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 Scott 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:
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.
“Introduction to Advanced Pharmacology” Program Transcript
NARRATOR: In this program, Dr. Terry Buttaro, Associate Professor of Practice at Simmons School of Nursing and Health Sciences, discusses the importance of advanced pharmacology for the advanced practice nurse. Let’s listen as she provides her insights to this course.
TERRY BUTTARO: As a nurse practitioner, probably advanced, you can’t learn anything in a silo to be a nurse practitioner or any kind of a health care provider because it all goes together. One complements another. But because advanced practice nurses are going to be prescribers and are going to monitor those meds, you really have to understand how the drugs work and what you intend them to do.
Again, everything goes back to what’s the path of physiology. So there are several different kinds of pneumonias. And those different kinds of pneumonias present in a different way, and those different kind of pneumonias are caused by different bacteria. Some are staphylococci, some are Moraxella catarrhalis. And the treatment is different.
You don’t want to treat someone who has an acute bacterial pneumonia with a medication that’s indicated for a different kind of pneumonia. You don’t want to treat somebody who actually has pertussis or whooping cough, which is very prevalent these days, with an antibiotic that doesn’t cover it. So understanding the different categories of antibiotics or the different categories of blood pressure medications is very important.
Otherwise you’re not going to treat the patient the right way. And with antibiotics this is really a huge issue because if we give the wrong antibiotics, even for the wrong length of time, we can increase antibiotics resistance and we don’t want to do that. Because we know as we’re living longer, for example, over the course of somebody’s lifetime they’re going to be exposed to many antibiotics.
And you don’t want them– you want to still have good antibiotics for those patients when they need them. The other thing is that you want to be able to get the best response you can. So you don’t want to give them medication, particularly any antihypertensive medication, that’s not really going to be effective for your patient. You know, different meds are tied into different pathophysiologic processes.
So a patient with diabetes, for example, you might not use a beta blocker as an antihypertensive, but you would want to use an ACE inhibitor or another drug that will also be renal-protective, protect the kidneys a little bit. So you always have to
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think about that. It’s picking the right drug at the right time for the right patient in the right dose.
And you can never be too careful. And the right dose means that you think about, is this a baby? Is this a child? Is this a child who only has one kidney, for example? Is this a child who’s had a kidney problem? Is this an elder who on paper their renal status looks good, but you know from pathophysiology that after age 50 everybody loses nephrons. So even though that BUN and creatinine look normal, they’re not really normal. So you have to be careful ordering that antibiotic.
So I think you do have to be focused and attentive. Every patient’s different, and that’s the other thing. No one drug works for every patient, and you can never say that a patient won’t have a bad reaction to a drug. Because we don’t know in terms of genetics what the response is going to be to a drug. We do know recently that some drugs just don’t work for some people.
They just don’t work. And it can be genetically related. Someday we’ll be able to do a test. We’ll be able to take a swab of saliva and say, OK, this antihypertensive’s going to work for this patient, this antiplatelet’s going to work for this patient, but we can’t do that yet.
So it really is kind of knowing the principles of advanced pharmacology, and be able to translate that into practice. And then you have to teach the patients about the meds too because health literacy is a huge issue in our country today. Most people really only read at the third grade level. And as we get older or if we’re too young or if we’re distracted, we don’t have the patience to really understand what drugs do to our body. And how important is to take a drug.
So there’s a new drug out on the market, Pradaxa. And Pradaxa’s a great drug, it’s a new antiplatelet, it’s probably going to, in the long-term, replace warfarin, which is an anticoagulant that’s used for people who have atrial fibrillation. And the problem with atrial fibrillation is the heart beats kind of fast, and it’s irregular, and people can get bloodclots. They can get strokes, they can get pulmonary emboli.
So you want somebody on a medication that’s going to help prevent those really bad things that are going to happen. The problem with Pradaxa is patients really need to understand that it has a very short half-life. And this is what the advanced practice nurse has to know. You have to know how long is the half-life for a drug.
So warfarin has a really long half-life. It’s greater than 24 hours. You don’t even see a response for warfarin for three days. So if somebody forgets a dose, if they go on a trip they forget get the dose, not a big deal. It’s once a day, warfarin. But Pradaxa is twice a day, and it has a very short half-life. So if they forget that
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second dose then their blood level’s not going to be where it should be, and they could have a stroke.
And that’s what we want to prevent, so health education is also an important part of that pharmacological understanding for nurse practitioners And NPs do this I think it– I think the educational process for nurse practitioners is different than it is for physicians. Because for NPs, we know about the relationship with patients, how important that is. And we know that a lot of what we do is patient teaching.
I think that’s why collaborating with a physician is so good. The doctor can say, they really need to know this. But most practices give the nurse practitioner a little bit more time, so they can explain it to the patient. And hopefully in that way you’ll have better outcomes.
I think advanced pharmacology you want to be sure that you’re going to be safe practitioner. And if you come through understanding the importance of looking things up and just kind of remembering those kind of things that really should click, uh-oh, something’s wrong with this, then you’ll be OK. It doesn’t mean something bad won’t happen because we never know what’s going to happen to people on medications.
And we always have to tell people that. You know, it looks like a safe drug, haven’t seen a lot of problems with this in the literature. And patients appreciate that when you talk about the studies and what they found. They appreciate that. And if you do that, you shouldn’t get in trouble. You should be OK.
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