Nurs 6521 Suggest additional patient facto

MYRENE POST

Introduction

           According to Grogan and Preuss (2022), pharmacokinetics is the study of how a medication moves through the body and how the body interacts with the administered medication.  Burchum & Rosenthal (2021) enumerated the four pharmacokinetics processes: absorption, distribution, metabolism, and excretion.  Meanwhile, pharmacokinetics was defined as the study of physiological effects or actions of medication in the body (Marino, et al., 2022). Grogan and Preuss (2022) stated that in the absorption process, the duration and concentration of drugs could be affected depending on how a person’s body processes the medication. The processes could be affected by aging, drug-to-drug interactions, route of administration, different illnesses, or organ problems.

Patient Case Scenario

           I currently work at a skilled nurse facility, and we have a patient that is an 88-year-old female who is a s/p fall, left hip fracture with a history of HTN, DM, DVT, multiple falls at home, osteoporosis, and HLD. The patient is alert and oriented x 1, combative, always attempts to get up from her bed, and asks to bring her home. Pad alarm was consented and applied. Even after multiple times of reminding the patient to stay on her bed and to use the call light for help, she will still try to get up and will shout for help. Per family, at home, the patient is given Melatonin 10mg, which sometimes helps and sometimes does not. MD was informed about the situation, and while waiting for orders that night, the patient fell from her bed. No injuries, no active bleeding, and normal vital signs were noted. MD ordered Ativan 0.5mg PO. Medication was administered, and still patient has not calmed down. The next night, the patient was shouting in the room, asking for help and wanting to go home. A sitter was requested, and MD added 0.5mg of Ativan to administer. In the morning, the sitter was about to feed the patient, and the sitter panicked. The patient was difficult to arouse. Staff went into the room. Vital signs were checked, and it was within normal limits. The patient was still sleeping at that time of the day, which was unusual. The patient was put under close monitoring, and later that day, the patient woke up. Vital signs were stable, and the patient returned to attempting to get up and shouting. Ativan was responsible for the difficulty of arousing the patient. MD lowered the Ativan back to 0.5mg, and the next nights, the patient was responding well.

Conclusion

           Healthcare professionals should be careful of using benzodiazepines, especially with the older age populations. According to Ghiasi, et al. (2022) Ativan toxicity can cause CNS and respiratory depression, such as extreme drowsiness, muscle weakness, confusion, hypotension, and coma. Ghiasi, et al. (2022) suggested tapering Ativan, but in the case scenario above, Ativan was increased the next night as medication did not help immediately on the first day. In Beers Criteria, the American Geriatrics Society (2019) stated that healthcare professionals should be aware of the increased sensitivity of older adults to benzodiazepines, especially of the decreased metabolism on long-acting agents. American Geriatrics Society (2019) suggested that benzodiazepines should be avoided by older adults as much as possible.

References:

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American

Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults.  Journal of the American Geriatrics Society, 67(4), 674-694. doi:10.1111/jgs.15767

Ghiasi, N., Bhansali, R., & Marwaha, R. (2022). Lorazepam.

https://www.ncbi.nlm.nih.gov/books/NBK532890/

Grogan, S. & Preuss, C. (2022). Pharmacokinetics.

https://www.ncbi.nlm.nih.gov/books/NBK557744

Marino, M., Jamal, Z. & Zito, P. (2022). Pharmacodynamics.

https://www.ncbi.nlm.nih.gov/books/NBK507791/

Rosenthal, L. & Burchum, J. (2021).  Lehne’s pharmacotherapeutics for advanced practice nurses

and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

NICOLE

Pharmacokinetic and Pharmacodynamics

     Pharmacokinetics-the absorption, distribution, metabolism, and excretion of drugs by the body (Rebar et. al., 2022). Pharmacodynamics- the biological and physical effects of drugs and the mechanisms of drug actions (Rebar et. al., 2022). A recent study was done on FNP students and Pharmacists to evaluate errors, the most preventable errors started from the prescribing stage. Medication selection and dose were the most common types of prescribing error, with the most error-prone factors being incorrect drug selection, contraindications such as medication allergies, incorrect dosing, and including insufficient information on the prescription (Sabatino et al., 2017).

Patient Case

I recently had a patient present with weakness, dizziness, and a fall. He is an 87-year-old man admitted for hypotension, weakness, dehydration, and malnutrition The patient blood pressure upon admission was 80/54. The patient was on an antihypertensive drug called Lisinopril 10 mg. Also taking a beta blocker Metoprolol 75 mg. Patient history of MI, dementia, and hypertension. The patient weighs 121 lbs and is 5 ft 8 in tall. The patient was unable to recall exactly how much medication he has taken. The patient was dehydrated upon admission. He has been traveling with his wife and had come to Minnesota from Florida.

Factors that influenced Pharmacokinetic and Pharmacodynamic Process

This patient is taking a beta-adrenergic antagonist and ACE inhibitor. Hypotension may occur, accompanied by dizziness and increased heart rate (Rebar et al., 2022). This hypotension was the probable cause of his fall and dizziness. The pharmacokinetics of metoprolol are absorbed in the GI tract (Rebar et al., 2022). Metoprolol is metabolized in the liver and its metabolites are excreted in urine (Rebar et al., 2022). Patients should be hydrated well while taking this medication to effectively work well in the body. In patients taking ACE inhibitors, Lisinopril is also absorbed in the GI tract, metabolized in the liver, and excreted by the kidneys. ACE inhibitors promote the excretion of sodium and water, reducing the amount of blood the heart needs to pump and reducing blood pressure (Rebar et al., 2022).

Plan of Care

Withhold the dose if the patient’s heart rate is less than 60 bpm or his systolic blood pressure drops below 90 mm Hg (Rebar et al., 2022). Evaluate the patient after lowering the dose of medications, maintain fluid balance and teach the family drug administration and understanding of symptoms. Patients should have a home blood pressure monitor and notify the primary care provider if any adverse reactions occur. The patient will need to have medications set up for him at home and drink an adequate amount of water and maintain a healthy diet.

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