NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics

NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics

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.

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.

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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.

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Discussion: Pharmacokinetics and Pharmacodynamics

 Pharmacokinetics (PK) can be defines as what the body systems does to the drug when it is taken into the body. It includes absorption, distribution, metabolism, and excretion or ADME. Pharmacodynamics (PD) on the other hand means what the drug actually does to the body or its mode of action (Katzung, 2018; Rosenthal & Burchum, 2018). A number of factors influence the PK and PD of medications and they include a person’s age, their genetic composition and their gender amongst others. The case patient from my experience that I would like to discuss here was an obese 68 year-old Caucasian male who also had coexisting hyperlipidemia and hypertension. He was on several medications for his conditions. The purpose of this paper is to look at the factor of age on the PD and PK of the medications on this patient.

Age as a Factor Influencing the Pharmacokinetics and Pharmacodynamics of Medications in the Case Scenario

As far as PK is concerned, glycoprotein pumps in the gut villi help in the absorption of medications. In the elderly such as this patient, their effectiveness is reduced and so the dose may have to be adjusted to get the correct bioavailability. After absorption from the gut the drugs undergo first-pass effect in the liver. Here, cytochrome P450 enzymes metabolize the drug to its active and inactive components. With age, however, this metabolism becomes less and less effective. Distribution of the active metabolites of medications depends on lean body mass and the amount of adipose tissue. In the elderly, lean body mass is less as is adipose tissue. What this means is that the effective distribution of the active metabolite of the drugs will be impaired in older persons. As for excretion, the older a person gets the less effective the kidney function gets (Hammer & McPhee, 2018; Katzung, 2018; Rosenthal & Burchum, 2018). Thus in old age as in the patient in the case scenario, excretion of drugs removed from the body by the kidneys will be impaired to some extent. Pharmacodynamics is finally also affected by age in that with defective excretion and inadequate metabolism the active metabolite of the drugs may linger on in the body longer and cause a greater effect than desired.

Personalized Plan of Care

There was need to adjust for the patient in the scenario the doses of the antihypertensives hydralazine and atenolol because of the renal factor. This was to prevent the dangerous accumulation of the medications in the patient’s body. In addition, the patient was put under close observation so as to spot early any unwanted side effects that may have occurred as a result of the weakening of body systems with age. In addition, because of the obesity and hyperlipidemia the patient was advised to eat a healthy diet and to exercise within the limits that his body could allow. This was according to the practice guidelines (Rubenfire, 2018). The patient did well and was discharged soon on medications.

Conclusion

Age is an important factor that affects the pharmacokinetics and pharmacodynamics of medications. When prescriptions are made, this and other factors such as genetics and gender should be kept in mind.

References

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14^th ed. McGraw-Hill Education.

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

Rubenfire, M. (2018). 2018 AHA/ACC Multi-society guideline on the management of blood cholesterol. American College of Cardiology. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/09/14/28/2018-guideline-on-management-of-blood-cholesterol