peer response
Peer response 1 Pharmacokinetics, or how a drug moves throughout the body, does so in four processes: absorption, distribution, metabolism, and excretion (Rosenthal & Burchum, 2020). Pharmacodynamics, on the other hand, encompasses the biochemical, physiologic, and molecular effects drugs have on the body (Farinde, 2022). As healthcare professionals, we must understand a patient’s individual factors that may affect their pharmacokinetic and pharmacodynamic processes. These specific patient factors include “genetics, gender, ethnicity, age, individual behaviors such as diet, nutrition, smoking, alcohol, illicit drug abuse, and/or pathophysiological changes due to disease, which may alter their response to mediations It is essential to consider individual patient factors when selecting drugs and determining dosages for patients, and this was an important topic of concern for many pediatric patients that I have cared for over the past 7 years. After reviewing these terms and patient factors, one specific patient scenario came to mind.
I was taking care of a medically complex patient with numerous diagnoses and medications. Her diagnosis of diabetes insipidus made other diagnoses particularly challenging to control. Diabetes insipidus is a disorder that causes an imbalance of fluids in the body which leads you to produce/excrete copious amounts of urine usually because of issues with anti-diuretic hormone. To address this problem the patient was put on DDAVP which she had in 3 different forms (injection, pill, and nasal spray). She started out on the injection which controlled things for several years until it slowly stopped working, regardless of adjusting the dosage many times. The patient then started on the pill form, which took an inpatient stay to regulate and get to a steady state in the body because she kept having issues with her sodium, and thus seizure activity. The nasal spray was prescribed as back up in case she was having too many wet diapers during the day.
There were many factors that affected the pharmacokinetic and pharmacodynamic processes of this medication and consequently many other medications. When the patient was sick, particularly with respiratory infections, it would be extremely difficult to regulate her diabetes insipidus even if she were previously well controlled with her DDAVP. Over the course of the 7 years, I cared for her, she would need her DDAVP dose adjusted constantly. She needed routine labs to monitor her sodium especially during periods of sickness, because she would always void more than usual. She was on a “fixed†nutrition plan/amount given via g/j tube, but this also had to be adjusted based on sodium results. There is no doubt the patient had many factors working against the efficacy of this specific medication, and another complex issue to work around was her constant constipation from being immobile. This also affected the pharmacokinetics (absorption, distribution, metabolism, excretion) of said medication.
A personalized plan for this specific patient consisted of strict intake/out. Weighing all her diapers throughout the day to make sure her hourly output was not exceeding a specific amount (determined by her endocrinologist). If her urine output were over a certain amount, she would need another dose of her DDAVP, and if the output continued an “emergency†dose intranasally. Consistently giving the medication via jejunostomy tube at the same time(s) every day. We had to make sure to contact her endocrinologist with any questions/concerns as soon as they arise. Another tricky task was her morning dose, which could not be administered until she had her “breakthrough†(a set amount of urine output from the nighttime hours). This was crucial to follow as DDAVP can cause fluid overload. One thing I would include/encourage was more education for the family/caregivers to make sure this was always done correctly.
There were many times the mother would give the morning dose “prematurely†without waiting for that “breakthrough†urine, and then when the patient would finally have a copious amount of urine output, the mother would get nervous and give her another “breakthrough†dose causing fluid overload and thus electrolyte imbalance. I was continuously educating her about the proper way and the concerns of what she was doing but I did not work with the patient every day, so it is important that other nurses and healthcare providers are properly educating family members and other caregivers on the accurate administration of DDAVP per patients’ needs. Unfortunately, these family members/caregivers are often burnt-out from lack of sleep, or the constant needs of the child and need to be reminded/educated often.
Peer response 2 Pharmacokinetic and Pharmacodynamic According to Keller & Hann (2018) pharmacokinetics are the cause and pharmacodynamics are the consequence of the drug therapy. Pharmacokinetics is the study of the way drug process in the body (Li et al., 2019). Absorption, distribution, metabolism, and excretion are the main basic of pharmacokinetic (Rosenthal & Burchum, 2021). Pharmacodynamics is about drug’s molecular, biochemical, physiologic effects or actions (Rosenthal & Burchum, 2021). It is important to consider pharmacokinetics and pharmacodynamics when any dosing regimen is determined (Keller & Hann, 2018). Personal Experience AJ is a 21-year-old Caucasian female brought to Emergency department by police officers for seeking inpatient psychiatry treatment. Patient’s family called police for physical altercation at home. Patient appears agitated and aggressive.
Patient is not cooperative with assessment; she thinks there’s surveillance camera everywhere which can read her mind and gather every information about her. Patient is paranoid and observed talking to herself. Patient is concerned about the vital signs monitor and computer in the examination room are being used to monitor her and concerned about her confidentiality. Due to the presenting condition of the patient, the attending physician ordered one time order of Haldol 10mg IM, Benadryl 50mg IM, Ativan 2mg IM. After received IM injections, patient became calm and cooperative with the assessment. Patient reported that she is feeling hopeless, sad, having no energy, and crying multiple times in a day. The PCP prescribed 50mg of Zoloft daily; however, patient stated that she doesn’t like the “cotton mouth†feeling she had it from the medicine. Without informing physician the patient stopped taking her prescribed medication and meanwhile she is depending on illicit drugs to cope with her depression Patient factor Pharmacokinetics can vary from individual to individual who undergo drug therapy.
It can be affected by age, gender, diet, environment, behavior, genetics, drug-drug or food-drug interactions, and patient’s pathophysiology (Johnson-Davis, 2021). The behavioral factors have an important role for the clients who are obtaining mental health services. Working with inpatient psychiatric unit for over 10 years, patient has often reported that they have been stopped taking their medication due to minor side effects, missing doses, unable to refill medications and stopping medication abruptly without notifying providers. It is important the client should be aware of mechanism of action of medication which can take up to several days and common side effects will slowly disappear. Plan of care 1. Education Educating patient about the importance of compliant with medication, common side effects, and report to the provider for any changes.
Educate the patient that Zoloft is an antidepressant and prescribed to treat for depression. The feeling of worthless, sad, tearful, loss of interest or pleasure in usual activities, trouble with concentration and low energy are some of the examples for the symptoms of depression (Kaltenboeck & Harmer, 2018). The possible common side effects of sertraline are headache, nausea, diarrhea, dry mouth, fatigue, sleepy or insomnia (Singh & Saadabadi, 2022). In addition, educate patient that it may take few weeks to observe the positive effect of medication management. 1. Antidepressant treatment and group therapies Patient may benefit from treatment of antidepressant treatment based on patient’s condition. Patient can begin at a low dose of antidepressant and increase the dose slowly after few weeks. In addition, encourage patient to consider taking ice chips or sip water regularly, avoid caffeinated beverages because it can make the mouth drier.
Since dry mouth was the one of the reasons for the patient to stop taking the medication. Encourage patient to attend group therapies which is provided during the inpatient treatment along with the medication management. Many patients in the past had reported that group therapies with medication management was effective with their treatment and obtained a positive therapeutic outcome. Conclusion It is important to understand each patient and the relationship to their bodies and medication action. It can be varied from each patient, so it is important to have personalized plan of care for each of them. Medication therapy has a crucial role when it comes to treatment, and it can enhance quality of life. The providers should always consider the key elements of pharmacokinetics and pharmacodynamics to obtain positive effective outcome.
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Peer Response
Peer Response 1
Hello. Thanks for the insightful discussion. From your analysis, I have learned the difference between Pharmacokinetics and Pharmacodynamics. Pharmacokinetics may also be defined as the study of how a drug moves through the body (Schüttler et al., 2020). On the other hand, Pharmacodynamics is the study of what a drug does to the body. Pharmacokinetics looks at how drugs are absorbed, distributed, metabolized and eliminated from the body. Pharmacodynamics looks at how drugs interact with cells and tissues in the body to produce their effects (Chen et al., 2020). It is essential to consider individual patient factors when selecting drugs and determining dosages for patients. The main factor that should be considered is the individual’s pharmacokinetics, which refers to how the body processes and eliminates a drug (Koziolek et al., 2019). Pharmacokinetic parameters such as age, weight, gender, liver and kidney function, etc. can all affect how a patient will respond to a medication. It is important to tailor treatments specifically for each patient in order to ensure the best possible outcome.
References
Chen, L., Krekels, E. H., Verweij, P., Buil, J. B., Knibbe, C. A., & Brüggemann, R. J. (2020). Pharmacokinetics and pharmacodynamics of posaconazole. Drugs, 80(7), 671-695. https://link.springer.com/article/10.1007/s40265-020-01306-y
Koziolek, M., Alcaro, S., Augustijns, P., Basit, A. W., Grimm, M., Hens, B., … & Corsetti, M. (2019). The mechanisms of pharmacokinetic food-drug interactions–A perspective from the UNGAP group. European Journal of Pharmaceutical Sciences, 134, 31-59. https://doi.org/10.1016/j.ejps.2019.04.003
Schüttler, J., Eisenried, A., Lerch, M., Fechner, J., Jeleazcov, C., & Ihmsen, H. (2020). Pharmacokinetics and pharmacodynamics of remimazolam (CNS 7056) after continuous infusion in healthy male volunteers: part I. Pharmacokinetics and clinical pharmacodynamics. Anesthesiology, 132(4), 636-651. https://doi.org/10.1097/ALN.0000000000003103
Peer Response 2
Hello. Thanks for the insightful discussion. From your analysis, I have learned the differences that exist between Pharmacokinetics and Pharmacodynamics. Pharmacokinetics is the study of how drugs are absorbed, distributed, metabolized, and eliminated by the body. It helps to determine the ideal doses of drugs and how they should be administered (Koziolek et al., 2019). Pharmacodynamics is the study of how drugs produce their therapeutic effects. It helps to understand how a drug works at the cellular and molecular level, as well as how different doses produce different effects.
Pharmacokinetics (PK) is the study of how a drug moves through the body. Pharmacodynamics (PD) is the study of how a drug affects the body. When determining a dosing regimen, it is important to consider both PK and PD (Nauck & Meier, 2019). One reason it is important to consider PK when determining a dosing regimen is because different people will absorb and metabolize drugs differently (Berends et al., 2019). For example, someone with poor liver function may not be able to clear a drug from their system as quickly as someone with normal liver function. This could lead to accumulation of the drug in the body and potentially toxic levels.
References
Berends, S. E., Strik, A. S., Löwenberg, M., D’Haens, G. R., & Mathôt, R. A. (2019). Clinical pharmacokinetic and pharmacodynamic considerations in the treatment of ulcerative colitis. Clinical Pharmacokinetics, 58(1), 15-37. https://link.springer.com/article/10.1007/s40262-018-0676-z
Koziolek, M., Alcaro, S., Augustijns, P., Basit, A. W., Grimm, M., Hens, B., … & Corsetti, M. (2019). The mechanisms of pharmacokinetic food-drug interactions–A perspective from the UNGAP group. European Journal of Pharmaceutical Sciences, 134, 31-59. https://doi.org/10.1016/j.ejps.2019.04.003
Nauck, M. A., & Meier, J. J. (2019). Management of endocrine disease: are all GLP-1 agonists equal in the treatment of type 2 diabetes?. European journal of endocrinology, 181(6), R211-R234. https://eje.bioscientifica.com/view/journals/eje/181/6/EJE-19-0566.xml