NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay

Pharmacokinetics and Pharmacodynamic Principles

I am working and hoping to be a Nurse practitioner soon. A nurse practitioner (NP), otherwise called an Advanced Registered Nurse Practitioner (ARNP), performs tasks comparable to those of a doctor from endorsing prescription and performing minor medical procedures to requesting tests and deciphering the outcomes. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay.

As indicated by Arcangelo et al., (2017), pharmacokinetics refers to the development and movement of drug all through the body, including the administration, absorption, dispersion, and elimination, whereas pharmacodynamics alludes to how the medication influences the body, including therapeutic or harmful impacts. The NP must understand how medications work and intention for the use and result (Laureate Education, Inc. (Executive Producer), 2012) NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay.

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As practitioner students, we must educate ourselves on the elements of appropriate, safe, and complete prescription writing in all patient cases. We hypothesized that the incorporation of a pharmacist in nurse practitioner student learning could improve preparedness to prescribe as well as encourage collaboration with pharmacists as part of an interprofessional health care team. (Sabatino et al.,2017)

In a specific case during one of my shifts in the emergency room, a 42-year-old Caucasian male arrived by EMS with complaints of severe mid-sternal chest pain radiating to his left shoulder Upon evaluation. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay. We horridly insert two large-bore peripheral IVs and immediately completed an EKG and my colleague received an order from the Physician who was standing across from the trauma room #1. She administered Morphine 4mg and Zofran 4 mg IV to help relief what appears to be severe mid-sternal pain expressed by facial and bodily movements and asking that we relieve his pain. As I continue to obtain a proper health history when suddenly the patient had what appears to be a sudden severe adverse reaction. Patient was given Narcan 0.4 mg IV. He became unresponsive coded and was revived after ten minutes of CPR and ACLS protocol, the patient’s mental and hemodynamic status had improved and the patient was sent to the cardiac catheter lab where it was discovered that he had 35 % ejection fracture and was diagnosed with myocardial infarction. He received post-cardiac treatment and left the hospital five days laterNURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay.

The factors

The patient was given Morphine for pain in an appropriate amount but it appears that it affected the heart rather than caused an allergic reaction. Morphine is a highly effective pain killer and some health professionals use it to help alleviate serious chest pains during angina or heart attacks. Although it helps in dilating the blood vessels around the heart, it can also cause low blood pressure which can further worsen the damage caused during a heart attack. In some instances of heart attack, morphine may only mask the pain, allowing further damage to occur without the patient receiving important pain signals to the brain. (McCance et al.,2019)

Huge pharmacokinetic and pharmacodynamic changes that happen within the myocardial tissues, age, and cardiac disease may demonstrate the danger of unfavorable impacts of narcotics (Prostran et al., 2016). In this specific case, the patient had no known history of cardiac disease, or allergic to medication but after the cardiac catheterization, it noted that his heart was functioning with 35 % ejection fracture. he hearts contracts and relaxes. When your heart contracts, it ejects blood from the two pumping chambers (ventricles). When the heart relaxes, the ventricles refill with blood. No matter how forceful the contraction, the heart can never pump all blood out of a ventricle. The term “ejection fraction” refers to the percentage of blood that’s pumped out of a filled ventricle with each heartbeat because of blockage of the coronary arteries and cardiovascular disease the heart was not able to pump effectively. ( McCance et al.,2019) NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay.

Patient was not able to give a history of cardiovascular disease and denies any history of allergies, no medical history was obtained before receiving Morphine and may have affected an injured myocardium. The nurse practitioner must make every effort to get a medical history and any pertinent information before administering medication. I believe that without the morphine the patient would have coded and presented with a different result NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).  Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology. Baltimore, MD: Author.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Prostran et al., (2016). Pharmacotherapy of Pain in the Older Population: The Place of Opioids. Frontiers in aging neuroscience, 8, 144. doi:10.3389/fnagi.2016.00144 NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of nurse practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay response

Thank you for your discussion post on pharmacokinetic and pharmacodynamics. I would like to add that during the initial treatment of the patient sublingual (SL) nitro 0.4mg can also be used for fast cardiac dilation and relief of chest pain. To combat hypotension intravenous fluid open wide if needed can also assist in the dizziness, nausea and vomiting associated with hypotension. As the patient was already in the hospital he would have been able to be assessed by professionals and received the recommended additional SL nitro within five minutes. According to the National Institute of Health [NIH]. 2020) SL nitro promotes peripheral pooling of blood, decreases venous return to the heart, and reduces left ventricular end-diastolic pressure (preload) NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay. Nitroglycerin also produces arteriolar relaxation, thereby reducing peripheral vascular resistance and arterial pressure (afterload), and dilates large epicardial coronary arteries (2020). Morphine is one of the first-line medications in acute angina pectoris. However the addition of SL nitro may also be beneficial.

Reference:

National Institutes of Health. (2020). U.S. National Library of Medicine, DailyMed. Nitroglycerin. Drug label information. Retrieved from https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=nitroglycerin

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay response 2

Thanks for the thorough post! I have had similar experiences when working on a trauma floor. I have had this happen more often in elderly patients. As you mentioned, age can have a significant effect on the pharmacokinetics and pharmacodynamics of morphine. Elderly patients are also at a higher risk of experiencing respiratory suppression with the use of opiates. Some other factors that could affect the pharmacokinetics of IV morphine include comorbidities such as hepatic or renal disease and hypothyroidism. (Davis’ Drug Guide, 2017).

When administering IV morphine, the patient should be closely observed as morphine has a rapid onset. Additionally, vital signs such as reservations, blood pressure and pulse should be monitored continually as well as level of consciousness.

References

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2017). Morphine. Davis’s Drug Guide (15th ed.). F.A. Davis Company.\

Discussion: Pharmacokinetics and Pharmacodynamics

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 NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay.

To 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. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay
• 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 NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay.

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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” 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 Submit! NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay Initial post

Drugs have different effects on the body. Pharmacokinetics and pharmacodynamic are two-term that explain how drugs react in the body. Many drugs are metabolized and eliminated by the liver and kidneys. If these systems are impaired, this can lead to increased adverse effects and possible medication overdose( Rosenthal & Burchum, 2018).

Pharmacokinetics is the study of drug movement throughout the body. Pharmacokinetic has four different levels, such as absorption, distribution, metabolism, and excretion (Rosenthal & Burchum, 2018). Pharmacodynamics is the response of the body to the drug. It is the relationship between drug concentration at the site of action and any effects, namely, the intensity and time course of the result and adverse effects. (Campbell & Cohall, 2017) NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay

Patient scenario

The case involved a 76-year-old female with a history of high blood pressure, diabetes, and seizure disorders presented to the hospital after a fall. The was complaining of generalized fatigue and weakness, dizziness, drowsiness, tremor, and slurred speech for the past two days. The current medications that the patient is taking are Dilantin 100 mg three times daily, Metformin 500 mg twice daily, Lantus 20 units at bedtime, and lisinopril 10 mg daily. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay

As the patient aging, they have fewer nephrons and smaller kidneys. The decreased in nephrons leads to a decrease in blood filtration. Also, older adults have vessel changes such as atherosclerosis that can lead to a reduction in kidney blood flow. Thus, the renal system has difficulty to excrete medications (Rosenthal & Burchum, 2018).

According to Miller and Vearri (2018), once Dilantin reaches a level of over 30Ug/ml, it is considered toxic (Miller and Vearri, 2018). This patient is experiencing Dilantin toxicity without knowing because of the symptoms that he has does not clearly show it. The blood revealed that his Dilantin level was high 30 µg/mL. Often, the patient does not know the side effect of the medication that they are taking. The plan of care for this patient is to reduce the dosage of Dilantin, educate the patient and family members about the side effects of Dilantin, and monitor Dilantin level weekly until the patient reaches a therapeutic level of 10 and 20 µg/mL. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay

References

Rosenthal L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice

providers. St. Louis, MO: Elsevier

Miller, C &  Vearri, D. (2018). Phenytoin Toxicity Workup: Laboratory Studies, Imaging

Studies, Electrocardiography.  Retrieved from https://emedicine.medscape.com/article/816447-workup

Campbell, J. E., & Cohall, D. (2017). Pharmacodynamics-A Pharmacognosy Perspective.

Retrieved from https://www.sciencedirect.com/science/article/pii/B9780128021040000263

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay response

Thank you for your discussion on your patient with epilepsy. My son was diagnosed with epilepsy after a grand mal seizure when he was 9 years old. He is 14 years old now and had been seizure-free for 5 years so we were hoping we could ween him off the Valproic Acid that he was taking. We were scheduled for an appointment with his neurologist and that same week he had another grand mal seizure. Therefore unfortunately instead of that conversation about weaning him off the medication, we had to increase it due to his increase in age, weight, and puberty changes. There are so many variables when considering medication options for children especially teens going through puberty. In a recent study done on Valproic Acid (VPA) by Wang, Hu, & Li, (2020), discussed the variability of plasma drug concentrations on epilepsy patients. The study analyzed the correlation between concentration and efficacy according to the subgroups of age, gender, and co-medications (Wang, Hu, & Li, 2020). In the conclusion of the study, they realized that age could explain some of the inter-individual pharmacokinetics of VPA, however, gender was not related to concentration or efficacy. Thus suggesting that concentration monitoring is vital to children on this medication (Wang, Hu, & Li, 2020). NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay As future Nurse Practitioners, we must keep ourselves up to date and informed on various medication options as well as pharmacokinetics and pharmacodynamics that play a role in each medication prescribed. Medical assessments, medical reconciliation, and physical assessments are essential for prescribing medications (Mitchell & Oliphant, 2016) NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay.

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Mitchell, Alison, and Catherine M. Oliphant. “Responsibility for Ethical Prescribing.” The

Journal for Nurse Practitioners, vol. 12, no. 3, 2016, doi:10.1016/j.nurpra.2016.01.008.

Wang, Y., Hu, W., & Li, Z. (2020). Influence of age and co-medication on the concentration and

efficacy of valproic acid in Chinese epilepsy children. Pakistan Journal of Pharmaceutical Sciences, 33(2), 537–542. NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics essay