Week 2: Basic Pharmacotherapeutic Concepts
In 2011, more than 3.7 billion drug prescriptions were filled at pharmacies in the United States (The Kaiser Family Foundation, 2011). With billions of drugs prescribed each year for the treatment and management of various disorders, it is essential for advanced practice nurses to familiarize themselves with common drug treatments and the effects that these treatments have on patients. When prescribing drugs, ensuring patient safety is the major concern. In many clinical settings, nurses work more closely with patients than any other health care provider, making it their responsibility to Help physicians with this task. As an advanced practice nurse maintaining patient safety, you must consider the many patient factors that impact pharmacotherapeutics.
This week you explore factors that influence pharmacokinetic and pharmacodynamic processes in patients. You also examine patient factors that advanced practice nurses must consider when developing drug therapy plans.
Reference:
The Kaiser Family Foundation. (n.d.). United States: Prescription drugs [Spreadsheet]. Retrieved August 14, 2012, from http://www.statehealthfacts.org/profileind.jsp?sub=66&rgn=1&cat=5
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
Learning Resources
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 2, “Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles”
This chapter examines concepts related to pharmacokinetics and pharmacodynamics. It also explores patient factors that health care providers consider when prescribing drug therapy to patients.
Chapter 3, “Impact of Drug Interactions and Adverse Events on Therapeutics”
This chapter explains drug-drug, drug-food, drug-herb, and drug-disease interactions. It also reviews patient factors that influence drug interactions and then covers adverse drug reactions.
Chapter 4, “Principles of Pharmacotherapy in Pediatrics”
This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.
Chapter 6, “Pharmacotherapy Principles in Older Adults”
This chapter describes issues and factors that affect drug therapy for elderly patients. It then explores concepts relating to drug selection, administration, and management for elderly patients.
Scott, S. A. (2011). Personalizing medicine with clinical pharmacogenetics. Genetics in Medicine,13(12), 987–995. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290900/
This article examines pharmacogenetic testing in relation to personalized drug therapy plans. It also explores evidence-based guidelines and recommendations on pharmacogenetic testing.
Optional Resources
Drugs.com. (2012). Retrieved from www.drugs.com
Haymarket Media, Inc. (2012). Monthly prescribing reference. Retrieved from http://www.empr.com/
Institute for Safe Medication Practices. (2012). Retrieved from http://www.ismp.org/
WebMD. (2012). Medscape. Retrieved from http://www.medscape.com/
Discussion: Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse Helping 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, and illicit drug abuse), and/or pathophysiological changes due to disease. In this Discussion, you reflect on a case from your past clinical experiences and consider how a particular patient’s pharmacokinetic and pharmacodynamic processes altered his or her response to a drug.
To prepare:
Review Chapter 2 of the Arcangelo text and the Scott article in the Learning Resources. Consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last 5 years. Select a case from that time period that involves a patient whose individual differences in pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
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
Discussion Post Needed: Post a description of the case you selected. Then, describe the factors that might have influenced the pharmacokinetic and pharmacodynamic processes of the patient from the case you selected. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case.
Spacing Double
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I remember a case from my past clinical experiences where a particular patient’s pharmacokinetic and pharmacodynamic processes altered his response to a drug. The patient was a 75-year-old man named John who was admitted to the hospital with pneumonia. He was started on a course of antibiotics, but he did not seem to be responding well. His doctor ordered a blood test to check his levels of the antibiotic, and it was found that his levels were much lower than expected. This was due to a number of factors, including his age, his liver function, and the fact that he was taking other medications that could interact with the antibiotic.
As a result of his low antibiotic levels, John’s pneumonia was not getting better. His doctor had to increase the dose of the antibiotic, and he also had to monitor John’s levels closely to make sure that they were not too high. This case taught me the importance of considering a patient’s individual pharmacokinetic and pharmacodynamic processes when prescribing medications. It is also important to monitor patients closely for signs of drug toxicity, especially in older adults and patients with other health conditions.
Here are some of the factors that might have influenced John’s pharmacokinetic and pharmacodynamic processes:
Age: Older adults tend to have slower metabolisms, which means that it takes them longer to break down and eliminate drugs. This can lead to higher drug levels in the blood, which can increase the risk of side effects or toxicity.
Liver function: The liver is responsible for metabolizing many drugs. If the liver is not functioning properly, it can lead to higher drug levels in the blood.
Other medications: Some medications can interact with other medications, which can affect how the body metabolizes and eliminates drugs. This can lead to higher or lower drug levels in the blood, which can increase the risk of side effects or toxicity.
In John’s case, all of these factors contributed to his low antibiotic levels. As a result, his pneumonia was not getting better. His doctor had to increase the dose of the antibiotic and monitor John’s levels closely to make sure that they were not too high.
This case taught me the importance of considering a patient’s individual pharmacokinetic and pharmacodynamic processes when prescribing medications. It is also important to monitor patients closely for signs of drug toxicity, especially in older adults and patients with other health conditions.
