Pharmacokinetic Considerations in The Elderly Essay

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Pharmacokinetic Considerations in The Elderly Essay

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. Pharmacokinetic Considerations in The Elderly Essay

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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. Pharmacokinetic Considerations in The Elderly Essay

 

Read a selection of your colleagues’ responses and respond to at least two of your colleagues 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 Colleague Discussion

Patient Description

Mr. X is a 57-year-old African American male with a complex medical history, including a five-year history of presenting to the psychiatric emergency room with suicidal ideations and auditory hallucinations . He has a diagnosis of type 2 diabetes and hypertension, for which he takes clonidine for blood pressure control and a combination of Metformin, Jardiance, Humulin, and Humalog for glycemic management. Additionally, he deals with neuropathic pain for which he is prescribed Gabapentin . Mr. X is homeless and struggles with drug addiction, with methamphetamine being his drug of choice. Pharmacokinetic Considerations in The Elderly Essay

Factors Influencing Pharmacokinetics and Pharmacodynamics

Polypharmacy

The patient’s extensive medication regimen raises the potential for drug interactions (Zhang, Zhang, & Zheng, 2018). This may impact the metabolism and elimination of medications, leading to altered pharmacokinetics (Smith & Jones, 2019).

Comorbid Medical Conditions

The patient’s hypertensive and diabetic conditions may influence the absorption, distribution, and metabolism of psychotropic medications (Smith & Jones, 2019). For instance, altered blood flow and organ function may impact the pharmacokinetics of drugs (World Health Organization, 2017).

Social Determinants of Health

Mr. X’s homelessness may contribute to challenges in medication adherence and access to consistent healthcare, potentially influencing treatment effectiveness and outcomes. Pharmacokinetic Considerations in The Elderly Essay

Substance Use Disorder

The use of methamphetamine by Mr. X adds another layer of complexity, as substance abuse can significantly impact the metabolism of psychiatric medications and their therapeutic effects (Zhang et al., 2018).

Personalized Plan of Care

Psychotropic Medication Adjustment

We need to consider adjusting the patient’s psychotropic medication. Given the chronicity of symptoms, a reassessment of the current regimen and potential trial of different medications or dosage adjustments may be necessary.

Example: Consider starting him on an antidepressant such as Venlafaxine, which has dual action on serotonin and norepinephrine and has shown efficacy in treating both depressive and anxious symptoms.

Drug Interaction Monitoring

Due to polypharmacy, we closely monitor for potential drug interactions between psychotropics and antidiabetic medications (Zhang et al., 2018). Consider medications with a lower risk of affecting blood glucose levels.

Example: Choose an antipsychotic with a favorable metabolic profile, such as Aripiprazole, to minimize the risk of exacerbating diabetes. Pharmacokinetic Considerations in The Elderly Essay

Regular Monitoring of Blood Pressure and Blood Glucose Levels

Given the patient’s hypertension and diabetes, regular monitoring of blood pressure and blood glucose levels is essential to ensure optimal control of these conditions and detect any medication-related adverse effects (World Health Organization, 2017).

Example: Schedule regular follow-up appointments to assess blood pressure and blood glucose levels, adjusting antihypertensive and antidiabetic medications as needed.

Psychoeducation and Adherence Support

We need to provide psychoeducation to the patient on the importance of medication adherence and the potential side effects of the prescribed medications (American Psychiatric Association, 2013). We shall encourage open communication about any concerns or difficulties with the medication regimen.

Example: Engage the patient in a discussion about the benefits and potential side effects of the medications, addressing any misconceptions or fears that may contribute to non-adherence.

Collaborative Care Team

Foster collaboration between us, psychiatric and medical professionals to ensure a holistic approach to the patient’s care (Smith & Jones, 2019). Regular communication between the psychiatric team, endocrinologist, and primary care physician is essential for coordinated and comprehensive care. Pharmacokinetic Considerations in The Elderly Essay

Example: Schedule regular case conferences involving the psychiatric team, endocrinologist, and primary care physician to discuss the patient’s progress, address any emerging concerns, and adjust the treatment plan accordingly.

This personalized plan of care takes into account the patient’s individual factors, aiming to optimize both psychiatric and medical management while minimizing potential risks associated with polypharmacy and comorbid conditions. It emphasizes a collaborative and patient-centered approach to ensure the best possible outcomes for Mr. X. Pharmacokinetic Considerations in The Elderly Essay

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. National Institute of Mental Health. (2018). Mental health medications. Retrieved November 27, 2023 from https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml
  3. Smith, A. B., & Jones, C. D. (2019). Pharmacokinetic considerations in the elderly. Journal of Geriatric Pharmacotherapy, 15(3), 145-160. doi:10.1080/10911359.2019.1602196
  4. World Health Organization. (2017). Diabetes fact sheet. Retrieved November 28, 2023 from https://www.who.int/news-room/fact-sheets/detail/diabetes
  5. Zhang, X., Zhang, S., & Zheng, Z. (2018). Drug interactions involving psychotropic medications and antidiabetic drugs. Current Drug Metabolism, 19(5), 409-417. doi:10.2174/1389200219666180130113630

Reply

2nd Colleague Discussion Post

Pharmacokinetics and Pharmacodynamics

Ms. Whitaker, a 25-year-old female presented to the hospital with a high fever with chills and shivering. The patient reported severe pain in her lower abdomen and pelvic region. Upon examination, urinalysis, and complete blood count test, she was diagnosed with severe Urinary Tract Infection (UTI) and was admitted. The patient has no significant past medical history. She reported being allergic to certain antibiotics. She was put on Ciprofloxacin to treat the UTI. Pharmacokinetic Considerations in The Elderly Essay

Pharmacokinetic and pharmacodynamics influences

First, the patient’s compliance with the prescribed antibiotic could affect the drug’s action in her body. Irregular intake or non-compliance to the prescribed dosage could result in a fluctuation of the concentration of the drug in the patient’s body, resulting in antibiotic resistance and generally compromised treatment efficacy (Endashaw Hareru et al., 2022). The other influencing factor is the patient’s renal function, which affects the drug’s pharmacokinetics (Roberts et al., 2018). Although the patient is relatively young with presumably healthy kidneys, the patient’s UTI could negatively impact her renal function. Once the patient’s kidneys are affected, the drug elimination, metabolism, and clearance in the body could be affected, which could alter the medication levels in the blood and inherently the responses (Stefani et al., 2019). Another factor that could influence the pharmacokinetic and pharmacodynamics processes is the patient’s history of antibiotic allergies. If prescribed the wrong antibiotic (one she is allergic to), the drug could result in adverse effects on the patient’s body. The disease severity could also contribute to the drug interactions in the patient’s body. This is in terms of the level of infection, inflammatory response, and the distribution of the pathogen (Chen et al., 2018). These could hinder the drug’s effectiveness and the patient’s response to treatment. Pharmacokinetic Considerations in The Elderly Essay

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Personalized care plan

For Ms. Whitaker, I would consider a number of factors before designing a care plan. First, I would consider her antibiotic allergies and ensure that I verify her allergy through careful antibiotic selection. Confirming the specific antibiotics that the patient is allergic to ensures that she is prescribed safe ones. For example, if Ciprofloxacin is contraindicated, I would select a safer alternative for the patient. I would also closely monitor the patient’s renal function to check whether the kidneys are compromised with the UTI and also to monitor the level of drug clearance in her body. I will also educate the patient on the importance on adhering to the prescribed drug regimen to eliminate the risk of antibiotic resistance. Also, I will closely monitor the patient’s progress to ensure that the UTI is cleared and under control through follow-up assessments. Pharmacokinetic Considerations in The Elderly Essay

Response 1

One additional factor that could impact the pharmacokinetics and pharmacodynamics for Mr. X is nutritional status. As a homeless individual with substance use disorder, Mr. X may have a poor diet that leads to nutritional deficiencies. Deficiencies in certain vitamins and minerals can affect drug metabolizing enzymes and drug transporters, altering how medications are processed in the body (Murugaiha, 2021). If Mr. X were older, such as 70 years old instead of 57, I would more closely monitor for adverse drug events due to age-related changes in pharmacokinetics and increased susceptibility to drug toxicity. More frequent lab work to check medication levels and organ function could be warranted. If Mr. X had renal failure, the kidneys’ impaired ability to filter and excrete drugs could lead to accumulation of medications in the body. Dose adjustments, increased monitoring of drug levels, and preference for psychotropic less dependent on renal clearance would be important (Zhang et al., 2022). According to Adams and Mosler (2022), with heart or liver failure, monitoring liver enzymes and assessing cardiovascular side effects would be crucial to ensure safety and efficacy of complex medication regimens.

References

Adams, J., & Mosler, C. (2022). Safety and efficacy considerations amongst the elderly population in the updated treatment of heart failure: A review. Expert Review of Cardiovascular Therapy, 20(7), 529-541. https://doi.org/10.1080/14779072.2022.2098118

Bouajram, R. H., & Awdishu, L. (2021). A clinician’s guide to dosing analgesics, anticonvulsants, and psychotropic medications in continuous renal replacement therapy. Kidney international reports, 6(8), 2033-2048. https://doi.org/10.1016/j.ekir.2021.05.004

Murugaiha, J. S. (2021). Micronutrient deficiency in pulmonary tuberculosis-perspective on hepatic drug metabolism and pharmacokinetic variability of first-line anti-tuberculosis drugs: special reference to fat-soluble vitamins A, D, & E and nutri-epigenetics. Drug Metabolism Letters, 14(3), 166-176. https://doi.org/10.2174/1872312814999211130093625 Pharmacokinetic Considerations in The Elderly Essay

 

Response 2

Additional factors that could impact pharmacokinetics for Ms. Whitaker are genetics, diet/nutrition, and inflammation from the infection. Genetic variations affecting drug metabolizing enzymes or transporters could influence how her body processes the antibiotic (Li et al., 2019). Malnutrition and vitamin/mineral deficiencies may also impact drug absorption and metabolism. The localized inflammation and immune response from her severe UTI could potentially accelerate antibiotic uptake and activity as well (Ofoedu et al., 2021). If Ms. Whitaker were older, say 65 years old, I would be more cautious with antibiotic selection and dosing due to age-related changes in drug clearance. More adverse effects are seen in older adults. If she had renal failure, the antibiotics might accumulate due to impaired kidney filtration, so medications mainly excreted by the liver may be preferred, and doses adjusted based on therapeutic drug monitoring (Zoratti et al., 2021). With heart or liver failure, cardiac and liver function tests would need to be closely tracked to avoid toxicity.Pharmacokinetic Considerations in The Elderly Essay

 

References

Li, Y., Meng, Q., Yang, M., Liu, D., Hou, X., Tang, L., … & Bi, H. (2019). Current trends in drug metabolism and pharmacokinetics. Acta Pharmaceutica Sinica B, 9(6), 1113-1144. https://doi.org/10.1016/j.apsb.2019.10.001

Ofoedu, C. E., Iwouno, J. O., Ofoedu, E. O., Ogueke, C. C., Igwe, V. S., Agunwah, I. M., … & Okpala, C. O. R. (2021). Revisiting food-sourced vitamins for consumer diet and health needs: a perspective review, from vitamin classification, metabolic functions, absorption, utilization, to balancing nutritional requirements. PeerJ, 9, e11940. https://doi.org/10.7717/peerj.11940

Zoratti, C., Moretti, R., Rebuzzi, L., Albergati, I. V., Di Somma, A., Decorti, G., … & Giuffrè, M. (2021). Antibiotics and liver cirrhosis: What the physicians need to know. Antibiotics, 11(1), 31. https://doi.org/10.3390/antibiotics11010031

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. Pharmacokinetic Considerations in The Elderly Essay

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.

Read a selection of your colleagues’ responses and respond to at least two of your colleagues 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. Pharmacokinetic Considerations in The Elderly Essay