NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics

Verapamil

Over the past few years, rules and regulations have changed for prescribing medication. The new rules and regulations have changed the prescriber, type of drugs, and the quantity. These changes have occurred due to overprescribing and abuse of medications by clinicians, doctors, and patients. Developmental education on prescribing medication enhanced the understanding of safe and effective medication use with improved recognition and avoidance of prescription errors(Sabatino et al., 2017) NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics. Drugs are more effective when pharmacokinetic and pharmacodynamic are consider.   In the specialty of Homecare, there is not a lot of medication handling. However, a doctor may be called to look into changing or increasing the dose of particular medications. In many of the cases, there is no consideration about the prescribed to determine if the drug will genuinely be effective a correcting the health issues with the patient or will it cause more problems. Lastly, in a lot of cases, the patient has been on the medications for a long time and is not willing to change.

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In one particular case, the patient was a young adult, female with a history of Crohn’s and hypertension. She was a new colostomy, and skilled nursing was ordered to assist with the management and teaching of the new device. During the experienced nurse visits, her blood pressure was elevated. An assessment was completed, and she prescribed Verapamil, and she did admit to not taking medication consistently. The patient was provided comprehensive education and tasked to write each blood pressure taking with her medicine. Once this was completed, after three more visits, it was explained to the patient her medication is not appropriate. Usually, this medication is not used to treat hypertension, and especially with African Americans. She contacted the doctor and scheduled an appointment to have her medication reassessed.

 Calcium channel blockers are found not to be effective in African Americans(Gepner et al., 2017) . Research has shown that African American culture is strongly associated with the profession of carotid arterial stiffness due to the use of calcium channel blockers (Gepner et al., 2017). It is essential to consider the side effects of the prescribed medication and follow up with the patient to monitor side effects and effectiveness (Rosenthal & Rosenjack-Burchum, 2018). The patient has prescribed the wrong antihypertensive medication, and a proper reevaluation was not completed.

As her Practitioner, I would prescribe her a thiazide antihypertensive, Hydrochlorothiazide starting with 12.5 mg daily with perimeters of 120- 130 Systolic blood pressure and anything more significant call the office. Hydrochlorothiazide is found to be successful in treating hypertension in African Americans when used in combination angiotensin receptor blockers.  Provide medication education about the risk and benefits of medications. The patient would then be scheduled to return to the office with recorded blood pressure readings and to check blood pressure manually to compare with the patient the automatic blood pressure readings. Lastly, before making any change to medication, an assessment of patients’ diet, exercise, and compliance would be assessed.

References

Gepner, A. D., Tedla, Y., Colangelo, L. A., Tettersall, M. C., Korcarz, C. E., Kaufman, J. D., Liu, K., Burke, G. L., Shea, S., Greenland, P., & Stein, J. H. (2017). Progression of carotid arterial stiffness with treatment of hypertension over 10 years. Hypertension, 69(1), 87–95. Advance online publication. https://doi.org/10.1161/hypertensionaha.116.08402

Rosenthal, L., & Rosenjack-Burchum, J. L. (2018). Lehne’s Pharmacotherapeutics for Advanced Practice Providers [Kindle Edition]. Elsevier.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. https://doi.org/10.1002/2327-6924.12446

 

 

 

response

As a former home health nurse, I can certainly relate to the challenges that present when dealing with differing levels of patient participation and compliance. I don’t know about your experience, but many patients feel as though it is the nurse’s responsibility to make sure that the patient comes by and checks these medications daily and then wonder why they aren’t feeling better. I feel as though it is a combination of unrealistic expectations and a lack of ability and/or responsibility.

Of course, one cannot discount a patient’s own level of intelligence and comprehension as well, whether due to an educational background or disease process. Sometimes, it is our fault as well. Prochnow, Meiers, and Scheckel (2019) noted that just over 60% of patients and caregivers are properly educated by medical staff about the medications they or their loved ones receive. Even with that amount of education given, these people only understand and retain perhaps half of what is told to them.

How many times have you asked a patient why they take a certain medication and they say, “Because the doctor told me to.”

Another problem faced by patients and prescribers is the very real danger of polypharmacy. In my own personal experience, it was nothing for me to become a case manager for a patient who, upon meeting them and reviewing their medications, it was evident that physicians were not talking to each other and talking to the patient. If a patient had a primary care doctor who prescribed a medication, then an endocrinologist who would prescribe another without reviewing the others, for example. The synergism between the mediations, and often times supplements that were not prescribed at all, could lead to adverse drug events (ADEs). While their prescribers are trying to what is best for their patient as they know how to do within their specialties, such polypharmacy and ADE occurrences actually increase hospitalizations ( Wang-Hansen, Wyller, Hvidsten, & Kersten, 2019). Clearly, better screening and communication is paramount.

 

References

Prochnow, J. A., Meiers, S. J., & Scheckel, M. M. (2019). Improving Patient and Caregiver New Medication Education Using an Innovative Teach-back Toolkit. Journal of Nursing Care Quality, 34(2), 101–106.

Wang-Hansen, M. S., Wyller, T. B., Hvidsten, L. T., & Kersten, H. (2019). Can screening tools for potentially inappropriate prescriptions in older adults prevent serious adverse drug events? European Journal of Clinical Pharmacology, 75(5), 627–637.

 

 

 

Discussion: Pharmacokinetics and Pharmacodynamics

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease NURS 6521 Week 1 Verapamil 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 NURS 6521 Week 1 Verapamil Discussion: 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.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics.

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 NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics.

By Day 6 of Week 1

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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

The selection of drugs for individuals involves considering different aspects about the person. Some considerations would be if there are any allergies, sensitivities, age, and how well their liver, kidneys, and heart

function to name a few. It is important to recognize the different pharmacokinetic processes, absorption, distribution, metabolism, and excretion when prescribing a medication to an individual.  Knowing the pharmacodynamics of drugs is equally as important (Rosenthal & Burchum, 2018). The purpose of this discussion is to share a clinical scenario and describe the pharmacokinetic processes and the pharmacodynamics of the drug given to the patient in the scenario.

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Clinical Scenario

A gentleman in his sixties was brought to the hospital extremely short of breath, crackles through out his lungs, pitting edema to his lower extremities, ascites, and scrotal edema. This patient has a history of

congestive heart failure, diabetes, atrial fibrillation, and kidney disease. In this situation, the primary focus to help this patient is diuresis. The patient admits to being non-compliant with his fluid restrictions at home,

and typically does not take his furosemide due to it making him use the bathroom too frequently. In this situation, the hospitalist has decided to start the patient on intravenous furosemide NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics.

Pharmacokinetic and Pharmacodynamic Factors

Furosemide is a loop diuretic that is used to maintain fluid balance. It targets edema that may be secondary to congestive heart failure, renal failure, and high blood pressure. By inhibiting the reabsorption of electrolytes, the excretion of water is enhanced. Blood pressure can be lowered by furosemide due to the change in plasma volume (Lamarche, Pichette, Ouimet, Stewart, & Pichette, 2016). Furosemide is plasma protein-bound with a majority excreted in the urine. The duration of furosemide after intravenous administration is two hours. Furosemide blocks the absorption of electrolytes such as sodium and chloride from filtered fluid in the kidney tubules leading to diuresis. Furosemide is metabolized minimally in the liver, and more than fifty percent is excreted in the urine.  In this scenario, it is important to monitor the patient’s kidney function because the furosemide can lead to dehydration and swelling of the kidneys.

This patient would benefit from furosemide because it is highly effective with treating fluid overload from congestive heart failure. However, his renal dysfunction can also play a role in how effective the furosemide is as well. There may a reduction of the secretion of furosemide in the proximal tubule cells due to his impaired renal function (De Denus, Rouleau, Mann, Huggins, & Cappola, 2017). For this patient it was important to find the right dosage of furosemide to get the desired therapeutic effect. Other medications related to his past medical history had to be changed to prevent further damage to his kidneys. During this stay, the patients lisinopril and metformin were put on hold. Metformin levels in a patient with renal impairment can build up leading to lactic acidosis. The ACE inhibitors are metabolized by the kidneys and sometimes

are put on hold until kidney function has improved.

Plan of Care

This patient’s plan of care begins with diuresis, strictly monitoring intake and output for the patient, and restricting daily fluid intake. The patient needs re-educated on congestive heart failure, fluid overload, and

signs and symptoms to monitor for. The patient also needs re-educated on the importance of compliance with medications, their purpose, and desired effects. It is important to make sure medications are affordable

and help the patient understand his medications and why it is important to not skip a dose. After the patient has received the therapeutic effects from intravenous furosemide, he should be switched over to an oral

dose to continue on a daily basis. NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics

References

De Denus, S., Rouleau, J., Mann, D., Huggins, G., & Cappola, T. (2017). A pharmacogenetic investigation of intravenous furosemide in decomensated heart failure: A meta-analysis of three clinical trials. The Pharmacogenomics Journal, 17(2), 192-200. doi:10.1038/tpj.2016.4

Lamarche, C., Pichette, M., Ouimet, D., Stewart, J., & Pichette, V. (2016). Pharmacokinetic and dynamic of furosemide in peritoneal dialysis patients. Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 36(1), 107-108. doi:10.3747/pdi.2014.00328

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

 

NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics response

Wonderful discussion post regarding the use of Furosemide in the elderly as you stated it is a loop diuretic that is used to maintain fluid balance. And you have described and applied knowledge of pharmacokinetics to drug therapy, and use your knowledge to help maximize beneficial effects and minimize harm. According to (Rosenthal et al.,2018) the intensity of the response to a drug is causally related to the concentration of the drug at its site of action. To maximize beneficial effects, a drug must achieve concentrations that are high enough to elicit desired responses; to minimize harm and must avoid concentrations that are too high. This balance is achieved by selecting the most appropriate route, dosage, and dosing schedule. Rosenthal, L. D., & Burchum, J. R. (2018) NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics

As I read your post, I recall many times where patients reported that they want to have good results from the medication but hate to get up two or three times during the night to run to the restroom. But must always remind our patient’s Furosemide is a type of diuretic drug that is used long term. Although it did not reduce the death rate, furosemide significantly improved clinical symptoms as well as curative effects (ZHI-HAO CHEN et al.,2016)

What I understand to be effective as stated by (Aguirre et al.,2017) that a legitimate arrangement of care can incorporate properly choosing drugs that have a clear proof for their showed use, just as whether it is suitable for the patient’s conditions, and whose advantages exceed the dangers (Aguirre et al., 2017) NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics. Great, post I enjoy reading it.

 

References

Aguirre, N., Martínez, A., Muñoz, L., Avellana, M., Marco, J., & Díez-Manglano, J. (2017).

 

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

ZHI-HAO CHEN, YU-RONG JIANG, JIA-QIN PENG, JIA-WANG DING, SONG LI, JIAN YANG, HUI WU, & JUN YANG. (2016). Clinical effects of combined treatment by an optimal dose of furosemide and spironolactone on diastolic heart failure in elderly patients. Experimental & Therapeutic Medicine, 11(3), 890–894. https://doi-org.ezp.waldenulibrary.org/10.3892/etm.2015.2967 NURS 6521 Week 1 Verapamil Discussion: Pharmacokinetics and Pharmacodynamics