Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Pharmacokinetics describes how the body handles drugs in terms of absorption, distribution, metabolism, and excretion. (2018) (Rosenthal and Burchum). Regen-Cov is a combination of lab-created human antibodies (Food and Drug Administration, 2021).

Regen-COV has a half-life of 26-30 days and is degraded in the body into small peptides and amino acids. It is not broken down by the liver or kidneys. As a result, patient weight, hepatic or renal impairment do not affect drug exposure or necessitate dose modification. Regen-COV is also unlikely to interact with other medications (Deeks, 2021).

Pharmacodynamics

Pharmacodynamics is the study of the effects of the drug on the body and how the effects are produced (Rosenthal and Burchum, 2018. pp 22-23). Regen-COV antibodies have a high affinity for the spike protein of the COVID-19 virus. The antibody binds to the spike protein and prevents the virus from binding to human cells. This reduces the viral replication in the lungs and other body tissues (Deeks, 2021).

Pharmacokinetics and Pharmacodynamics

Pharmacokinetics involves sequential processes, including absorption, distribution, metabolism, and excretion that occur in the body following drug administration (Arcangelo & Peterson, 2018). On the other hand, pharmacodynamics is the effect of a particular drug on the body. It includes side effects, physiological processes, and drug reactions. Unique patient features, including sex, age, and health condition, influence the two processes. My focus for this discussion purpose from my experience will be a 48-year-old male with diabetes mellitus Type 2.

Scenario: 48-year-old male with diabetes type 2 who was diagnosed with diabetes since the age of 20 but recently started going into diabetic ketoacidosis frequently. Patients presents with blood glucose of 690. Patient takes multiple medications including Lyrica, Metformin, Atorvastatin, and Lisinopril for hypertension, renal disease, gout, coronary artery disease, and neuropathy. I do not recall all the medications he was on.

Due to the complications of diabetes, these patients are usually prone to cardiovascular diseases, stroke, kidney diseases, vision alterations, among other diseases. Therefore, these patients are usually on many other drugs apart from the ones specified for diabetes mellitus.

Factors affecting pharmacokinetics

Patients with diabetes often have problems with metabolism due to polypharmacy. Liver metabolizes many drugs but in diabetic Mellitus condition, there is a decreased CYP 3A4 which is hepatic enzymatic activity and protein levels due to taking other medications for other complications brought about by diabetes (Uehara et al 2017). More often, these patients also experience an increase in glomerular infiltration rate causing excretion concerns related to micro vascular and macro vascular changes and renal function loss (Trevisan & Dodesini, 2017). There is also the effect of distribution due to the process of glycation where albumin has decreased affinity for some fatty acids decreasing efficiency of fatty acid grafted drugs (Gajahi Soudahome et al., 2018). Due to the different drugs that this patient was taking, there was the effect of decreased membrane permeability influenced by insulin induced capillary perfusion affecting absorption (McConell et al., 2020)

Pharmacodynamics

Polypharmacy is a factor in determining the effects and actions of drugs. This patient had problem in adhering to the diet advised by the PCP. Her taking high protein foods affected her glomerular filtration rate decreasing excretion of drugs prescribed. Due to the compromised absorption, there was reduced effect of glycemic medications.

Personalized Care

This patient was seeing different doctors for diabetes, renal disease, and hypertension. Her medications were not revised by these providers hence the complications due to polypharmacy. For her personalized care, I would recommend her medications to be revised by the providers, a goal placed to focus on decreasing A1C, avoiding sedentary lifestyle including diet change, at home glycemic control, improved physical activity, and regular follow ups.

References

Uehara, S., Uno, Y., Nakanishi, K., Ishii, S., Inoue, T., Sasaki, E., & Yamazaki, H. (2017). Marmoset Cytochrome P450 3A4 Ortholog Expressed in Liver and Small-Intestine Tissues Efficiently Metabolizes Midazolam, Alprazolam, Nifedipine, and Testosterone. Drug Metabolism and Disposition, 45(5), 457–467. https://doi.org/10.1124/dmd.116.074898

McConell, G. K., Sjøberg, K. A., Ceutz, F., Gliemann, L., Nyberg, M., Hellsten, Y., Frøsig, C., Kiens, B., Wojtaszewski, J. F. P., & Richter, E. A. (2020). Insulin‐induced membrane permeability to glucose in human muscles at rest and following exercise. The Journal of Physiology, 598(2), 303–315. https://doi.org/10.1113/jp278600

Trevisan, R., & Dodesini, A. R. (2017). The Hyperfiltering Kidney in Diabetes. Nephron, 136(4), 277–280. https://doi.org/10.1159/000448183

Gajahi Soudahome, A., Catan, A., Giraud, P., Assouan Kouao, S., Guerin-Dubourg, A., Debussche, X., le Moullec, N., Bourdon, E., Bravo, S. B., Paradela-Dobarro, B., Álvarez, E., Meilhac, O., Rondeau, P., & Couprie, J. (2018). Glycation of human serum albumin impairs binding to the glucagon-like peptide-1 analogue liraglutide. Journal of Biological Chemistry, 293(13), 4778–4791. https://doi.org/10.1074/jbc.m117.815274

Patient Scenario and Medical History

https://nursingpaperslayers.com/discussion-pharmacokinetics-and-pharmacodynamics-nurs-6521/

As an inpatient mental health care nurse, I received a patient from Cook County Hospital Chicago, who had been the ward of the state for most of her life, she was a 28-year-old female with a history of schizoaffective disorder. This patient had been in and out of several psychiatric hospitals over the course of the last 5 years. There

Discussion Pharmacokinetics and Pharmacodynamics NURS 6521
Discussion Pharmacokinetics and Pharmacodynamics NURS 6521

were several other underlining past medical conditions that included, high blood pressure, type 2 diabetes mellites, elevated cholesterol, renal failure and GERD. Lack of stable placement in this young woman’s life resulted in her becoming non medication compliant. With her diagnosis of schizoaffective disorder, I knew that it was necessary for her to be involved in long-term treatment, to avoid relapses, and further hospitalizations. The short-term goal was to reduce symptoms of the diagnosis and delay future relapses and episodes, as there no general.

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

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Pharmacodynamics and Pharmacokinetics

Van der Graaf & Benson 2011 suggests, “Drugs produce their effects by interacting with receptor targets, and drug discrimination is one behavioral procedure that is useful for investigating determinants of this interaction”. Evidence based research has proven that drugs can have different effects on the body, and this reaction of drugs in the body can be broken down into 2 parts that are referred to as pharmacokinetics and pharmacodynamics. Pharmacokinetics refers to how a drug navigates throughout the body system, while the concept of pharmacodynamics deals with is how the drug affects the body as well as its therapeutic or toxic effect in the body (Rosenthal, L. D., & Burchum, J. R, 2018).

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Certain medical conditions, such as acute and chronic kidney disease, heart disease, and diabetes, generally impair the efficacy of psychotropic medications (Van der Graaf & Benson, 2011). Patients with these co-morbidities must be closely observed and monitored during pharmacotherapy to achieve the best drug therapeutic effect. Age and body composition are two factors that influence a patient’s pharmacokinetics. The drug’s malabsorption causes slower elimination, resulting in higher levels of the drug in the blood. Because of the direct coloration of the dosage administered and how the body responds to the drug, there is an increased risk of adverse drug reactions. Drugs that require metabolism and excretion can have a significantly longer half-life in older people than in younger people (Le, 2020). It would also determine the route of medication administration. The patient’s overall body composition, such as body weight and height, also influenced pharmacokinetics. However, pharmacokinetics is also affected by a drug’s chemical properties. Similar factors could have influenced pharmacodynamics.

Plan of care

To accurately establish the diagnosis of schizoaffective disorder, all other mental health issues including substance abuse and chemical dependency must be ruled out. I conducted a thorough head to toe physical assessment to establish a baseline and to find out any prior related complications. Following this I ran some routine tests and screenings, such as a urinalysis and drug screen test. The psychiatrist also requested that an MRI and CT scan be completed. A complete psychiatric evaluation was also done by a mental health professional, and then I collected more data afterwards on family and personal history, as well as issues regarding any major stresses or recent life changes. A full medication list, including dosages and frequencies of vitamins, herbal preparations and supplements, and the dosages

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Medical treatment

A medication regimen that would fit the patient’s lifestyle is imperative due to a history of non-compliance with medication, the drug of choice ordered by the psychiatrist was targeted to relieve psychotic symptoms, maintain mood stability and depression. A monthly shot of Invega was prescribed for psychosis. Other drugs for mood stability and depression were prescribed on an as needed basis.

Psychotherapy

It was important to develop a trusting relationship with the patient as this allowed for strong therapeutic communication. The patient was able to understand some of the core dynamics of schizoaffective disorder, which leads to creating normalized thought patten and decrease symptoms. We also explored several other coping strategies for issues and concerns problems, relationships and coping strategies.

Reference

Le, J. (2020, October). Overview of Pharmacokinetics. Retrieved from https://www.merckmanuals.com/professional/clinicalpharmacology/pharmacokinetics/overview-of-pharmacokinetics

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Van der Graaf PH, Benson N. Systems pharmacology: bridging systems biology and pharmacokinetics-pharmacodynamics (PKPD) in drug discovery and development. Pharm Res. 2011 Jul;28(7):1460-4. doi: 10.1007/s11095-011-0467-9. Epub 2011 May 11. PMID: 21560018.

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

As an advanced practice nurse aiding physicians with disorder diagnosis and treatment, it is critical to understand not just the impact of illnesses on the body, but also the impact of pharmacological treatments on the body. Pharmacokinetics and pharmacodynamics discuss the interactions between medications and the body.

Pharmacokinetics is concerned with what the body does to the medication via absorption, distribution, metabolism, and excretion, whereas pharmacodynamics is concerned with what the drug does to the body.

 

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Photo Credit: Getty Images/Ingram Publishing

Individual patient characteristics that may effect the patient’s pharmacokinetic and pharmacodynamic processes must be considered when selecting medications and calculating dosages for patients. Genetics, gender, ethnicity, age, behavior (e.g., diet, nutrition, smoking, alcohol, and illicit drug misuse), and/or pathophysiological changes caused by disease are examples of patient factors.

You will reflect on a case from your previous clinical experiences for this Discussion and explore how a patient’s pharmacokinetic and pharmacodynamic processes may influence his or her response to a medicine.

To Get Ready

Examine the Resources for this topic and think about pharmacokinetics and pharmacodynamics.
Consider your recent experiences, observations, and/or clinical practices, and consider how pharmacokinetic and pharmacodynamic factors changed his or her anticipated response to a medicine.
Consider factors such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or probable pathophysiological changes caused by disease that may have altered the patient’s pharmacokinetic and pharmacodynamic processes.
Consider a customised plan of care in your case study based on these contributing factors and patient history.

 

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By the third day of Week 1,

Post a description of a patient case from your recent experiences, observations, and/or clinical practice. Then, describe any circumstances that may have altered the patient’s pharmacokinetic and pharmacodynamic processes. Finally, describe the specific plan of care that you would establish in your case based on influencing circumstances and patient history. Provide specifics and instances.

By Week 1’s Day 6

Read a selection of your colleagues’ comments and respond to at least two of your colleagues on two different days by suggesting additional patient factors that may have interfered with the pharmacokinetic and pharmacodynamic processes mentioned by the patients. Furthermore, consider how the tailored plan of care may alter if the patient’s age changed and/or if the patient had a comorbid illness, such as renal failure, heart failure, or liver failure.

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion

Week 1-Initial post
COLLAPSE

     Pharmacokinetics and pharmacodynamics are two major relationships between medications and the body that should be considered when determining patient dosing (Rosenthal & Burchum, 2018). Pharmacokinetics is the absorption, distribution, metabolism, and excretion of a drug. Pharmacodynamics is the biochemical and physiologic effects of a drug.

Patient Case

Mr. K is a 10-years old male with a rare hereditary metabolic disorder glutaric aciduria type 1 (GA1) accompanied by neurologic impairment of speech, feeding difficulties, cerebral palsy, and spastic dystonia. The patient had periodic episodes of dystonic movements whenever he got happy or excited. He would have jerking movements of legs, tighten his body, fists his hands, and sometimes screams or cries. The patient enjoyed watching TV and watching other children play; unfortunately, those were some of his triggers at times. Sometimes the patient’s dystonic movements had no triggers. The patient’s dystonic movements could be periodic most of the day, lasting for up to a minute or the movements may start an hour or two before his next medication time. Mr. K could go a day without any dystonic movements, usually following exhaustion from two to three days of spasticity. The patient was on several medications, such as anticholinergics, benzodiazepine, and muscle relaxants. His primary medication was Baclofen (Lioresal), which he had four times a day through an enteral feeding tube to control his dystonia.

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Pharmacokinetics and Pharmacodynamics

Dystonia refers to physical signs or symptoms of involuntary muscle contractions, and in children, it can cause motor disability (Adis Medical Writers, 2018). Dystonia can be acquired or inherited. In Mr. K’s case, his dystonia was due to genetic disorder GA1. Baclofen (Lioresal) is usually prescribed as a spasmolytic agent with GABA-B receptor agonist properties (Simon, Franchitto, & Rolland 2018). The medication comes in oral and intrathecal therapy. Oral Baclofen is rapidly absorbed in the intestinal tract, travels through the bloodstream, and binds with GABA-B receptors in the central nervous system (CNS) (Simon, Franchitto, & Rolland, 2018). Intrathecal Baclofen is administered directly to the spinal cord through a medication pump. Baclofen is metabolized in the liver and excreted by the kidney within 72 hours. The medication peaks plasma concentration in one hour and has a half-life of 3-6 hours.  Eighty-five percent of the drug is excreted unchanged by the kidney, and the remainder is excreted in the feces unchanged (Simon, Franchitto, & Rolland, 2018).

Baclofen binds on GABA-B receptors in the CNS, inhibits calcium influx, and reduces motor neuron excitability (Adis Medical Writers (AMW), 2018). Due to a short medication half-life, frequent administration is required for optimal effect. The maximum dosage is 60mg/day for children older than two years of age. Common adverse effects of Baclofen include drowsiness, dizziness, fatigue, constipation, and hypotonia at high doses. Baclofen cannot be discontinued abruptly due to the risk of withdrawal symptoms such as worsening spasticity, seizures, and hallucination.

Patient’s Personalized Plan of Care

Patient prevention, education, and health promotion should be included in the plan of care. Some conditions may become worse when Baclofen is abruptly stopped. Patient teaching should be centered on tapering medication dosage per healthcare provider’s orders. Urine output should be monitored while the patient is taking Baclofen to avoid toxicity. Sleep inducing and over-the-counter medications that cause drowsiness or mood changes should be avoided while on Baclofen. The provider should be notified of any increased dizziness or any change in the level of consciousness. Fall precautions should also be included in the patient’s plan of care while on Baclofen.

References

Adis Medical Writers. (2018). Tailor the pharmacological management of childhood dystonia to meet the needs of each child. Drugs & Therapy Perspectives, 34(5), 216–221. https://doi-org.ezp.waldenulibrary.org/10.1007/s40267-018-0495-1

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s Pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Simon, N., Franchitto, N., & Rolland, B. (2018). Pharmacokinetic Studies of Baclofen Are Not Sufficient to Establish an Optimized Dosage for Management of Alcohol Disorder. Frontiers in psychiatry, 9, 485. https://doi.org/10.3389/fpsyt.2018.00485

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

RE: Week 1-Initial post
COLLAPSE

 

I enjoyed reading your posts. There are limited options in pharmaceuticals when it comes to treating children with dystonia. The two medications used for children for the treatment ofdystonia are Lioresal (baclofen) and Artane (trihexyphenidyl). Deep brain stimulation is used to treat dystonia; however, only few children are appropriate for this treatment for dystonia (Lumsden, 2018). The role of the primary care provider is to identify when dystonia occurs and ensure that the symptom is not being caused by any medications being taken. Interestingly, a few medications can cause dystonia including some antiemetics, antipsychotics such as Haldol(haloperidol), and psychostimulants such as Provigil (modafinil) (Lumsden, 2018).

Other considerations regarding baclofen in the treatment plan include monitoring and managing side effects. A few bothersome and frequent side effects of baclofen can include nausea, constipation, and urinary retention (Rosenthal & Burchum, 2018). You mentioned monitoring for urinary retention in your care plan. I think that monitoring for nausea could be crucial as well in that your client has impaired speech. Perhaps, monitoring of food intake and bowel movements could help identify any gastrointestinal upset that could be due to baclofen. There are limited options for treating dystonia in children and baclofen is reported to have frequent bothersome side effects, as discussed.

References

Lumsden, D. E. (2018). The child with dystonia. Pediatrics and Child Health, 28(10), 459–467. DOI:10.1016/j.paed.2018.04.016

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Discussion on Pharmacokinetics and Pharmacodynamics in NURS 6521

Working in an intermediate care unit, I encounter individuals of varying racial backgrounds and medical issues. The prevalence of diabetes, hypertension, and chronic obstructive pulmonary disease (COPD) among individuals aged 20 years and older is evident from the sheer number of people admitted to the institution. Although the disorders are prevalent, the medications used to treat them can vary in dose, brand, and cost. When prescribing pharmaceuticals to a specific patient, the prescribing physician analyzes the effects and mechanism of action of the drugs on that patient.
Consider a 75-year-old man patient with uncontrolled Diabetes who is admitted. The patient has a history of type II diabetes and uses metformin to maintain his glucose levels, but he had not been able to afford medicine refills. On admission, the patient’s blood glucose level was 288 mg/dl. He was prescribed Lispro on a low dose sliding scale, with blood glucose monitoring before meals and before bedtime. The patient was assigned to a new-to-the-unit nurse who had just started working there. Just prior to the arrival of the lunch plates, the nurse reviewed the patient’s blood glucose levels that the nurse tech had measured. The nurse drew out eight units of lispro insulin and provided it to the patient for what she believed to be a blood sugar level of 288 mg/dL. After around 20 minutes, the nurse observed that the patient had profuse perspiration, an elevated heart rate, and minor tremors. The inexperienced nurse drew the attention of an experienced nurse and detailed the treatment she had administered to the patient prior to finding his current condition. The two nurses studied the patient’s data on the computer and discovered that the patient’s last blood glucose level was 98mg/dl, not 288mg/dl as the young nurse had assumed. The older nurse promptly obtained a glucometer and measured the patient’s blood glucose level, which was 52 mg/dl. She also determined that the patient had not eaten. The older nurse quickly followed the institution’s policy and delivered 1 milligram of glucagon to the patient before checking his blood pressure.

The doctor supplied another gram of glucose to the patient, rechecked his blood glucose level, and then gave him a tiny cup of orange juice and a cracker.
As nurse practitioners, it is essential to comprehend pharmacokinetics and pharmacodynamics. Pharmacokinetics is the study of the absorption, distribution, metabolism, and elimination of drugs in the body (Rosenthal and Burchum, 2021). Pharmacodynamics is the study of the link between drug concentration at the site of action and the subsequent effects, such as the duration and intensity of therapeutic and unfavorable effects (DiPiro, 2008).
Lispro Insulin is a rapid-acting insulin with a brief duration of action that is used to enhance diabetes patients’ blood glucose management (Rosenthal and Burchum, 2021). It is more effective than regular human insulin in enhancing and sustaining blood glucose control (Campbell et al., 1996). Insulin’s pharmacokinetics and pharmacodynamics may be affected by the size of the dose, the injected volume, and the insulin concentration, as well as by vigorously rubbing the injection site, an increase in temperature which increases the absorption rate, the site of the injection (absorption is faster when administered in the abdomen), and by exercising the extremities within an hour of injection (Donner and Sarkar, 2019). The patient came with hypoglycemia due to the administration of a significant dose of insulin in response to an incorrect blood glucose level.
A personalized care plan for the patient based on influencing factors and the patient’s history would include setting goals for the patient that include effective treatments to normalize and manage blood glucose levels, decreasing the risk for hypoglycemic or hyperglycemic events using insulin medication, diet, and exercise, informing and educating the patient on the importance of compliance with medication regimen and importance of monitoring blood glucose, and providing the patient with the necessary tools to achieve these goals.

Providing the patient with savings or discount cards, such as Good Rx, and the location of local community clinics that provide low-cost prescription drugs.
Ensuring that the patient is appropriately educated and supplied with the tools necessary to provide for his medication will encourage his participation in self-care and ensure his compliance with monitoring and maintaining blood glucose levels that are manageable.

Campbell, R. K., Campbell, L. K., and White, J. R. are cited as sources (1996, November). The role of insulin lispro in the treatment of diabetes mellitus. The Pharmacotherapy Annals.
https://pubmed.ncbi.nlm.nih.gov/8913409/
.
Donner, T., & Sarkar, S. (2019). Insulin – Pharmacology, Therapeutic Regimens, and Intensive Insulin Therapy Principles. Endotext [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK278938/
.
DiPiro, J. T. (2008). An approach based on pathophysiology to pharmacotherapy. The company McGraw-Hill Medical.
Rosenthal, L. D., & Burchum, J. R. (2021). The second edition of Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) Elsevier.

Name: NURS_6521_Week1_Discussion_Rubric

ExcellentGoodFairPoor
Main Posting
Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3
First Response
Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response
Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed. .

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days
Total Points: 100

Name: NURS_6521_Week1_Discussion_Rubric

Main Discussion

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Pharmacokinetics and Pharmacodynamics 

Rosenthal & Burchum (2021) characterized pharmacokinetics as the study of drug circulation, and pharmacodynamics as the study of the biochemical and physiological effects of drugs and its molecular processes in the body. As an advanced practice nurse, understanding diagnosis and disorders is essential, but pharmacodynamics and pharmacokinetics and how drug therapies and individualized patient care plans are also crucial. Overall, doing no harm and providing an appropriate, safe, strategic, and personalized treatment plan that is grounded in ethical and legal connotation are vital to the success and effectiveness of patient management.

Patient Scenario and its Influence on Pharmacokinetics and Pharmacodynamics 

I had a patient last night in the surgical intensive care unit who had sepsis from a perforated bowel. He was on a volume-controlled ventilation and cooling blanket for a temperature of 102.3 Fahrenheit, on Levophed and Vasopressin drips for hypotension, received two normal saline boluses, had a lactate level of four, on Zosyn and Vancomycin for positive blood cultures, and produced 25 milliliters of urine per hour.

Sepsis is a systemic inflammatory response that can cause tissue damage and organ failure due to physiological processes. Charlton & Thompson (2019) explained that sepsis alters drug absorption, distribution, metabolism and elimination, affecting pharmacodynamic and pharmacokinetic variability. Compromised tissue perfusion reduces volume distribution, but increased capillary permeability may enhance drug distribution. Bakdach (2019) said that with sepsis, natural body compensation is lost, and a state of shock characterized by hypotension and abnormal cellular metabolism follows and dysregulates the pharmacokinetic and pharmacodynamic properties of drugs. It leads to cellular damage caused by cytokines, proteases, and oxygen reaction.

The antibiotics Zosyn and Vancomycin were given in a timely manner to be absorbed and distributed in the patient’s circulation effectively and have an appropriate targeted concentration level against the organisms in the blood cultures. Normal saline boluses were administered immediately for volume resuscitation and lactate correction, as well as Levophed and Vasopressin drips to correct hypoperfusion and hemodynamic instability, as evidenced by decreased urinary output and blood pressure. The pharmacokinetics and pharmacodynamics of these drug treatments involved timely administration to target metabolism, efficacy, and circulation in the system that had compromised tissue perfusion and enhanced capillary permeability.

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Plan of Care 

The Society of Critical Care Medicine (2021) discussed that the measurement of lactate levels, immediate resuscitation using capillary filling time, fixing the source, and early recognition of symptoms are recommended in the management of sepsis.

Antibiotics based on culture results, immediate intravenous resuscitation, lactate level control, maintaining an adequate organ perfusion and correction of the source of infection should be developed in the management and plan of care for sepsis. Patients may have physiological changes, but timely initiation of antibiotic therapy is critical. The goal of the care plan is to enhance efficacy, reduce toxicity, and safely prescribe drug therapy to a patient with altered pharmacokinetics and pharmacodynamics variability.

References 

Bakdach D. (2019). Pharmacokinetic/pharmacodynamic variations during sepsis/septic shock.

            Qatar Medical Journal, 2019(2), 41. https://doi.org/10.5339/qmj.2019.qccc.41

Charlton, M., & Thompson, J. P. (2019). Pharmacokinetics in sepsis. BJA Education, 19(1), 7–13.

https://doi.org/10.1016/j.bjae.2018.09.006

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

and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Society of Critical Care Medicine. (2021). Surviving sepsis campaign guidelines 2021. SCCM.

https://www.sccm.org/Clinical-Resources/Guidelines/Guidelines/Surviving-Sepsis-Guidelines-2021

Week 1 Discussion
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Ativan in the Elderly

Working as an LPN in a Long Term Care facility, I have administered psychotropic medications to ease unwanted behaviors in the elderly population. In the case of my assigned patient. Although she was pleasant, there were times that Ms. Johnson could be a handful by needing constant monitoring due to her diagnosis of Dementia. One particular evening, she wandered into other resident rooms and continued to resist redirection. Staff and I were unable to calm her as she continued to awaken other residents by refusing to leave their rooms while she searched through their clothing and took their personal belongings. Ativan was ordered and the outcome was not therapeutic! In some populations, such as the children and the elderly, Ativan can cause a “paradoxical effect.” Instead of having a calming effect, it may cause agitation and confusion (Duan, 2020) as it did with Ms. Johnson. She became combative with staff and although she resisted redirection, previously, she did not try to hit or spit on staff.  Benadryl IM was then ordered to “reverse” the actions of the Ativan. With so many medications that can help ease unwanted behaviors in the elderly population, alternative, non-medicated approaches have been proven more beneficial. To decrease agitation and aggression in people with dementia, nondrug options are more effective than medications. Physical activity, touch and massage, and music can all be used as tools to manage agitation related to dementia (Collier, 2020).

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

References:

Collier, S. (2020). What’s the best way to manage agitation related to dementia? Retrieved from Harvard Health Blog: https://www.health.harvard.edu/blog/whats-the-best-way-to-manage-agitation-related-to-dementia-2020021418816

Duan, C. (2020). Very Well Mind. Retrieved from What Are the Side Effects of Ativan (lorazepam)?: https://www.verywellmind.com/side-effects-of-ativan-lorazepam-4775729

NURS_6521_Week1_Discussion_Rubric

ExcellentGoodFairPoor
Main Posting
Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3
First Response
Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response
Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed. .

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days
Total Points: 100

Name: NURS_6521_Week1_Discussion_Rubric