NURS 6521: Advanced Pharmacology week 1 Discussion post with responses: Pharmacokinetics and Pharmacodynamics
Initial Post
Nurse practitioners holds numerous responsibilities when it comes to patient care, such as drug prescription, the progress of drug therapy, history, and physical of patients. As an advanced practice nurse, advance knowledge of pharmacotherapeutics is very essential. They need to understand how drugs affect the body through the process of pharmacokinetics (which is the movement of drugs into, through and out of the body) and pharmacodynamics (which is the biochemical and physiological effect of drugs in the body) (Rosenthal, & Burchum, 2018). In this discussion, I will talk about a patient case from my past experiences, factors that influenced the pharmacokinetics and pharmacodynamics processes of the patient, and explain a personalized plan of care that I will develop based on influencing factors and patient history my case with examples.
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Patient Scenario
The patient in my past clinical practice was a 70-year-old female who presented to the hospital with severe depression and insomnia, which resulted in a suicide attempt. The patient is divorced, unemployed, and has multiple chronic conditions. She was hospitalized and treated for depression and sleep disorder. Upon discharge, she was prescribed Zoloft and Ambien higher than the hospitalized dose to continue at home. She was doing very well with the medication while hospitalized. Two weeks later, the patient returned to the hospital and was re-admitted due to confusion, leathery, loss of coordination, and restlessness. The patient endorses that she sometimes takes more than the prescribed dose of her Ambien to fall asleep and other over-the-counter sleep aids medication (Melatonin 6 mg PO) and her prescription medication for hypertension and arthritis. The patient was placed on bed rest and hydrated with no sleeping aid medications for two days, and she responded very well. NURS 6521: Advanced Pharmacology week 1 Discussion post with responses: Pharmacokinetics and Pharmacodynamics
Patient Factor: Age
Given that medication, efficacy depends on absorption, distribution, metabolism, excretion, and the effect of the drugs in the body. The patient is 70 years old, meaning she has decreased hepatic metabolizing capacity with advanced age that can affect the ability to clear therapeutic drugs (Ginsberg, Hattis, Russ, & Sonawane, (2005). Because the patient was taking more than the required prescribed amount of medication together with the OTC resulted in drug toxicity due to decreased metabolism and kidney function. The decrease in hepatic and renal function leads to the prolonged retention of drugs and delayed clearance from the patient’s renal system, resulting in patient symptoms and hospitalization. According to Andersen, MP, Weisberg, & Petersen,2021, polypharmacy can stress pharmacokinetics and pharmacodynamics systems that are already at a reduced level of function in elderly patients due to normal aging processes the loss of functional reserve. Patient medication needs to be reviewed and tempered accordingly to prevent drug overdose and toxicity.
Personalized Care plan
Polypharmacy is prevalent with elderly patients due to multiple chronic conditions, and they tend to consume drugs from numerous prescribers resulting in overdosing on the same medication with a different brand name or for the same disease. Managing medicines for the above patient is a significant part of providing care to him as an elderly patient (Hung, 2020). In this light, the patient needs to be educated on adherence to the medication regimen and avoid taking any other medication without consulting with a health care provider. It is imperative to take inventory of all prescribed medication patients have at home to prevent giving them the medication he already has or ask them to stop taking it at home. It is also essential to examine the patient’s level of understanding of her medication schedule and why she is taking it. The patient also needs a pill minder to fill medication and send it home with her to prevent overdosing. According to Hung (2020), elderly patients need a periodic comprehensive medication review to reevaluate the risks and the benefits of current medications in light of goals of care, life expectancy, and the patient’s preferences. And finally, elderly patients need to be educated of the danger of using over-the-counter medications without consulting their provider, proper nutrition, and hydration while taking medication.
Finally, it is dangerous for prescribers to prescribe medication to the elderly just like young adults without considering the pharmacokinetics and pharmacodynamics of drug effects on the elderly. Prescribers need to pay more attention and give consideration when prescribing drugs to the elderly and also make sure they are not duplicating on patients’ medications. As part of elderly care, it is the responsibility of health care providers to take an inventory of already-prescribing medication to prevent overdosing and drug toxicity.
References
Andersen, T., MP, V. H., Weisbjerg, L. M., & Petersen, L. (2021). 4CPS-374 A screening model to identify elderly polypharmacy patients that may benefit from pharmacist led medication review during hospital admission. European Journal of Hospital Pharmacy.Science and Practice, 28, A100-A101. doi:http://dx.doi.org/10.1136/ejhpharm-2021-eahpconf.206
Ginsberg, G., Hattis, D., Russ, A., & Sonawane, B. (2005). Pharmacokinetic and pharmacodynamics factors that can affect sensitivity to neurotoxic sequelae in elderly individuals. Environmental health perspectives, 113(9), 1243–1249. DOI:10.1289/ehp.7568
Hung, W. W. (2020). Optimizing medication use in older adults. Clinical Therapeutics, 42(4), 556-558. doi:http://dx.doi.org/10.1016/j.clinthera.2020.02.021
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
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