NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics

March 6, 2022

NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics

NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics

NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics

https://www.allnursingessays.com/nurs-6521-discussion-pharmacokinetics-and-pharmacodynamics/

Working in an intermediate care unit, I get to see patients from all races with different healthcare needs and conditions. One obvious thing observed from the so many patients that come into the facility is the prevalence of diabetes, hypertension and chronic obstructive pulmonary disease (COPD) in patients ages 20 years and above. Though the diseases are common, the types of medications used in treating them may differ in dose, brand, and pricing. When prescribing medications for an individual patient, the physician considers the effects of the drugs and the mechanism of their action on that particular patient.

Let us consider a 75-year-old male patient who is admitted for uncontrolled Diabetes. The patient has a past medical history of Diabetes type II and takes metformin to control his glucose but had not been able to afford the refills for his medication. On admission the patient presented with a blood glucose of 288 mg/dl and was ordered Lispro on a low dose sliding scale with blood glucose monitoring before meals and at bedtime. The patient was assigned to a young nurse who had recently just started working on the unit. Just before the lunch trays came in, the nurse went to review the patients’ blood glucose levels the nurse tech had checked. Without paying much attention, the nurse drew up 8 units of lispro insulin and administered it to the patient for what she thought was a blood sugar of 288mg/dl. After about 20 minutes the nurse discovered that the patient was sweating a lot and had an increased heart rate with slight shivers. The young nurse called the attention of an older nurse and explained all the care she had provided to the patient prior to discovering his current state. The two nurses reviewed the documentation on the computer and saw that the patients’ last blood glucose check was 98mg/dl and not 288mg/dl as the young nurse had thought it was. The older nurse immediately got a glucometer and checked the patients’ blood glucose which was now 52mg/dl, and also discovered that the patient had not eaten anything. The older nurse immediately followed the establishment’s protocol and administered 1 gram of glucagon to the patient, checked his blood glucose which had gone up slightly and then administered another gram, checked his blood glucose again, and then provided the patient with a small cup of orange juice and a cracker.

As nurse practitioners, it is important to know and understand the pharmacokinetics and pharmacodynamic processes. Pharmacokinetics is the process of a drug being absorbed, distributed, metabolized, and excreted from the body (Rosenthal and Burchum, 2021). Pharmacodynamics is the relationship between drug concentration at the site of action and the resulting effects which include the time and severity of therapeutic and adverse effects (DiPiro, 2008).

NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics

NURS 6521 Discussion Pharmacokinetics and Pharmacodynamics

Lispro Insulin is a rapid-acting insulin that has a short duration of action which is used to improve blood glucose management in patients with diabetes (Rosenthal and Burchum, 2021). It is more effective than the normal human insulin in improving and helping to maintain blood glucose control (Campbell et al., 1996). Factors that might influence the pharmacokinetics and pharmacodynamics of insulin are the size of the dose, the injected volume and the insulin concentration, vigorously rubbing the site of the injection, increase in temperature which increases absorption rate, site of the injection (absorption is faster when administered in the abdomen), and exercising of extremity within an hour of injection can speed up absorption (Donner and Sarkar, 2019). The patient received a large dose of insulin for an inaccurate blood glucose reading and presented with a hypoglycemic reaction due to the large amount of insulin that was administered.

A personalized care plan for the patient based on influencing factors and the patients history would be to set goals for the patient that include effective treatments to normalize and manage blood glucose levels, decrease the risk for hypoglycemic or hyperglycemic events using insulin medication, diet, and exercise, informing and educating the patient on the importance of compliance with medication regimen and importance of monitoring blood glucose, providing the patient with prescription savings or discount cards like Good Rx, and providing the patient with location to local community clinics that help with providing low-cost prescription medications.

Ensuring that the patient is properly educated and provided with the necessary resources to provide for his medication will promote his participation in self-care and ensure his compliance with monitoring and maintaining manageable blood glucose levels.

 

References:

Campbell, R. K., Campbell, L. K., & White, J. R. (1996, November). Insulin lispro: its role in the treatment of diabetes mellitus. The Annals of pharmacotherapy. https://pubmed.ncbi.nlm.nih.gov/8913409/.

Donner, T., & Sarkar, S. (2019). Insulin – Pharmacology, Therapeutic Regimens, and Principles of Intensive Insulin Therapy. Endotext [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK278938/.

DiPiro, J. T. (2008). Pharmacotherapy: A pathophysiologic approach. McGraw-Hill Medical.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) Elsevier.

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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.

Photo Credit: Getty Images/Ingram Publishing

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!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

 

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion

 Week 1: Basic Pharmacotherapeutic Concepts/Ethical and Legal Aspects of Prescribing

How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.

This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.

Learning Objectives

Students will:

  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients
  • Assess patient factors and history to develop personalized plans of care
  • Evaluate ethical and legal implications related to prescribing drugs
  • Analyze ethical and legal practices of prescribing drugs
  • Analyze strategies to address disclosure and nondisclosure
  • Justify advanced practice nurse strategies to guide prescription drug decision-making
  • Analyze the process of writing prescriptions to avoid medication errors

Learning Resources

Required Readings (click to expand/reduce)

 

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

  • Chapter 1, “Prescriptive Authority” (pp. 1–3)
  • Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
  • Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
  • Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
  • Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
  • Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

 

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

 

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

 

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

 

This website details key aspects of drug registration.

 

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application (2nd ed.). American Nurses Association.

 

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

 

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

 

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

 

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

 

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

Required Media (click to expand/reduce)

 

Introduction to Advanced Pharmacology

Meet Dr. Terry Buttaro, associate professor of practice at Simmons College of Nursing and Health Sciences as she discusses the importance of pharmacology for the advanced practice nurse. (8m)

Nature Video. (2016). The evolution of oral anticoagulants [Video]. https://www.youtube.com/watch?v=Gp-ucDRiaUA
Note:
This media program is approximately 5 minutes.

Speed Pharmacology. (2015). Pharmacology Pharmocokinetics (Made Easy) [Video]. https://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s
Note: This media program is approximately 14 minutes.

Speed Pharmacology. (2017).  Pharmacology Diuretics (Made Easy) [Video]. https://www.youtube.com/watch?v=9OBvNpnS0h4&t=664s
Note:
This media program is approximately 18 minutes.

Speed Pharmacology. (2017). Pharmacology Antiarrhythmic Drugs (Made easy) [Video]. https://www.youtube.com/watch?v=9xSqezCMHnw&t=1205s
Note:
This media program is approximately 23 minutes.

Speed Pharmacology. (2015). Pharmacology Pharmocokinetics (Made Easy) [Video]. https://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s
Note: This media program is approximately 14 minutes.

Speed Pharmacology. (2016). Pharmacology – Adrenergic receptors & agonists (MADE EASY) [Video]. https://www.youtube.com/watch?v=KtmV-yMDYPI&t=372s
Note: This media program is approximately 18 minutes.

Speed Pharmacology. (2017). Drugs for Hyperlipidemia (Made Easy) [Video]. https://www.youtube.com/watch?v=Of1Aewx-zRM&t=24s
Note:
This media program is approximately 14 minutes.

 Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6521_Week1_Discussion_Rubric

  Excellent Good Fair Poor
Main Posting Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness Points Range: 10 (10%) – 10 (10%)

Posts main post by day 3

Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%)

Does not post by day 3

First Response Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed. .

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation Points Range: 5 (5%) – 5 (5%)

Meets requirements for participation by posting on three different days.

Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%)

Does not meet requirements for participation by posting on 3 different days

Total Points: 100

Name: NURS_6521_Week1_Discussion_Rubric

Hello Class,

About a year ago, a 70-year-old male patient was brought to the emergency care with complaints of severe chest pain, sever headache, confusion, and blurry vision. Following examination, he was tachycardic and hypertensive. He had a health history of depression, hypertension, and chronic kidney disease (CKD). He was diagnosed to have a hypertensive crisis. He used to take ACE inhibitor for hypertension and Sertraline (Zoloft) for depression.

The key factor of consideration in the treatment of this patient was CKD, which is the possible reason being uncontrolled hypertension. It would be to be taken into account when treating the patients and prescribing medications. The other consideration is the patient’s age. Being elderly, he is at risk of mental/ cognitive decline which affects medication compliance and altered pharmacokinetics which affect medication’s effectiveness (Rosenthal & Burchum, 2018). To address the issue of CKD, his real function panel was obtained to establish if he had an acute renal failure (ARF) to develop a more personalized long-term care for his multiple chronic illnesses.

According to Keller and Hann (2018), acute kidney failure/ injury affects drug pharmacokinetics and at least 50% of essential drugs are affected by kidney dysfunction.

Personalized care for the patient involved assessing his mental/ cognitive functionality to to determine whether he needed assistance with activities of daily living (ADL) and altering the medication dosages to ensure they attain high effectiveness with minimal adverse drug reactions (ADRs) (Rosenthal & Burchum, 2018). Personalized care also involves continued patient monitoring and education on medication, disease, and self-management, includin

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