Advanced Pharm Nursing
Reply Posts 1
Respond to a minimum of two peers on two separate days. Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource that is different than the one you used for the initial post.
Your responses to each peer’s chosen drug categories should include one evidence-based article from the Regis College Library that connects culture, genomics, pharmacogenomics, or a particular age group (infant or pregnancy, for example.)
Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation.
In your initial post, please select two classifications of drugs from the following list and explain the factors that may influence the pharmacokinetics and pharmacodynamics processes of these agents.
List of Drug Categories
· Selective Serotonin Inhibitors
· Fluoroquinolones
· Beta-Adrenergic Antagonists
· Antilipidemics
· Corticosteriods
· ACE Inhibitors
MY peer’s Initial post
In order to effectively treat a patient, it is important to understand the pharmacokinetics and pharmacodynamics of medications to meet a desirable outcome. However, there are certain factors to be considered that may affect different patient populations. The impact of medications such as Fluoroquinolones and ACE inhibitors on organ systems may be beneficial to some patients while other factors need to be considered to avoid negative effects.
Broad spectrum antibiotics, like Fluoroquinolones, are bactericidal to repair infectious DNA in organisms effected by gram negative, staphylococcus, enterococcus and streptococcus bacteria (Woo & Robinson, 2020). Despite the beneficial effects of fluoroquinolones, certain factors need to be considered that influence its pharmacokinetics and pharmacodynamics. Some factors include renal impairment in patients such as the elderly, those with kidney or liver transplants or those taking steroids for an extended amount of time (Woo & Robinson, 2020). These factors are important to consider in order to avoid toxicity and subsequent unfavorable events as the metabolism and excretion of fluoroquinolones are primarily via the renal and hepatic system (Woo& Robinson, 2020). Lengthening the dosing interval in patients with impaired renal function is also an important consideration when prescribing fluoroquinolones (Hoo, Liew & Kwa, 2017). It has also been found in a large cohort study that fluoroquinolone use was correlated with increased risk of tendon rupture (Merel & Paauw, 2017).
The pharmacokinetics and pharmacodynamics of ACE Inhibitors (ACEIs) lower blood pressure by acting on the renin-angiotensin-aldosterone system (Woo & Robinson, 2020). However, the action in ACE inhibitors also affect the elderly and those with renal impairment (Woo & Robinson, 2020). Due to its effect on the kinin-kallikrein-bradykinin system, ACE inhibitors facilitate the breakdown of bradykinin, therefore promoting vasodilation (Woo & Robinson, 2020). As a result, the effect of vasodilation prevents perfusion maintenance within the kidneys, potentiating ischemic or worsening renal failure (Woo & Robinson, 2020). The kidney is also the primary organ of excretion with the exception of a few different ACEIs (Woo & Robinson, 2020). With renal impairment, delayed excretion of ACEIs can significantly prolong the drugs half-life (Woo & Robinson, 2020). ACE inhibitors also increase the probability of adverse effects in the elderly due to physiological decline in renal and musculoskeletal function (Mukhtar & Jackson, 2015).
Understanding the pharmacokinetics and pharmacodynamics of medications is important in order to safely prescribe. While fluoroquinolones and ACE inhibitors can provide effective treatment for some patients, certain factors that influence the pharmacodynamics and pharmacokinetics can create undesirable effects. Factors such as the elderly and those with renal impairment can significantly influence how these medications effect the organ systems they target as well as metabolism and excretion.
References
Hoo, G. S.R., Liew, Y. X., & Kwa, A. L.H. (2017). Optimization of antimicrobial dosing based on pharmacokinetic and pharmacodynamic principles. Indian Journal of Medical Microbiology, 35(3), 340–346. doi.org/10.4103/ijmm.IJMM_17_278
Merel, S. E., & Paauw, D. S. (2017). Common drug side effects and drug-drug interactions in elderly adults in primary care. Journal of the American Geriatrics Society, 65(7), 1578– 1585. doi.org/10.1111/jgs.14870
Mukhtar, O., & Jackson, S. H. D. (2015). Drug therapies in older adults (part 2). Clinical Medicine, 15(2), 155–159. doi.org/10.7861/clinmedicine.15-2-155
Woo, T.M., & Robinson, M.V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers. Philadelphia, PA: F.A. Davis