Week 9 Journal Reflection sample by one of our top writers
This pharmacological course’s first week’s journal entry has significantly impacted my knowledge. Before the course unit, I had the basic medical knowledge from my nursing education and hospital floor experience. The knowledge gained previously was effective in teaching me about different ways to handle patients and prescribe drugs. I was also able to diagnose patients and provide the necessary guidance regarding their medical complexity and treatment options. That is because I was just familiar with many of the common medication classes we use: antibiotics, anti-hypertensive, and diabetic medications. However, this course allowed me to dive much deeper into the pharmacokinetics, pharmacodynamics, and pharmacotherapeutics underlying these drug treatments.
The pharmacology course effectively expanded my understanding of the molecular mechanisms of how different drug classes work at the receptor and cellular levels. Before attending the course, I knew about the therapeutic effects and common side effects of many drugs that we use frequently. However, I did not understand the “how” and “why” behind those effects. Therefore, learning how drugs interact with and modulate receptors, inhibit or induce enzymes, and increase or decrease the expression of proteins has given me a much richer appreciation of why they cause the effects they do on the body.
For now, I have a much better understanding of how protein-bound drugs are impacted by factors such as albumin levels since only the free fraction can cross membranes. I also have relevant knowledge of cardiac medications such as beta blockers. I, therefore, comprehend how their specific binding characteristics determine their selectivity for different beta receptor subtypes. These diverse aspects aid my practice as a pharmacologist through my familiarity with different medications and other drugs. This mechanistic understanding will allow me to predict potential drug interactions and adverse events better and optimize medication selection and dosing for individual patients.
Furthermore, I better understand diverse perspectives in areas such as pharmacogenomics and how genetic variability can dramatically impact drug response between patients. Looking at examples such as the genetics behind poor or ultra-rapid metabolizers of certain drugs was an eye-opening experience. The course section facilitated a better understanding of diverse factors that revealed the relevant ways to control the spread of chronic conditions. I appreciate the reason why standards of certain drugs may not be appropriate for all patients. The knowledge was gained from reviewing different drug performances learned throughout the course and researching different pharmacological aspects. Applying principles of pharmacokinetics to calculate dosing adjustments for patients with renal or hepatic impairment is something I did not have experience with previously. Practicing these calculations and conceptualizing the physiologic pharmacokinetic processes involved, like how different metabolic pathways are impacted, has solidified this knowledge.
My Thoughts about Medication Use
I think differently about medication use in my current employment. Since starting the course, I have been much more inquisitive when administering medications or seeing how patients respond to them on my nursing floors. I am more apt to consider potential drug-drug interactions based on their metabolic pathways or protein binding. I also think more about the time to maximum concentration and half-life of medications we give and how that impacts developing therapeutic blood levels. I find myself looking more closely at medication dosing relative to factors like weight, age, and renal function and making sure dosing is optimized.
I think about medications from a much more comprehensive, mechanism-based perspective now. Whereas before, I may have simply matched a medication to its general therapeutic use, now I have a deeper appreciation for why that drug is a good choice based on its specific mechanism of action. I think more about a drug’s adverse effect profile and try to anticipate potential issues before they arise based on what I know about how the drug works.
While I cannot necessarily implement advanced dosing strategies or take on prescriptive authority in my current nursing role, this new mindset enhances my understanding and critical thinking and will allow me to monitor patients more effectively. It also drives me to be a better advocate. I am more prone to notice potential issues related to medication dosing, interactions, and side effects and bring those up to physicians and advanced practice providers to get adjustments made. My ability to understand and communicate using that pharmacological understanding has improved greatly.
Going into this course, I understood and respected the responsibilities of advanced practice providers like nurse practitioners in prescribing medications. However, after completing the course, I greatly appreciate the depth and breadth of pharmacology knowledge required to truly excel in an advanced practice role. Being able to thoroughly integrate knowledge of pharmacokinetics, pharmacodynamics, pharmacotherapeutics, and pharmacogenomics is crucial for making safe, effective, and individualized decisions around medication selection, initiation, dosing, monitoring, and de-prescribing. I now recognize that advanced practice providers cannot rely on pharmacology knowledge from their initial nursing education. However, they must continually maintain a contemporary, pharmacy-level understanding of how drugs work at the molecular level. Besides, they must integrate knowledge about drug interactions, their optimal uses for various diseases, and how to apply that to diverse patients.
Advanced practice providers must have this comprehensive understanding while maintaining a big-picture perspective on treating patients holistically using other therapeutic modalities. They have to weigh medication risks and benefits for each specific patient. It’s a delicate balance of deeply understanding the pharmacological science while taking a judicious, conservative approach to avoid inappropriate polypharmacy.
Ultimately, my goal in pursuing an advanced practice nursing path is to eventually work as a nurse practitioner in a primary care or acute care setting. The comprehensive pharmacology education I have received in this course will be invaluable for my future nurse role. It will help me ensure I can prescribe medications skillfully and judiciously to care for my patients and optimize treatment.
Based on the knowledge gained, I have a stronger grasp of medication mechanisms and pharmacokinetic principles. Therefore, the knowledge will enable me to choose optimal drug therapies and avoid potential adverse effects or interactions. Besides, I will be able to anticipate situations where I need to adjust dosing. That will consider factors such as genetics, obesity, and renal impairment. Besides, I can make those adjustments based on my understanding of physiology and how the drug is metabolized and cleared.
Also, I will be able to better educate patients on what to expect from their medications. That will include the intended therapeutic effects and potential side effects they need to monitor for. Patients will appreciate having a provider who can explain the “whys” behind treatments. Additionally, my deeper understanding will allow me to properly monitor patient responses. That is because I am capable of assessing things such as symptom management. I will also be able to look at relevant laboratory data and biomarkers. If therapies are not effective, I will be able to make evidence-based adjustments or drug regimen changes.
In summary, completing this pharmacology course has greatly enriched my knowledge in this crucial area for advanced practice. It made me feel much better prepared to take on the major responsibility of prescriptive authority that comes with being a nurse practitioner. However, there exists a gap in where I will benefit from preceptor supervision as I apply this knowledge clinically. Pharmacology is truly at the core of modern treatment approaches. Therefore, skilled medication management will allow me to provide higher quality, more personalized care to my future patients using current clinical guidelines and best practices. I now have a strong theoretical and scientific foundation that will allow me to build clinical judgment around pharmacotherapeutics.
