PHARMACOKINETICS AND PHARMACODYNAMICS
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
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.
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.
HANNA
As a Med-Sure nurse for the past 2 1/2 years I’ve been a nurse, I’ve seen how medications can help or make a patient’s condition worse depending on how they react to it. There are medications that patient may be allergic to which can be deadly. “Absorption is the drug’s movement from its site of administration into the blood.” (Rosenthal & Burchum, 2021, p.13). Pharmacokinetics and pharmacodynamics work hand in hand so we can understand how the drug work, how we can safely administer them, and their effects. Pharmacokinetics and pharmacodynamics work hand in hand together when administered in the body. It is the way we as providers can help understand the mechanism of how it works for us to write the proper correct prescriptions for patients. There are many variations in drug responses. A few to mention are race, age, gender, genetics and tolerance.
Reflecting on a past time encounter with a patient last month, he had numerous episodes of bloody stools, so many times that I’ve given him about 4 blood transfusions within three weeks span. He has been newly diagnosed with Parkinson’s disease and has had a spinal fusion which typically made him uncomfortable in bed, having to find the best position for him while resting in bed. For pain Oxycodone 5 mg has been ordered for him. As the team who was following him talk talked to him by updating his condition and plan of care, he was told that maybe the oxycodone may be the cause or one of the cause for his bleeding. He did have a few colonoscopies done which showed ulcers. Now with any mediation taken long term can result in addiction, resistance, worsening responses, and death. According to Memorial Sloan Kettering Center, the drug may cause or worsen stomach ulcers and bleeding.
References
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Oxycodone and Ibuprofen. Memorial Sloan Kettering Cancer Center. (n.d.). Retrieved November 27, 2022, from https://www.mskcc.org/cancer-care/patient-education/medications/oxycodone-and-ibuprofen
JINKLE
As a nurse for 3 years, I have taken care of patients with a variety of disorders and illnesses. When determining the best treatment for patients, pharmacokinetics, or how the body processes the drug as well as how it interacts within the body is critical. “That is, when two drugs are taken together, one may alter the absorption, distribution, metabolism, or excretion of the other.” (Rosenthal & Burchum, 2021). When I used to work as a bedside Med/Surg Nurse I remember taking care of a patient with Post-op Knee Arthroplasty, with Chronic Kidney Disease (CKD) who was on hemodialysis. It was crucial to make sure what medicines you are giving patients when their kidneys are not functioning properly and may cause further damage due to lack of systemic clearance, build-up of toxins, and lack of metabolism. For a post-op surgical patient pain medications were very important to control the patient’s pain. Blood pressure monitoring is important with CKD patients as pain also increases blood pressure. Hemodialysis also tends to cause cramping and pain. The patient was in excruciating pain post-op surgery and was scheduled for hemodialysis the next day, morphine 1mg was ordered as needed and oxycodone 5mg. Morphine 1mg was given as per the pain scale. “Morphine and codeine are not recommended, because the accumulation of their metabolites may cause neurotoxic symptoms” (Coluzzi et al., 2020) Moreover, elder patients have pharmacodynamic sensitivity compared with younger adults. Hence, constant monitoring was needed to make sure the patient blood pressure, respiration, and other vitals are stable. I educated the patient as his pain subsided a bit on tramadol that was ordered because getting morphine every time is not good for him or his kidneys. Controlling pain with Opioids post-op can heavily affect patients with chronic kidney disease as the metabolites accumulate and increase the risk of toxicity. The glomerular filtration rate (GFR) needs careful monitoring.
Due to the patient’s history and recent surgery, it was crucial to not only control the pain but also anticipate it. It was also important to prescribe medications that would be less harmful to the kidneys and also take the age into the consideration. Tylenol IV around the clock would have been slightly beneficial so the patient would not have been in excruciating pain post-surgery. Tylenol tends to be less harmful to the kidneys and is the choice of drug for CKD patients. IV route would have enhanced the relief a lot faster. Taking morphine, not only negatively affects the kidney but also causes drowsiness and respiratory distress. It is also only effective for a short amount of time. Oxycodone 5mg would have helped but a higher dose would have helped with such unbearable pain. Older patients tend to excrete and metabolize a lot slower than younger patients, hence having oxycodone 10mg and Tylenol 1000mg around the clock for the first day after surgery would have been more beneficial than morphine as a needed dose. I would also add non-pharmacological interventions Tylenol IV would be beneficial for the patient.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Coluzzi, F., Caputi, F. F., Billeci, D., Pastore, A. L., Candeletti, S., Rocco, M., & Romualdi, P. (2020, September 9). Safe use of opioids in chronic kidney disease and hemodialysis patients: Tips and tricks for non-pain specialists. Therapeutics and clinical risk management. Retrieved November 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490082/
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