21.Wk1DisRe1

DIRECTIONS

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. (2 paragraphs and 2 sources)

POST

Pharmacokinetic properties of a drug determine its onset of action and the duration of its the effect which describes the absorption, distribution, metabolism, and excretion of a drug (i.e., what the body does to the drug), Pharmacodynamics describes the responsiveness of receptors to a drug and the mechanism by which these effects occur (i.e., what the drug does to the body; Griffin, Kaye, Bueno, & Kaye, 2016). According to Hilmer, McLachlan, & Le Couteur (2017), understanding pathophysiology, pharmacokinetics, and pharmacodynamics is imperative for every advanced practice nurse also because advance practice nurses assist physicians in the diagnosis and treatment of body disorders. In this paper, I will discuss my past clinical experience about how pharmacokinetic and pharmacodynamic process altered a patient’s response to a drug, the factors that influence the patient pharmacokinetic and pharmacodynamic processes and plan of care.

A scenario I can recall in my past clinical experience about how pharmacokinetic and pharmacodynamic processes altered a patient’s response to a drug is the case of a 75 years old female. Sandra is a 75-year-old female patient who is brought to the floor from ER following a fall sustained at the nursing home. Sandra has a medical history of dementia, hypertension, and atrial fibrillation. The patient required a one on one sitter per order. On assessment, Sandra is alert and oriented to name, confused conversation. During the night, Sandra is refusing to stay in bed, anxious, and attempting multiple times to get out of the bed by dangling her legs off the bed rails or throwing the pillows and trying to hit the sitter. The doctor was notified and ordered to give the patient 1mg of Ativan (Lorazepam) IV PRN every 8 hours for agitation. After one hour of administration, Sandra is getting more agitated and setting off the bed alarm every fifteen minutes, trying to get out of the bed and yelling at the staff using profanity also attempting to hit the staffs.

Factors Influencing Pharmacokinetics and Pharmacodynamics

According to Substance Abuse and Mental Health Services Administration (SAMHSA, 2018), explained that age, genetics, ethnicity, behavior, and pathophysiological changes due to disease are factors that could change pharmacokinetic and pharmacodynamics process in a patient (Hilmer et al., 2017). Benzodiazepines(BZDs) act as positive allosteric modulators on the gamma-aminobutyric acid (GABA)-A a receptor which is a ligand-gated chloride-selective ion channel in the central nervous system found in high concentration in the cortex and limbic system (Griffin et al., 2016). As people age, there is a decline in the function of homeostatic mechanisms in the body especially the central nervous system, liver, and kidney; therefore, in the elderly compared to the young there is an increased sensitivity directly related to the accumulation of benzodiazepines causing greater confusion and disorientation (Hilmer et al., 2017). According to Rochon, Vozoris, & Gill (2017), clinicians avoid prescribing benzodiazepines for older people with dementia because these drugs are associated with harms, including fall-related injuries such as fractures and cognitive worsening, an adverse event that is especially concerning in vulnerable older individuals who already have cognitive deficits. There are mechanisms that support the link between benzodiazepine use and pneumonia, these medications produce sedation leading to hypo ventilation, reduce pressure in the lower esophageal sphincter leading to reflux and aspiration, and can suppress immune function, all of which may contribute to pneumonia risk (Rochon et al., 2017). There is an increase sensitivity of the effect of BZD on patient especially the elderly as compared to a young individual such as altered mental status and disorientation. When administering BZDs, prescriber must take special precaution in dosage and frequency. This medication should also be given in a short period of time or as needed and must be discontinued when appropriate. In addition, making sure safety precautions are in place due to the side effect of this medication.

Plan of Care

Advanced practice nurse needs to determine the best treatment for a patient, what medication is suitable for the patient, the right dose, time, and duration. Also, the age, gender, and genetic disposition of the patient should be considered during assessment (Rosenthal, & Burchum ,2018). The plan of care for Sandra will be assessment using nondrug intervention such as assessing environment, checking for full bladder, constipation, room temperature, turning on light to reduce nighttime confusion or restlessness. Pharmacological treatment may include use of neuroleptic agents such as haloperidol as first line of treatment. Haloperidol and olanzapine can be safely used in the treatment of delirious patients, and low doses of antipsychotics for short duration are usually sufficient with patient’s response to attention and concentration, thinking, consciousness, and sleep-wake cycle (Jain, Arun, Sidana, & Sachdev, 2017)

References

Griffin, C. 3., Kaye, A. M., Bueno, F. R., & Kaye, A. D. (2016). Benzodiazepine pharmacology and central nervous system-mediated effects. The Ochsner Journal, 13(2), 214-223.

Hilmer, S. N., McLachlan, A. J., & Le Couteur, D. G. (2017). Clinical pharmacology in the geriatric patient. Fundamental & Clinical Pharmacology, 21(3), 217-230.

Jain, R., Arun, P., Sidana, A., &Sachdev, A. (2017). Comparison of efficacy of haloperidol and olanzapine in the treatment of delirium. Indian Journal Of Psychiatry, 59(4), 451-456. doi:10.4103/psychiatry.IndianJPsychiatry_59_17

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Rochon, P. A., Vozoris, N., & Gill, S. S. (2017). The harms of benzodiazepines for patients with dementia. CMAJ: Canadian Medical Association Journal, 189(14), E517-E518. doi:10.1503/cmaj.170193

Substance Abuse and Mental Health Services Administration (SAMHSA) (2018). Age-and gender-based population. Retrieved from: http://www.samhsa.gov/specific-population/age-gender-based