Pharmacokinetics is the absorption, distribution, metabolism, and excretion (Rosenthal & Burchum, 2018). The pharmacodynamics is what the medication does to the body is vital to prescribing the drugs to patients (Rosenthal & Burchum, 2018). It is essential to understand how the medicines work, the pathophysiology of the bacteria, and different categories of medications to prescribed the right type of drugs in treating patients (Walden University, 2019).
In the dialysis unit, I have encountered a 45-year-old male patient of Hispanic descent who has end-stage renal failure scheduled three times a week of dialysis about three and a half hours per session. I have observed that the patient’s heart rate every dialysis treatment for the past few weeks was elevated, which is above one hundred twenty of pulse rate and elevated blood pressure of above 180/65-200/95. This patient gains about three to five kilograms from his dry weight—the water weight in one to two days. The three to five liters of increased water weight is hard on the body during the pulling of much fluid within three and a half liters within 3 hours, if the patient can tolerate the dialysis treatment. The patient is non-compliant with fluid management and taking his blood pressure regimen. The patient has no history of diabetes, no heart problems and hypertension in the family.
Furthermore, non-compliance with blood pressure medication is the reason he was diagnosed with end-stage renal failure.
Now during the dialysis treatment, I told the nephrologist about the increased heart rate and hypertension. The nephrologist then prescribed Atenolol 50 mg by mouth once a day to lower down the heart rate along with other additional blood pressure medications to control his hypertension. The physician changed the blood pressure medication from Lisinopril to Atenolol instead. Atenolol is a beta-blocker blood pressure, water-soluble, slowly metabolized by hemodialysis patients (Rosenthal & Burchum, 2018). The most valuable used for non-compliant hemodialysis patients (Rosenthal & Burchum, 2018). It has properties that lower down the heart rate and longer half-life that effectively lowers the hypertension with hemodialysis patients to better control his blood pressure (Argarwal, 2015). Atenolol has fifty percent of oral dose is absorbed and peak plasma levels occur in two to four hours after oral ingestion (Argarwal, 2015). The half-life with renal failure is prolonged (Argarwal, 2015). Also, Atenolol 50 mg dose is administered to post-dialysis to adequately control hypertension and lower the heart rate in hemodialysis patients (Argarwal, 2015).
The factors that affected his hypertension are fluid overload, not suitable blood pressure medication, and non-compliance to blood pressure medication. For his increased heart rate, Atenolol has better pharmacokinetics with the patient’s body, which is more effective in lowering the heart rate and blood pressure. According to Rosenthal & Burcham, 2018, Atenolol will take effect after one to two weeks, which is the effectiveness of the drug. Therefore, the patient’s heart rate is within normal limits during dialysis, and blood pressure post-dialysis treatment is below 160/65-140/75, depending on how much fluids were removed during dialysis after two weeks after taking the Atenolol. However, the main side effects of the Atenolol are dizziness, lightheadedness, tiredness, cold extremities, numbness extremities, and blood sugar will decrease for a diabetic patient (Rosenthal & Burchum, 2018). The patient’s chief complaint is the tiredness, dizziness, lightheadedness, numbness in the extremities, but he does not have diabetes.
The plan of care for him is to avoid drinking apple juice or orange juice; it may prevent the full absorption of the medication (Rosenthal & Burchum, 2018). The patient needs to be educated on regularly taking the medication regimen (Rosenthal & Burchum, 2018). The patient is instructed on getting up slowly from lying down to sitting and standing to avoid the dizziness and lightheadedness (Rosenthal & Burchum, 2018). Also, lifestyle changes such as stress reduction, exercise programs, and dietary changes may increase the effectiveness of this medication (Rosenthal & Burchum, 2018). Moreover, the patient needs to check his blood pressure and pulse regularly (Rosenthal & Burchum, 2018). In regards to the numbness and cold extremities, the patient educated on Atenolol’s main side effects. The patient needs to wear warm clothing and stretch the extremities to relieve the symptoms (Rosenthal & Burchum, 2018). The patient needs to comply with maintain