Advanced practice nurse assisting physicians in the diagnosis and treatment of disorders

  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. 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 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. Response 1 Pharmacokinetics and Pharmacodynamics define how drugs and the human body interact, with Pharmacokinetics explaining how the body reacts after a person takes drugs. Pharmacodynamics, on the other hand, describes what the drug does to a body after intake. Several patient factors may impact the Pharmacodynamics and Pharmacokinetics of medications. Considering this, providers must be cognizant of the medications prescribed in light of several patient factors to improve the patients’ experiences (Burchum & Rosenthal, 2021). Accordingly, prescribers ought to consider several aspects, including drug dosages, based on patient factors. Patient Scenario The patient case scenario involved Mr. Daniel, a 32-year-old male with a history of drug abuse and admitted in critical care after a motor vehicle accident. The patient’s right leg had been crushed severely, and a replantation surgery to repair the damaged anterior and posterior tibial nerves and tendons were needed. Internal fixation of the tibial bone was also performed. After the surgery, the patient was in severe pain and requested ‘something’ for pain. The physician prescribed Butorphanol 2 mg intravenously. 30 to 60 minutes later, the patient was still complaining of severe pain, had become very agitated, uncooperative, and abusive, and needed something more potent. The physician was notified of the patient’s complaint and behavior. While the doctor was hesitant to prescribe another medication, he gave Demerol 25 mg intramuscularly every 4 hours as needed. Patient factors influencing the pharmacodynamics and pharmacokinetic processes The patient in the scenario had a significant history of illicit drug use. According to Vadivelu et al. (2017), drug use causes a substantial impact on medications' efficacy and how the body responds to medications. For example, individuals who have prolonged use of opioids may develop tolerance to other potent opioids and may require larger and more frequent doses to relieve pain (Kim, Nolan, & Ti, 2017). In the scenario above, the patient may have developed tolerance to opioid medications due to the chronic use of controlled substances. A Personalized plan of care The individualized plan of care for Mr. Daniel was to manage pain and avoid unnecessary suffering while minimizing relapse. This may require slightly higher doses of opioid medications to help relive his pain. Providers must also accept and believe the patient’s report about the degree of pain to fully manage their pain. This would eliminate the risk of pain under treatment, pseudo-addiction, and the unnecessary suffering that may result in agitation. Additionally, a pain management plan is critical to ensure that the adverse effects of opioid medications, including respiratory depression, are minimized (Vadivelu, et al., 2017). As a result, a balance between under treatment and over treatment of the patient’s pain is attained. Response 2 I have an example from this past week at the hospital where I am currently working. We had a patient come to our floor through the emergency room with chest pain and hypertension. This patient was an 80-year-old white male with a past medical history of hypertension, type two diabetes, obesity, and heart catheterizations with stents. While the patient was in the emergency room blood pressures were running 200s/100s prior to being medicated. The patient arrived to the floor with improved blood pressures, but remained hypertensive. The troponin in the emergency room was 0.29. The cardiologist and his PA decided to add in metoprolol 25 mg BID to cover the hypertension. This was a new medication for the patient. Metoprolol is a selective beta blocker that blocks beta 1 receptors. Some of the side effects is hypotension and bradycardia (Comerford, 2017). Rosenthal and Burchum (2021) reiterate that all medications have side effects. Some of the effects are wanted and some are detrimental to the patients, and we must constantly monitor for those side effects throughout the medication usage. The repeat troponin resulted at 0.44 and the cardiologist decided to take the patient to the cath lab for a heart cath stat where they placed two stents to open an 80 percent blockage in the obtuse marginal branch. When the patient returned to the floor from the procedure both blood pressure and pulse had decreased. Gedela et al. (2017) states that bradycardia is a common side effect of heart characterizations. The cardiologist had not discontinued the metoprolol and specifically put in a physician to nurse order to give all cardiac medications as long as the patient met the parameters. The patient’s pulse was fluctuating between the high 40s to the low 60s. At the point when the medication was due all parameters were met so the medication was administered. Soon after the patient’s pulse dipped down into the high 30s, but systolic blood pressure remained above 100 and the patient was asymptomatic. As I move into my practice as an ARNP I have to keep in mind that the pharmacokinetics and pharmacodynamics can change post procedure if the acute problem is fixed during that procedure. I must assess the whole patient again after they undergo something that might change how the patient presents in order to determine whether new medications that were added during and acute situation are still needed post procedure. It may have been a good idea for the cardiologist to adjust the metoprolol to PRN to see if it was still needed, but still have it available for administration if the blood pressure became elevated again.