NURS 6521 Week 1 Discussion
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 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.
To prepare:
- 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.
BY DAY 3 OF WEEK 1
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.
BY DAY 6 OF WEEK 1
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.
Sample Discussion Post
While working at an acute psychiatric floor at a V.A hospital, I was providing care for a 41-year-old African American male with PTSD, major depression, alcohol abuse, and uncontrolled hypertension. The presentation was a complex case due to the interplay of genetic factors, ethnicity, age-related changes, and lifestyle behaviors.
As the patient was middle aged, with possible liver and renal damage from substance use and uncontrolled hypertension, they may experience altered metabolism and excretion of medications. Pharmacogenetics could inform the selection and dosing of psychiatric medications, with consideration that CYP2D6 and CYP2C19 variants are thought to explain up to 42% of the variability in antidepressant drug response (Anderson et al., 2022). Also, the patient’s ethnicity will impact treatment. For example, thiazide diuretics and calcium channel blockers are recommended as the best initial treatment for hypertension in African Americans over ACE inhibitors and Angiotensin receptor blockers. (Clemmer et al., 2020). Regarding behaviors, chronic alcohol use may induce or inhibit liver enzymes responsible for drug metabolism. This can potentially increase risks of adverse effects due to prolonging and enhancing drug availability, or result in enhanced drug elimination and diminished therapeutic effects (Cheng et al., 2018).
In creating a personalized treatment plan, immediate psychiatric risk management is critical, necessitating hospitalization and a focus on patient safety. Substance abuse treatment would address alcohol dependency with medication-assisted detoxification from alcohol. Medications like SSRIs or SNRIs would be considered for treatment of depression and PTSD. Antihypertensive therapy tailored to the patient’s race and genetic background, alongside lifestyle modifications would be advised to manage hypertension and improve overall well-being. Coordination across healthcare disciplines, regular monitoring, intensive outpatient therapy such as Cognitive behavioral therapy and trauma focused interventions, and adjustments to treatment would increase the likelihood of reduced alcohol use and better patient outcomes (Roberts et al., 2022).
References
Anderson, H. D., Thant, T. M., Kao, D. P., Crooks, K. R., Mendola, N. D., & Aquilante, C. L. (2022). Pharmacogenetic testing among patients with depression in a US managed care population. Clinical and Translational Science. https://doi.org/10.1111/cts.13279
Cheng, C., Mithoowani, F., Ungar, T., & Lee, M. (2018). Interaction between Psychotropic Medications and Alcohol: Perceptions among Patients Attending an Adult Mental Health Day Hospital Program. The Canadian Journal of Hospital Pharmacy, 71(1), 7–13.
Clemmer, J. S., Pruett, W. A., & Lirette, S. T. (2020). Racial and Sex Differences in the Response to First-Line Antihypertensive Therapy. Frontiers in Cardiovascular Medicine, 7. https://doi.org/10.3389/fcvm.2020.608037
Roberts, N. P., Lotzin, A., & Schäfer, I. (2022). A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder. European Journal of Psychotraumatology, 13(1). https://doi.org/10.1080/20008198.2022.2041831
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