Discussion: Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.
Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.
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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.
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.
- 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.
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!
Week 1 Post- Pharmacokinetics and Pharmacodynamics
One specific case that I remember when I was a floor nurse on a Med-Surg unit was a young lady that came thru the ER with an infected diabetic wound. This patient was non-compliant with following her diabetic regimen such as diet and medications. This patient also had mild renal issues as well. Down in the ER the patient was given a round of Vancomycin as soon as she arrived at the ER. Now at the hospital where I was working at the time, we had a medication scan system in place to help prevent and reduce medication errors. However, this medication scan system was not in place down in our ER at the time.
A lot of the times, nurses would receive the verbal orders from the ER physician then directly put them into the ER pharmacy, administered the medication and then chart it later. This patient came in right before the change of shift, received the Vancomycin and completed the infusion from the first nurse and was handed off to the next nurse on the next shift. The first nurse did not chart that she had administered the Vancomycin, nor did she pass this information in report to the second nurse. The order for the medication was still on the MAR and looked like it had not been given, so of course the second nurse administered a second dose of the Vancomycin. With that being done, this placed the patient into renal failure.
Factors that influenced the patient’s pharmacokinetics are that she already before receiving the double dose of Vancomycin had some mild renal issues which alters her kidney metabolism. Receiving the one dose was already risky due to her impaired renal function. Orders for a vanco peak and trough were place in the patient’s chart to check her vanco levels before the next round of Vancomycin was due to be given, which was in the next 24hours.
Personalize Plan of Care
Personalized plan of care for this patient, I would first immediately discontinue the antibiotics and start hemodialysis on the patient the try to preserve what renal function that they have left. I also would order labs daily to continuously monitor the patient’s creatinine levels, to see if they have improved or worsened. Once the patient creatinine levels are improved, I would start this patient on oral antibiotics and continue to closely monitor her renal functions and her glucose levels. Continue to educate the patients on the importance of modification of her diet and compliance with her hyperglycemic medications.
References
Web MD, LLC. (n.d.). Drug and Diesease. Retrieved from Medscape: https://reference.medscape.com/drug/firvanq-vancocin-vancomycin-342573