an enema to release the impaction. Polyethylene glycol (PEG) is the standard medication for children with bowel impaction so I would start with that medication (Lamanna et al., 2018) Because the patient has lost so much weight I would consider admitting him to the hospital for nutritional support.
Gorgan, S., & Preuss, C. (2023). Pharmacokinetics – statpearls – NCBI bookshelf. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK557744/
Lamanna, A., Dughetti, L. D., Jordan-Ely, J. A., Dobson, K. M., Dynan, M., Foo, A., Kooiman, L. M. P., Murakami, N., Fiuza, K., Foroughi, S., Leal, M., Vidmar, S., Catto-Smith, A. G., Hutson, J. M., & Southwell, B. R. (2018). Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate. JGH open : an open access journal of gastroenterology and hepatology, 2(4), 144–151. https://doi.org/10.1002/jgh3.12062
Smith A.E., Badireddy M., (2022) Failure to thrive. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK459287/Links to an external site.
2nd Response …. To Nylen
My patient is an 87-year-old woman with a medical history of hypertension, bipolar illness, gout, dyslipidemia, and diabetes. The subject was sent to the mental hospital following a trial study. The patient’s health has considerably decompensated and shows signs of impaired judgment and insight, as shown by the patient’s family history. In addition, the patient has been refusing oral meds for the previous 498 hours. The patient exhibits bewilderment and seems to be shut away from the world in her hospital room.
The terms “pharmacokinetics” and “pharmacodynamics” explain the various effects of drugs on the human body. The study of how drugs are metabolized and eliminated from the body, or “pharmacodynamics,” is the focus of pharmacologists. Pharmacodynamics describes how a medicine produces its therapeutic or harmful effects in a living organism (He et al., 2019). The pharmacokinetics and pharmacodynamics of medications are affected by several variables. The patient’s age, gender, weight, surroundings, food, and pregnancy all have a role in these variables. Genetics, drug-food interactions, and the physiology of individual individuals may also play a role. As can be seen from the preceding case scenario, the clinical outcomes of patients were impacted by several circumstances, as shown by the present clinical symptoms. The polarity of a drug, its ability to attach to proteins, and how it is formulated all affect how well the body absorbs it.
The patient in this hypothetical situation was taking oral drugs, which might cause poor absorption. Medications taken orally are absorbed more slowly than those given intravenously. In addition to the patient’s age, the compromised state of their immunological and physiological systems makes for a dismal clinical prognosis. This might reduce the drug’s efficacy and negatively affect patient care. The patient also suffers from many comorbid diseases, leaving them with a dismal outlook. Patients’ ability to stick to their treatment regimen may be negatively impacted by an increase in the number of pills they must take.
Current clinical manifestations inform the treatment strategy. Due to the patient’s various comorbidities, developing a comprehensive treatment plan is essential to improve the patient’s clinical prognosis. Selective Serotonin Reuptake Inhibitors will be used as part of the therapy plan for bipolar disorder. To further improve medication adherence and clinical results, the patient should additionally be started on mood stabilizers and psychotherapy therapies (van den Anker et al., 2018). Improved clinical results cannot be achieved without optimizing the patient’s dose for other underlying conditions, such as diabetes, gout, dyslipidemia, and hypertension. To make educated clinical judgments about the patient’s treatment, the physician, nurses, pharmacist, nutritionist, and psychiatrist must all work together to provide comprehensive care.
References
He, H., Yuan, D., Wu, Y., & Cao, Y. (2019). Pharmacokinetics and pharmacodynamics modeling and simulation systems to support the development and regulation of liposomal drugs. Pharmaceutics, 11(3), 110. https://doi.org/10.3390/pharmaceutics11030110
van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58, S10-S25. https://doi.org/10.1002/jcph.1284
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