Advanced practice nurses will be working with a multitude of individuals and it is important for an advance practice nurse to know and understand pharmacokinetics and pharmacodynamics of the different medications that they will be prescribing throughout their career. According to Rosenthal and Burchum (2018), pharmacokinetics is the study of drug movement throughout the body and pharmacodynamics is the study of the biochemical and physiologic effects of drugs on the body and the molecular mechanisms by which those effects are produced. Pharmacokinetics involves four basic processes which includes absorption, distribution, metabolism, and excretion (Rosenthal & Burchum, 2018). NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics.
A 68-year old female comes to the hospital because she is feeling flushed and just not feeling like herself. Upon examination the patient is hypertensive and slightly tachycardic. The patient does not have any complaints of pain. The patient has a health history of anxiety, depression, COPD, hypertension, and chronic kidney disease. The patient is being admitted for hypertensive crisis. The patient takes a serotonin reuptake inhibitor for her depression, an ace inhibitor for her hypertension.
One factor to consider while treating this patient is their chronic kidney disease. The chronic kidney disease could be one reason that the patient is having uncontrolled hypertension and will also need to be considered when treating this patient with new medications. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics A second factor could be the patient’s compliance with medication regimen at home. A third reason could be environmental exposure.
One of the first things that would need to be done would be to ask the patient about her compliance with her home medication regimen. It would be important to obtain a renal function panel to determine if the patient was in acute renal failure. After this information is obtained a better plan of care could be made for the patient’s long-term treatment.
If a patient is having acute kidney failure or injury the alterations of drug responses are attributed to pharmacokinetics and that at least 50% of all essential medications are influenced by kidney dysfunction (Keller & Hann, 2018). The four basic processes of pharmacokinetics play a major role in renally compromised patients NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics. All four phases involve movement and if one phase is compromised it can cause a disruption in the effectiveness of the medication.
Environmental exposures can also be taken into consideration when considering the pharmacokinetics and pharmacodynamics of the effectiveness of a medication. In a recent study it was shown that environmental pollutants such as pesticides can alter drug-metabolizing enzymes, as well as pharmacokinetics of drug metabolism (Banerjee, 2020).
In conclusion, having the full details of this patient’s case would be beneficial in determining a full treatment plan. After the hypertensive crisis was under control then I would continue with the patient’s home dose and continue to monitor the patient. The patient may need to have an increase in their medication, or they may need to add in a secondary medication for hypertension NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics.
References
Banerjee, et al. (01/17/2020). Effect of environmental exposure and pharmacogenomics of drug metabolism.
DOI: https://doi.org/10.2174/1389200221666200110153304
Keller, F., & Hann, A. (2018). Principles of drug response and alterations in kidney disease. CJASN September 2018, 13 (9) 1413-1420; DOI: https://doi.org/10.2215/CJN.10960917
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
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