Factor Influencing the Pharmacokinetics and Pharmacodynamics of Medications Essay Case Study

Week 2: Cardiovascular System
Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. In clinical settings, patients often present with symptoms of several cardiovascular disorders, making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options.  Factor Influencing the Pharmacokinetics and Pharmacodynamics of Medications Essay Case Study

This week, you examine the impact of patient factors that may lead to changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.

Learning Objectives
Students will:

Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes
Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies
Evaluate drug therapy plans for cardiovascular disorders

Age as an Important Factor Influencing the Pharmacokinetics (PK) and Pharmacodynamics (PD) of Medications Used to Treat Hypertension and Hyperlipidemia in an Obese Patient
A number of factors are known to influence the pharmacokinetics (PK) and pharmacodynamics (PD) of medications, especially those that are taken orally. These factors include gender, age, and genetics. Pharmacokinetics in simple terms means what the body does to the drug once administered. It encompasses absorption, distribution, metabolism, and excretion (ADME). On the other hand, pharmacodynamics is concerned with what the drug does to the body. Thus includes the mechanism of action of the drug (Rosenthal & Burchum, 2018; Katzung, 2018). Patient AO is obese and has confirmed hypertension and hyperlipidemia, three of the most significant risk factors for cardiovascular disease (Hammer & McPhee, 2018; Huether & McCance, 2017). The patient is currently on atenolol 12.5 g daily, doxazosin 8 mg daily, hydralazine 10 mg qid, sertraline 25 mg daily, and simvastatin 80 mg daily. The purpose of this paper is to discuss how age as a factor impacts the PK and PD of the above medications in patient AO.
How the Factor of Age Can Affect the Pharmacokinetic and Pharmacodynamic Processes of in Patient AO
There are molecules that are known as p-glycoproteins in the plasma membranes of the cells of the villi in the gastrointestinal tract. These protein molecules normally act as pumps to transport ingested oral medications from the lumen of the gastrointestinal tract to the liver (absorption). In the liver, the absorbed drugs undergo first pass metabolism by cytochrome P3A4 isoenzymes. In older patients, the efficiency of these p-glycoprotein pumps is significantly reduced, affecting the rate of absorption of oral medications negatively (Rosenthal & Burchum, 2018; Katzung, 2018; Jacobson, 2013). Likewise, the efficiency of first pass metabolism by the cytochrome P450 isoenzymes is also reduced with advancing age. Hydralazine, for instance, would suffer from this effect.
Another way in which the factor of age affects pharmacokinetics (distribution) is through the concept of lean body mass. Lean body mass determines how efficiently drugs are distributed in the body. Unfortunately, in older patients there is less lean body mass and this affects how well medications are distributed and therefore bioavailability. The drugs affected are hydrophilic drugs whose distribution is reduced. Lastly on excretion, it is known that the estimated glomerular filtration rate (eGFR) which measures renal function decreases with age. This means that in older patients, the kidneys do not effectively excrete medications and their metabolites. Therefore, the doses of medications need to be adjusted in older patients to avoid dangerous accumulation of the drug and its metabolites in the body (Rosenthal & Burchum, 2018; Katzung, 2018). Hydralazine and atenolol are excreted through the kidneys. Age will also affect pharmacodynamics in a profound way. For instance, because of the combined effect of a less effective first pass effect and renal excretion, a small dose of the medication will produce a large effect since there is inadvertent accumulation of the active drug in the body.Factor Influencing the Pharmacokinetics and Pharmacodynamics of Medications Essay Case Study

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A patient can easily be overdosed therefore if the dosages are not adjusted accordingly.
How Changes in the Pharmacokinetic and Pharmacodynamic Processes Might Affect Patient AO’s Recommended Drug Therapy
The changes brought by age on the processes of pharmacokinetics and pharmacodynamics mean that there has to be dose titration for the medications prescribed to patient AO. This is the route taken to avoid adverse drug events (Armstrong, 2014). This will be the most important measure on top of instituting lifestyle changes in terms of diet and exercise (Rubenfire, 2018). A good example in this case is the sertraline (Zoloft). Older patients of age 65 years and above are known to be at a higher risk of accidental falls (McCarthy, 2016). It so happens that sertraline increases this risk of falls in older patients and therefore the dose must be looked into carefully. If patient AO is elderly, the doses of hydralazine and atenolol will also have to be reduced since the eGFR of the kidneys will have dropped significantly. Simvastatin is not affected by these changes in the two processes and the usual dose can continue to be administered. The same is true for doxazosin which has been shown to be beneficial in managing hypertension and lowering the levels of low density lipoprotein cholesterol or LDL-C (Rosenthal & Burchum, 2018; Katzung, 2018).
Improving Patient AO’s Drug Therapy Plan
The bioethical principles of beneficence (doing good) and nonmaleficence (avoiding causing harm to the patient intentionally) apply in this case. In order not to cause the patient harm from adverse drug events in an unethical way, the doses of atenolol, hydralazine, and sertraline will be lowered if he were older (Fowler & ANA, 2015). The nursing code of ethics clearly requires that the nurse be the patient’s foremost advocate.
Conclusion
It is clear that age is an important factor that can profoundly affect the PK and PD of medications. This effect is especially most noticeable and significant when one grows older and becomes part of the elderly population. Luckily, knowledge of these processes and their relationship with age helps to modify medication doses accordingly to avert pharmacotherapeutic disaster.
References
Armstrong, C. (2014). JNC 8 guidelines for the management of hypertension in adults. American Family Physician, 90(7):503-504. https://www.aafp.org/afp/2014/1001/p503.html
Fowler, M.D.M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with interpretive statements: Development, interpretation, and application, 2nd ed. American Nurses Association.
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.
Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6th ed. Elsevier, Inc.
Jacobson, S. (2013). Effects of pharmacokinetic and pharmacodynamic changes in the elderly. Psychiatric Times, 29(1). https://www.psychiatrictimes.com/view/effects-pharmacokinetic-and-pharmacodynamic-changes-elderly
Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. McGraw-Hill Education.
McCarthy, M. (2016). Falls are leading cause of injury deaths among older people, US study finds. BMJ, 354 (i5190). https://doi.org/10.1136/bmj.i5190
Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.
Rubenfire, M. (2018). 2018 AHA/ACC Multi-society guideline on the management of blood cholesterol. American College of Cardiology. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/09/14/28/2018-guideline-on-management-of-blood-cholesterol

Assignment: Pharmacotherapy for Cardiovascular Disorders

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

Photo Credit: Getty Images/Science Photo Library RF

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

  • Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
  • Review the case study assigned by your Instructor for this Assignment.
  • Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
  • Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
  • Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
  • Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

By Day 7 of Week 2

Write a 2- to 3-page paper that addresses the following:

  • Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
  • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
  • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.  Factor Influencing the Pharmacokinetics and Pharmacodynamics of Medications Essay Case Study

Submission and Grading Information

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  • Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
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  • Click on the Submit button to complete your submission.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6521_Week2_Assignment_Rubric

  • Grid View
  • List View
  Excellent Good Fair Poor  
Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. 23 (23%) – 25 (25%)

The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

20 (20%) – 22 (22%)

The response provides a basic explanation of how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

18 (18%) – 19 (19%)

The response inaccurately or vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

0 (0%) – 17 (17%)

The response inaccurately and vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient, or is missing.

 
Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. 27 (27%) – 30 (30%)

The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy.

Accurate, complete, and aligned examples are provided to support the response.

24 (24%) – 26 (26%)

The response accurately describes how changes in the processes might impact the patient’s recommended drug therapy.

Accurate examples may be provided to support the response.

21 (21%) – 23 (23%)

The response inaccurately or vaguely describes how changes in the processes might impact the patient’s recommended drug therapy.

Inaccurate or vague examples are provided to support the response.

0 (0%) – 20 (20%)

The response inaccurately and vaguely describes how changes in the processes might impact the patient’s recommended drug therapy, or is missing.

Inaccurate and vague examples may be provided to support the response, or is missing.

 
Explain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements. 27 (27%) – 30 (30%)

The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan.

The response includes an accurate and detailed explanation to support the recommended improvements.

24 (24%) – 26 (26%)

The response accurately explains how to improve the patient’s drug therapy plan.

The response may include an accurate explanation to support the recommended improvements.

21 (21%) – 23 (23%)

The response inaccurately or vaguely explains how to improve the patient’s drug therapy plan.

The response may include an inaccurate, vague, or misaligned explanation to support the recommended improvements.

0 (0%) – 20 (20%)

The response inaccurately and vaguely explains how to improve the patient’s drug therapy plan, or is missing.

The response may include an inaccurate and vague explanation to support the recommended improvements, or is missing.

 
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

 
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors

4 (4%) – 4 (4%)

Contains a few (1–2) grammar, spelling, and punctuation errors

3.5 (3.5%) – 3.5 (3.5%)

Contains several (3–4) grammar, spelling, and punctuation errors

0 (0%) – 3 (3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

 
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors

4 (4%) – 4 (4%)

Contains a few (1–2) APA format errors

3.5 (3.5%) – 3.5 (3.5%)

Contains several (3–4) APA format errors

0 (0%) – 3 (3%)

Contains many (≥ 5) APA format errors

 
  Total Points: 100

Name: NURS_6521_Week2_Assignment_Rubric

CASE STUDY FOR ASSIGNMENT

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Welcome to Week 2

Posted on: Sunday, June 6, 2021 6:00:00 AM EDT

Dear Class,

Welcome to Week 2.

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

  • Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
  • Review the case study assigned by your Instructor for this Assignment.
  • Select onethe following factors: genetics, gender, ethnicity, age, or behavior factors.
  • Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
  • Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
  • Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

By Day 7 of Week 2

Write a 2- to 3-page paper that addresses the following:

  • Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
  • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
  • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Case Study 1

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

  • Atenolol 12.5 mg daily
  • Doxazosin 8 mg daily
  • Hydralazine 10 mg qid
  • Sertraline 25 mg daily
  • Simvastatin 80 mg daily

Factor Influencing the Pharmacokinetics and Pharmacodynamics of Medications Essay Case Study

 

 

 

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