Posted: September 2nd, 2022

Grogan and Preuss (2022) say that pharmacokinetics

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.
Introduction
Grogan and Preuss (2022) say that pharmacokinetics is the study of how a drug moves through the body and how the body responds to the drug. Burchum and Rosenthal (2021) listed the four processes of pharmacokinetics: absorption, distribution, metabolism, and elimination. On the other hand, pharmacokinetics was defined as the study of how drugs affect the body physiologically (Marino, et al., 2022). Grogan and Preuss said in 2022 that how a person’s body handles a drug could affect how long it stays in the body and how much of it is in the body. The processes could be changed by getting older, interactions between drugs, how they are taken, different diseases, or organ problems.
Patient Case Scenario
I work at a skilled nursing facility, and one of our patients is an 88-year-old woman with a history of high blood pressure, diabetes, deep vein thrombosis, multiple falls at home, osteoporosis, and heart failure. The patient is awake and aware x 1, fights back, tries to get out of bed all the time, and asks to go home. Pad alarm was agreed upon and used. Even after being told many times to stay in bed and use the call light to get help, the patient will still try to get up and shout for help. The patient’s family gives them 10mg of Melatonin at home, which sometimes works and sometimes doesn’t. MD was told what was going on, and while the patient was waiting for orders that night, she fell out of bed. No one was hurt, and there was no active bleeding. Vital signs were normal. MD ordered Ativan 0.5mg PO. The patient was given medicine, but he or she hasn’t calmed down yet. The next night, the patient was shouting in the room, asking for help and saying he wanted to go home. A babysitter was asked for, and the doctor gave 0.5mg of Ativan. When the sitter was about to feed the patient in the morning, she got scared. The patient was hard to wake up. The room was entered by staff. The vital signs were checked, and everything was fine. It was strange that the person was still sleeping at that time of day. The patient was closely watched, and he or she woke up later that day. The patient’s vital signs were stable, and he or she tried to get up and shouted again. Ativan was to blame for how hard it was to wake the patient up. MD cut back the amount of Ativan to 0.5mg, and the patient did well the next night.
Conclusion
When working with older people, doctors and nurses should be careful when using benzodiazepines. Ghiasi et al. (2022) say that too much Ativan can cause CNS and respiratory depression, which can lead to extreme drowsiness, weak muscles, confusion, low blood pressure, and even coma. Ghiasi et al. (2002) suggested decreasing the amount of Ativan over time, but in the case described above, the amount of Ativan was increased the next night because the medication didn’t work right away on the first day. In Beers Criteria, published in 2019, the American Geriatrics Society said that health care professionals should be aware that older people are more sensitive to benzodiazepines, especially because their metabolism of long-acting drugs has slowed down. The American Geriatrics Society said in 2019 that older adults should try to stay away from benzodiazepines as much as possible.

References:
American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American
Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674-694. doi:10.1111/jgs.15767
Ghiasi, N., Bhansali, R., & Marwaha, R. (2022). Lorazepam.
https://www.ncbi.nlm.nih.gov/books/NBK532890/
Grogan, S. & Preuss, C. (2022). Pharmacokinetics.
https://www.ncbi.nlm.nih.gov/books/NBK557744
Marino, M., Jamal, Z. & Zito, P. (2022). Pharmacodynamics.
https://www.ncbi.nlm.nih.gov/books/NBK507791/
Rosenthal, L. & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses
and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

NICOLE

Pharmacokinetic and Pharmacodynamics
Pharmacokinetics-the absorption, distribution, metabolism, and excretion of drugs by the body (Rebar et. al., 2022). Pharmacodynamics- the biological and physical effects of drugs and the mechanisms of drug actions (Rebar et. al., 2022). A recent study was done on FNP students and Pharmacists to evaluate errors, the most preventable errors started from the prescribing stage. Medication selection and dose were the most common types of prescribing error, with the most error-prone factors being incorrect drug selection, contraindications such as medication allergies, incorrect dosing, and including insufficient information on the prescription (Sabatino et al., 2017).
Patient Case
I recently had a patient present with weakness, dizziness, and a fall. He is an 87-year-old man admitted for hypotension, weakness, dehydration, and malnutrition The patient blood pressure upon admission was 80/54. The patient was on an antihypertensive drug called Lisinopril 10 mg. Also taking a beta blocker Metoprolol 75 mg. Patient history of MI, dementia, and hypertension. The patient weighs 121 lbs and is 5 ft 8 in tall. The patient was unable to recall exactly how much medication he has taken. The patient was dehydrated upon admission. He has been traveling with his wife and had come to Minnesota from Florida.
Factors that influenced Pharmacokinetic and Pharmacodynamic Process
This patient is taking a beta-adrenergic antagonist and ACE inhibitor. Hypotension may occur, accompanied by dizziness and increased heart rate (Rebar et al., 2022). This hypotension was the probable cause of his fall and dizziness. The pharmacokinetics of metoprolol are absorbed in the GI tract (Rebar et al., 2022). Metoprolol is metabolized in the liver and its metabolites are excreted in urine (Rebar et al., 2022). Patients should be hydrated well while taking this medication to effectively work well in the body. In patients taking ACE inhibitors, Lisinopril is also absorbed in the GI tract, metabolized in the liver, and excreted by the kidneys. ACE inhibitors promote the excretion of sodium and water, reducing the amount of blood the heart needs to pump and reducing blood pressure (Rebar et al., 2022).
Plan of Care
Withhold the dose if the patient’s heart rate is less than 60 bpm or his systolic blood pressure drops below 90 mm Hg (Rebar et al., 2022). Evaluate the patient after lowering the dose of medications, maintain fluid balance and teach the family drug administration and understanding of symptoms. Patients should have a home blood pressure monitor and notify the primary care provider if any adverse reactions occur. The patient will need to have medications set up for him at home and drink an adequate amount of water and maintain a healthy diet.

References
Rebar, C. R., Heimgartner, N. M., Gersch, C., & Willis, L. M. (2022). Pharmacology Made Incredibly Easy (4th ed.). Wolters Kluwer.
Rossenthal, L.D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). St. Louis, MO: Elsevier.
Sabatino, J. A. , Pruchnicki, M. C. , Sevin, A. M. , Barker, E. , Green, C. G. & Porter,

K. (2017). Improving prescribing practices. Journal of the American Association of Nurse

Practitioners, 29 (5), 248-254. doi: 10.1002/2327-6924.12446

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