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- Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.<\/li>\n\n\n\n
- 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.<\/li>\n\n\n\n
- Consider factors that might have influenced the patient\u2019s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and\/or possible pathophysiological changes due to disease.<\/li>\n\n\n\n
- Think about a personalized plan of care based on these influencing factors and patient history in your case study.<\/li>\n<\/ul>\n\n\n\n
By Day 3 of Week 1<\/h4>\n\n\n\n
Post<\/strong> 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.<\/p>\n\n\n\n
By Day 6 of Week 1<\/h4>\n\n\n\n
Read<\/strong> a selection of your colleagues\u2019 responses and respond<\/strong> to at least two<\/strong> of your colleagues on two different days<\/strong> 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.<\/p>\n\n\n\n
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Note:<\/strong> For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues\u2019 postings. Begin by clicking on the \u201cPost to Discussion Question\u201d link, and then select \u201cCreate Thread\u201d 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!<\/strong><\/em><\/p>\n<\/blockquote>\n\n\n\n
Solution<\/h3>\n\n\n\n
Patient Factors that Influence Pharmacokinetic and Pharmacodynamics Processes<\/h4>\n\n\n\n
Nurses all over the world have a significant effect on their patients\u2019 health and well-being. Besides maintaining records and monitoring the patient\u2019s conditions, they also communicate with physicians to administer medications (Franken et al., 2016). The nursing staff also has to ensure a patient reacts well to treatments necessitating that they understand the fundamentals of pharmacokinetics and pharmacodynamics (Sandritter et al., 2017). <\/p>\n\n\n\n
In the context of this discussion, pharmacokinetics refers to the study of what it takes for medications to absorb, distribute, metabolize, and excrete (ADME). Likewise, pharmacodynamics herein describes the study of the physiological and biochemical impact of medications and their mechanisms of action. Therefore, this post aims to reflect on a case from a past clinical experience with a bias towards how the patient\u2019s context pharmacokinetic and pharmacodynamics processes may change their response to the drug administered. <\/p>\n\n\n\n
Description of the Patient Case from My Clinical Practice <\/h4>\n\n\n\n
One of the primary goals of any healthcare provider who administers medications is to ensure the individual gets the correct prescription and dosage to enhance efficiency and decrease toxicity in the body. I have encountered several patient cases, but the scenario that stands out was Miss Jane Doe (JD), a 27-year-old female of African American race who was in the recovery room following an open hernia repair procedure. <\/p>\n\n\n\n
During the SOAP note-taking, the patient reported having comorbidities through Type 2 diabetes mellitus (T2DM), hyperlipidemia, hypertension and back pain. JD also had issues with alcohol and narcotics. She was prescribed a 75 mg\/h Fentanyl patch and 300 mg Vicodin tablets after the anesthesia wore off to manage the pain. JD reported having severe pain, which she rated at 9 on a scale of 10.<\/p>\n\n\n\n
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The physician recommended I give the patient 2 mg of Dilaudid medication every 10minutes as recommended by the anesthesiologist. When the pain persisted, the anesthesiologist instructed the Dilaudid to be increased to4 mg, administered intravenously. 40minutes later, JD was not only shouting but also crying hysterically while complaining of severe pain. The anesthesiologist increased the drug dosage to a maximum of 6 mg and explained that she was not to take more than 6 mg if discharged. Half an hour later, the patient reported her pain had subsided to 7 out of 10 and requested that she be discharged. <\/p>\n\n\n\n
Description of the Factors That Might Have Influenced Pharmacokinetic and Pharmacodynamics Processes of the Patient Identified in This Case Scenario<\/h4>\n\n\n\n
JD has a history of substance abuse and use of narcotics, making her develop drug tolerance. This is one of the likely reasons why the patient requires high doses of Dilaudid. According to Injection (2011), Dilaudid injection should be used in opioid-tolerant patients. Another behavioral choice that would significantly affect how JD \u2018s body reacts to Dilaudid is her continued alcohol use. Dilaudid is an opioid analgesic that effectively manages moderate to severe pain after surgery (Jeleazcov et al., 2014). <\/p>\n\n\n\n
It is worth noting that hydromorphone has its fair share of side effects, but the use of alcohol means the side effects of Dilaudid could even be fatal. The limited scope of this post necessitates that the third and last of the patient factors that may have influenced Dilaudid\u2019s pharmacokinetics and pharmacodynamics is that she is of African American race. Kim et al. (2019) report that African Americans have the highest pain tolerance. As such, her pain assessment at 7 out of a possible 10 was sufficient for her to request to be discharged.<\/p>\n\n\n\n
The Personalized Plan of Care That One Would Develop Based on Influencing Factors and Patient History in the Selected Case<\/h4>\n\n\n\n
The personalized treatment plan would not interfere with the dosage or medications the patient was taking to manage her T2DMlike Metformin. The reason for Metformin continued use is that it is a non- sulfonylurea and does not interact with Dilaudid. Be that as it may, the patient would be advised to stop taking alcohol while under Dilaudid treatment because this may significantly increase side effects like impaired thinking and judgement, dizziness, and drowsiness. In severe cases, serious side effects like low blood pressure, difficulties in breathing or even death could result. (Drugs.com, n.d.).<\/p>\n\n\n\n
This post has established that pharmacokinetics concentrates on how medications move within the body from the point of administration until they are entirely absorbed, while pharmacodynamics refers to studying the impact drugs\/medications or substances have on an individual\u2019s body. In clinical practice settings, the principles of pharmacokinetics and pharmacodynamics should be applied during the entire treatment process if the patient receives safe and effective treatment. <\/p>\n\n\n\n
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Most importantly, the healthcare provider should be aware of the interplay of patient factors like genetics, gender, race or ethnicity, age, lifestyle choices and pathophysiological processes resulting from diseases that impact the specific patient pharmacokinetics and pharmacodynamics.<\/p>\n\n\n\n
References<\/h2>\n\n\n\n
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- Drugs.com(n.d.) Dilaudid (hydromorphone) and Alcohol\/Food Interactions URL: https:\/\/www.drugs.com\/food-interactions\/hydromorphone,dilaudid.html Accessed August 31st, 2021.<\/li>\n\n\n\n
- Franken, L. G., de Winter, B. M., Van Esch, H. J., van Zuylen, L., Baar, F. P. M., Tibboel, D., \u2026 & Koch, B. C. P. (2016). Pharmacokinetic considerations and recommendations in palliative care, with a focus on morphine, midazolam and haloperidol. Expert opinion on drug metabolism & toxicology, 12(6), 669-680<\/li>\n\n\n\n
- Injection, D. (2011). and Dilaudid-HP Injection (hydromorphone hydrochloride) [packageinsert]. Stamford, Conn: Purdue Pharma, LP.<\/li>\n\n\n\n
- Jeleazcov, C., Saari, T. I., Ihmsen, H., Mell, J., Fr\u00f6hlich, K., Krajinovic, L., \u2026 & Sch\u00fcttler, J. (2014). Population pharmacokinetic modelling of hydromorphone in cardiac surgery patients during postoperative pain therapy. Anesthesiology, 120(2), 378-391.<\/li>\n\n\n\n
- Kim, H. J., Greenspan, J. D., Ohrbach, R., Fillingim, R. B., Maixner, W., Renn, C. L., \u2026 & Dorsey, S. G. (2019). Racial\/ethnic differences in experimental pain sensitivity and associated factors\u2013Cardiovascular responsiveness and psychological status. PloS one, 14(4), e0215534.<\/li>\n\n\n\n
- Sandritter, T. L., Mclaughlin, M., Artman, M., & Lowry, J. (2017). The Interplay between Pharmacokinetics and Pharmacodynamics. Pediatrics in review, 38(5), 195-206.<\/li>\n<\/ul>\n\n\n\n
Epidemiology & Pathophysiology Papers<\/h2>\n\n\n\n
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