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- QUESTION
As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics. Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body. When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharamcodynamic 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. In this Discussion, you reflect on a case from your past clinical experiences and consider how a particular patient’s pharmacokinetic and pharmacodynamic processes altered his or her response to a drug.
To prepare:
Review this week’s media presentation with Dr. Terry Buttaro, as well as Chapter 2 of the Arcangelo and Peterson text, and the Weitzel et al (2014) article in the Learning Resources. Consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last five years. Select a case from the last five years that involves a patient whose individual differences in pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
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.
With these thoughts in mind:By Day 3
Post a description of the case you selected. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient from the case you selected. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case.Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.--
Outstanding Performance 44 (44%) - 44 (44%)
Thoroughly responds to the discussion question(s)is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
supported by at least 3 current, credible sources
Excellent Performance 40 (40%) - 43 (43%)
Responds to the discussion question(s)is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
75% of post has exceptional depth and breadth
supported by at least 3 credible references
Competent Performance 35 (35%) - 39 (39%)
Responds to most of the discussion question(s)is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
50% of post has exceptional depth and breadth
supported by at least 3 credible references
Proficient Performance 31 (31%) - 34 (34%)
Responds to some of the discussion question(s)one to 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 fewer than 2 credible references
Room for Improvement 0 (0%) - 30 (30%)
Does not respond to the discussion question(s)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 1 or no credible references
Main Posting:
Writing--Outstanding Performance 6 (6%) - 6 (6%)
Written clearly and conciselyContains no grammatical or spelling errors
Fully adheres to current APA manual writing rules and style
Excellent Performance 5.5 (5.5%) - 5.5 (5.5%)
Written clearly and conciselyMay contain one or no grammatical or spelling error
Adheres to current APA manual writing rules and style
Competent Performance 5 (5%) - 5 (5%)
Written conciselyMay contain one to two grammatical or spelling error
Adheres to current APA manual writing rules and style
Proficient Performance 4.5 (4.5%) - 4.5 (4.5%)
Written somewhat conciselyMay contain more than two spelling or grammatical errors
Contains some APA formatting errors
Room for Improvement 0 (0%) - 4 (4%)
Not written clearly or conciselyContains more than two spelling or grammatical errors
Does not adhere to current APA manual writing rules and style
Main Posting:
Timely and full participation--Outstanding Performance 10 (10%) - 10 (10%)
Meets requirements for timely and full participationposts main discussion by due date
Excellent Performance 0 (0%) - 0 (0%)
NA
Competent Performance 0 (0%) - 0 (0%)
NA
Proficient Performance 0 (0%) - 0 (0%)
NA
Room for Improvement 0 (0%) - 0 (0%)
Does not meet requirement for full participation
First Response:Post to colleague's main post that is reflective and justified with credible sources.--
Outstanding Performance 9 (9%) - 9 (9%)
Response exhibits critical thinking and application to practice settingsresponds to questions posed by faculty
the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives
Excellent Performance 8.5 (8.5%) - 8.5 (8.5%)
Response exhibits critical thinking and application to practice settings
Competent Performance 7.5 (7.5%) - 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting
Proficient Performance 6.5 (6.5%) - 7 (7%)
Response is on topic, may have some depth
Room for Improvement 0 (0%) - 6 (6%)
Response may not be on topic, lacks depth
First Response:
Writing--Outstanding Performance 6 (6%) - 6 (6%)
Communication is professional and respectful to colleaguesResponse to faculty questions are fully 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
Excellent Performance 5.5 (5.5%) - 5.5 (5.5%)
Communication is professional and respectful to colleaguesResponse 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
Competent Performance 5 (5%) - 5 (5%)
Communication is mostly professional and respectful to colleaguesResponse to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible sources
Response is written in Standard Edited English
Proficient Performance 4.5 (4.5%) - 4.5 (4.5%)
Responses posted in the discussion may lack effective professional communicationResponse to faculty questions are somewhat answered if posed
Few or no credible sources are cited
Room for Improvement 0 (0%) - 4 (4%)
Responses posted in the discussion lack effectiveResponse to faculty questions are missing
No credible sources are cited
First Response:
Timely and full participation--Outstanding Performance 5 (5%) - 5 (5%)
Meets requirements for timely and full participationposts by due date
Excellent Performance 0 (0%) - 0 (0%)
NA
Competent Performance 0 (0%) - 0 (0%)
NA
Proficient Performance 0 (0%) - 0 (0%)
NA
Room for Improvement 0 (0%) - 0 (0%)
Does not meet requirement for full participation
Second Response:
Post to colleague's main post that is reflective and justified with credible sources.--Outstanding Performance 9 (9%) - 9 (9%)
Response exhibits critical thinking and application to practice settings * responds to questions posed by facultythe use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives
Excellent Performance 8.5 (8.5%) - 8.5 (8.5%)
Response exhibits critical thinking and application to practice settings
Competent Performance 7.5 (7.5%) - 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting
Proficient Performance 6.5 (6.5%) - 7 (7%)
Response is on topic, may have some depth
Room for Improvement 0 (0%) - 6 (6%)
Response may not be on topic, lacks depth
Second Response:
Writing--Outstanding Performance 6 (6%) - 6 (6%)
Communication is professional and respectful to colleaguesResponse to faculty questions are fully 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
Excellent Performance 5.5 (5.5%) - 5.5 (5.5%)
Communication is professional and respectful to colleaguesResponse 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
Competent Performance 5 (5%) - 5 (5%)
Communication is mostly professional and respectful to colleaguesResponse to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible sources
Response is written in Standard Edited English
Proficient Performance 4.5 (4.5%) - 4.5 (4.5%)
Responses posted in the discussion may lack effective professional communicationResponse to faculty questions are somewhat answered if posed
Few or no credible sources are cited
Room for Improvement 0 (0%) - 4 (4%)
Responses posted in the discussion lack effectiveResponse to faculty questions are missing
No credible sources are cited
Second Response:
Timely and full participation--Outstanding Performance 5 (5%) - 5 (5%)
Meets requirements for timely and full participationPosts by due date
Excellent Performance 0 (0%) - 0 (0%)
NA
Competent Performance 0 (0%) - 0 (0%)
NA
Proficient Performance 0 (0%) - 0 (0%)
NA
Room for Improvement 0 (0%) - 0 (0%)
Does not meet requirement for full participation
| Subject | Nursing | Pages | 9 | Style | APA |
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Answer
Pharmacokinetics and Pharmacodynamics
One of the nurse roles, alongside the physician and/or pharmacist, is to ensure that pharmacotherapeutic agents are administered appropriately. A nurse must have excellent understanding and knowledge of pharmacology as well as relevant drug calculation techniques to promote safety and quality of patient care. The basic principles of pharmacology in nursing practice include pharmacokinetics and pharmacodynamics. Pharmacokinetics refers to the study of the manner in which therapeutic agents are absorbed, distributed, metabolized and excreted from the body, whereas pharmacodynamics is the study of the effects of therapeutic agents on the body (Arcangelo & Peterson, 2011). This is a reflective essay on the manner in which wrong medications were administered owing to failure to consider pharmacokinetics of agents and pathophysiology of the infectious pathogen.
Contrary to role expectations, I do reflect on a case in which a typhus fever patient received inappropriate and ineffective therapy. The prescribing nurse never involved peers or consulted when developing treatment plan for this patient. After receiving his medications, the patient was let discharged only to reappear in the hospital five days later complaining that the disease was getting worse with time and not responding to treatment. The patient reported that signs and symptoms such as rash, headache, and fever seemed to have been getting worse throughout the last five days following discharge (Parola et al., 2013). It prompted reevaluation of the treatment plan since the laboratory work and associated diagnostic investigations that had been previously done on this patient were exemplary. Hence, the multidisciplinary team decided that there was no need of redoing diagnosis and laboratory investigations but the main area of focus was on the treatment plan.
Reevaluation of the treatment plan revealed medication choice errors. The main issue was the nurse’s failure to reconsider the physiology and pathogenicity of Rickettsia prowazekii (Parola et al., 2013). The pathogen is an obligate intracellular parasite; however, the patient had been prescribed generally hydrophilic antimicrobials including benzylpenicillin, gentamycin, and paromycin, which are limited to the extracellular compartment (Blot, Pea, & Lipman, 2014; Parola et al, 2013). Conversely, R. prowazekii is an intracellular parasite; thus, helping explaining why the previous medication plan was not effective for controlling and treating the condition.
To correct this, the patient was asked to discontinue current drugs but instead commence use of chloramphenicol 500 mg orally four times daily for one week and doxycycline 100 mg orally twice per day for one week (Akram & Prakash, 2018). Doxycycline is the primary agent of choice for treating typhus fever due to good tolerance properties (Parola et al., 2013). The new set of medications were appropriate since they are lipophilic agents, thus, tissue distribution is not limited to the extracellular environment but can achieve intracellular accumulation (Blot, Pea, & Lipman, 2014). Typhus fever may have fatal outcome in humans (Parola et al., 2013). Fortunately, the patient was quick to suspect error in medication and made a good move by revisit the hospital to launch his complaint. On follow-up, the patient showed to have recovered fully following one week treatment with doxycycline and chloramphenicol.
References
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Akram, S.M., & Prakash, V. (2018). Rickettsia prowazekii (Epidemic Typhus) [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Retrieved on Jan 07, 2019 from, https://www.ncbi.nlm.nih.gov/books/NBK448173/ Arcangelo, V.P., & Peterson, A.M. (2011). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. Blot, S.I., Pea, F., & Lipman, J. (2014). The effect of pathophysiology on pharmacokinetics in the critically ill patient – concepts appraised by the example of antimicrobial agents. Advanced Drug Delivery Reviews, 77(2014), 3-11. Parola, P., Paddock, C.D., Socolovschi, C., Labruna, M.B., Mediannikov, O., et al. (2013). Update on tick-borne rickettsioses around the world: a geographic approach. Clinical Microbiology Reviews. DOI: https://doi.org/10.1128/CMR.00032-13.
Appendix
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