Pharma WK 1 Discussion post reply

Respond to the two following discussion post response 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.

APA format 150 to 250 word count

2 scholarly References within the last two years for each post

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Discussion post reply #1

Shantrice c

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Working in long term care; I have patients that are affected frequently with bacteria infections. Common infections range from UTIs to MRSA, all the way to wound infections. One scenario I experienced is with a patient that had ESBL in her urine. The patient was  a 75 year old African American women with a history of chronic kidney disease, diabetes, hypertension, and hyperlipidema. The patient was prescribed the antibiotic, Nitrofurantoin before the sensitivity report results were in. Nitrofurantoin is an old drug used for uncomplicated UTI. Kashanian  et al. has mentioned about the potential role of nitrofurantoin for uncomplicated UTI in the growing resistance era ( Tulara, 2018). When dealing with Pharmacokinetics it is important that medication is absorb and distributed properly to each individual to produce positive results. When a provider prescribes medication, it is with the ultimate goal of a therapeutic outcome while minimizing adverse reactions. A thorough understanding of pharmacokinetics is essential in building treatment plans involving medications ( Grogan & Preuss, 2022). If the medication doesn't fit each patient it can cause adverse reactions and  delay proper treatment.  Since the patient had chronic kidney disease, the drug Nitrofurantoin was a risk factor for this patient to take.  The medication plasma levels increases since the renal impairment is altered from CKD. As renal function deteriorates, the nitrofurantoin bladder concentration decreases and plasma levels increase. Therefore, in renal impairment efficacy is reduced and the potential for adverse reactions increased ( Medsafe, 2015). The patient started to develop generalized rashes on her body because of the pharmacodynamics of the patient, since she had CKD.  In the future if I  had a patient with ESBL and my first line of treatment was the medication Nitrofurantioin, I would make sure that the patient doesn't' have any kidney issues. If the patient has kidney issues I would get a  creatinine lab to determine if the drug is suited for the patient, after a sensitivity report is ran.

Discusion post #2

Keri M

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When caring for a patient, it is crucial to remember that every person is different and requires individualized care. There are numerous factors that can affect the way a patient responds to treatment. One of these factors include disease processes. Until recently, I have spent the last eight years of my nursing career as a critical care nurse. I have worked in surgical, neurological, medical, and trauma intensive care units. Recently, I chose to take a job as an outpatient dialysis nurse while completing my degree. Before now, I did not really stop to consider just how much renal dysfunction can affect medications on a daily basis. As an ICU nurse, I always knew how important renal function was for fluid and electrolyte regulation, however, I usually had more pressing concerns for my patients while they were under my care. As a dialysis nurse, I must evaluate how the patient’s renal function will affect their treatment, especially for patients taking Digoxin.

Renal disease and dialysis cause a fluctuation in the concentration of electrolytes such as potassium. This potassium fluctuation in patients taking Digoxin can increase their risk of digoxin toxicity (Shah, et al. 2021). Some potential symptoms of Digoxin toxicity can include confusion, decreased apatite, nausea, vomiting, diarrhea, visual disturbances, and arrythmias (Mayo Clinic. 2022). Recently, I had a patient arrive to the clinic for their dialysis treatment and they were exhibiting most of these symptoms. The patient was an 89-year-old Caucasian female that had been on dialysis for multiple years. She is normally alert, oriented, and ambulates with a walker but on this day, she was confused, and wheelchair bound. She was lethargic and upon assessment she was found to have an irregular slow heartbeat in the 30’s. She was taken by ambulance to the hospital and was found to have digoxin toxicity.

As a preventative measure, a personalized plan of care should be developed for each patient. For this patient, I would include a thorough assessment of her cognitive, physical, and psychological health to ensure she can comply with her medication regiment. If deemed necessary, the appropriate referrals and or accommodations would be made to make certain she is having her medications safely managed and administered. Extensive medication and dialysis related education would be completed with the patient and her caregiver. Weekly lab draws during her dialysis treatments, especially electrolyte panels and digoxin levels, would be included until deemed stable. Her dialysate concentrations (i.e. a 3K+ dialysate bath) would be evaluated and adjusted based on her lab values to ensure proper electrolyte replacements. Her plan of care would also include monthly dietary evaluations with a registered dietician to help her avoid excessive intake of potassium, sodium, fluid, et cetera. Finally, a plan of care meeting and consultation with her prescribing cardiologist and primary care physician would also be included to determine if Digoxin is the safest medication for her based on her comorbidities. 

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