How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.

This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.

Students will:

• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients
• Assess patient factors and history to develop personalized plans of care
• Evaluate ethical and legal implications related to prescribing drugs
• Analyze ethical and legal practices of prescribing drugs
• Analyze strategies to address disclosure and nondisclosure
• Justify advanced practice nurse strategies to guide prescription drug decision-making
• Analyze the process of writing prescriptions to avoid medication errors
• NURS 6521: Advanced Pharmacology Week 1-11

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, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• 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.
• 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.

Post 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.

Week 1 Main Discussion Post: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurses, it’s important to understand the impact disorders have on the body as well as how prescribed medications and treatments effect the body (Rosenthal & Burchum, 2021). Each patient’s pharmacokinetics and pharmacodynamics vary based on their age, genetics, gender, ethnicity, behaviors, and disease process (Rosenthal & Burchum, 2021). Working in the Cardiac ICU there are several experiences and observations I have examined in my clinical practice. Each patient plan of care should be individualized to their person pharmacokinetic and pharmacodynamic factors. The purpose of this discussion is to describe a patient case from your experience, observation or clinical practice in the last five years and explain the influence and pharmacodynamic processes of the patient you identified with explanation on detail.

In the CCU there is often a  struggle with management of ICU delirium and sedation in the geriatric population. Many times, in our attempt to manage the patients symptoms we often exacerbate their confusion and delirium leading to increased ICU day stays and poor patient outcomes. Its important that we take a patient-centered approach when managing symptoms with current tools and best evidence-based practice (2019 American Geriatric Society Beers Criteria, 2019). When treating the geriatric population it’s important to remember the changes and  different functions of the body that occur naturally with aging. Studies have shown that oversedation in the ICU with benzodiazepines increase mechanical ventilatory days and increase rates of delirium with the geriatric populations (Synchev et al., 2021). There is a constant conflict between sedating and over sedating. When attempting to wean a patient off a ventilator there is often a struggle due to the long-lasting effects midazolam and other benzodiazepines not being excreted from the geriatric patient’s population (Synchev et al., 2021).  Factors that impact this are poor renal function and decreased hepatic function. This often leads to increase ICU days and inability to wean patients from ventilators NURS 6521: Advanced Pharmacology Week 1-11.

Pharmacokinetics and pharmacodynamics are impacted by the geriatrics population by decrease in cardiac output, decreased elasticity of vessels, decreased renal filtration capacity, decreased liver volume, a reduced functioning hepatocyte, and decreased hepatic blood flow (Synchev et al., 2021). As we age there is a decrease in our glomerular filtration rate and decreased renal performance (Synchev et al., 2021). Many sedatives are excreted though the kidneys and with reduced function we see higher plasma level of these medications days after discontinuing.  With decreased secretions this leads to the medications lasting longer in the patient’s system, which often leads to longer ventilatory days due to the patient unable to participate in pressure support measures. In addition, ICU delirium with benzodiazepines are seen due to the blocking of  γaminobutyric acid pump, affecting reuptake ( Zhang et al., 2021). This results in which thus results in increased levels of the inhibitory neurotransmitter (Zhang et al., 2021).

Strategies and patient-centered care models are important when managing the geriatric populations. (Kirsten et al., 2021). The nurse should also focus on the patient’s disease process and assess for a risk of delirium. Some of these conditions are patients with hypertension, DM, myocardial ischemia, atrial fabulation and heart failure (Ali MA et al., 2021). Its also important for the nurse to assess electrolyte disorders and abnormalities that could contribute and create a combination of ICU delirium (Ali MA et al., 2021) NURS 6521: Advanced Pharmacology Week 1-11. When plasma concentration drug levels were assessed in relation to delirium assessments it showed that medications such as lorazepam had a direct correlation of delirium the following day compared to medications such as dexmedetomidine. (Stollings et al., 2018). Strategies such as this can increase our effectiveness of treating patients based on their disease process and age considerations. In my personal practice I have found that early weaning and titrating off IV sedatives and replacing them with oral medications have increased the success rate of successfully preventing ICU delirium and successful extubating in the geriatric population. Incorporating practice models such as the AGS Beers Criteria has shown to increase outcomes when managing medications in older adults. The tool has shown as being valuable in the acute care setting and is based on a comprehensive approach and a valuable resource to improve medication therapy.

            In conclusion, as future advanced practice nurses we need to understand the patient’s body, disease and the impact drugs have on our given patient population. Understanding how drugs are absorbed, distributed, metabolized and excreted are important when providing best patient outcomes.

References

Ali MA, Hashmi M, Ahmed W, et al Incidence and risk factors of delirium in surgical intensive care unit Trauma Surgery & Acute Care     

                Open 2021;6:e000564. doi: 10.1136/tsaco-2020- 000564

2019 American Geriatrics Society Beers Criteria® Update Expert Panel (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially

Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 67(4), 674–  694. https://doi.org/10.1111/jgs.15767

Kirsten Fiest, Tom Stelfox, Philippe Couillard, Colin Casault, & Chel Hee Lee. (2021). Sedation strategy and ICU delirium: a multicenter, population-based

propensity score-matched cohort study. BMJ Open, 11(7). https://doi.org/10.1136/bmjopen-2020-045087

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced         practice nurses and physician assistants

(2^nd ed.) St. Louis, MO: Elsevier.

Stollings JL, Thompson JL, Ferrell BA, et al. Sedative Plasma Concentrations and Delirium Risk in Critical Illness. Annals of Pharmacotherapy. 2018;52(6):513-521.

doi:10.1177/1060028017753480

Sychev, O. D. Ostroumova, A. P. Pereverzev, A. I. Kochetkov, T. M. Ostroumova, M. V.   Klepikova, & E. Yu. Ebzeeva. (2021). Advanced Age as a Risk Factor of

Drug-Induced Diseases. Безопасность и Риск Фармакотерапии, 9(1), 15–24.

             https://doi.org/10.30895/2312-7821-2021-9-1-15-24

Zhang, H., Yuan, J., Chen, Q., Cao, Y., Wang, Z., Lu, W., & Bao, J. (2021). Development and        validation of a predictive score for ICU delirium in critically ill

patients. BMC Anesthesiology, 21(1), 1–8.    https://doi.org/10.1186/s12871-021-01259-z

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days 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.

This mandatory assignment is an acknowledgement that you fully understand the course guidelines.

Submit your Assignment.

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

• Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
• Review the scenario assigned by your Instructor for this Assignment.
• Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
• Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

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

• Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
• Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
• Explain the process of writing prescriptions, including strategies to minimize medication errors.

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