NSG-533 Advanced Pharmacology Discussion SOLVED

NSG-533 Advanced Pharmacology Discussion

NSG-533 Advanced Pharmacology Discussion

The patient’s heart failure should be classified as moderate to severe, left ventricular heart failure (Stage C). The ejection fraction (EF) determines how well your heart is able to sufficiently pump blood. The normal ejection fraction is 55%-70%. An ejection fraction of 30% is deemed to be extremely low and life-threatening. Based on her EF, she is having heart failure with reduced ejection fraction. There need to be adjustments made to the patient’s current medication regimen. I could either increase the HCTZ to 25mg PO daily or add furosemide of 20–40 mg PO daily because it is the more effective drug for heart failure. The change will improve her symptoms by reducing the amount of fluid in her body, allowing her to breathe easier. Diuretics acting on the loop of Henle, are more effective for the treatment of heart failure than thiazide diuretics, acting on the distal tubule (Biondi-Zoccai et al, 2017). This will improve her symptoms of edema. In the long-term taking HCTZ or furosemide. The patient would have to discontinue the use of taking her ibuprofen because it is an NSAID and they are contraindicated because they can create sodium retention and reduce the effectiveness of diuretics. I would inform her to take Tylenol for her arthritic knee pain.

The verapamil that the patient is currently taking is contraindicated in individuals with any degree of heart failure. I would discontinue that order and start her on a more conducive medication like hydralazine. Vasodilators have been shown to reduce mortality in patients self-prescribed as African-Americans with NYHA class III-IV HFrEF. They are also recommended to reduce morbidity and mortality in patients with current or prior symptomatic HFrEF who cannot be given ACE inhibitor or ARB because of drug intolerance, hypotension, or renal insufficiency, unless contraindicated (Ghandi et al., 2017). In the long-term, hydralazine and furosemide don’t have any long-term negative outcomes. In order to monitor parameters for HCTZ, if prescribed could potentially cause kidney failure so I would advise her to have her levels checked every 6 months. Also, with the use of Tylenol, I would recommend she only take the minimum dosage (no more than 3000mg daily) necessary to alleviate her knee pain in order to reduce hepatic toxicity. I would also have her come back in 3 months following medication adjustments/changes to determine if her EF has improved.

There are a few non-pharmacological recommendations for this patient. The long-term goal of the treatment and management of heart failure is to avoid exacerbation of heart failure and to decrease the hospital readmission rate (Inamdar & Inamdar, 2016). I would inform the patient of her new diagnosis to ensure she understands why these new changes are imperative. I would recommend that she would attempt to lose weight because she is only 62 inches tall, but she weighs 139 lbs. That equals a BMI of 25.42 which classifies her as being obese. I would encourage her to increase her physical activity and reduce her sodium intake. It is unclear if the patient smokes or consumes alcohol. If she does, I would encourage her to reduce and/or stop smoking or drinking alcohol.

References:

Biondi-Zoccai, G., Borges, A.R., Resende, E.S., & Roever, L. (2017). Drugs used to treat heart

failure with reduced ejection fraction. Current Trends in Cardiology, 1(1), 8–11.

https://doi.org/10.35841/cardiology.1.1.8-11

Ghandi, D., Mansukhani, R., Shah, A., Shah, K.J., & Srivastava, S. (2017). Heart failure: A

class review of pharmacotherapy. Pharmacy and Therapeutics, 42(7), 464–472.

Inamdar, A. A. & Inamdar, A.C. (2016). Heart Failure: Diagnosis, management and utilization.

Journal of Clinical Medicine, 5(7), 62.

https://doi.org/10.3390/jcm5070062

Advanced pharmacology Discussion: Pharmacokinetics and Pharmacodynamics

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 p harmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

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 abo out 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

SAMPLE

Pharmacokinetics and Pharmacodynamics

As a psychiatric and mental health nurse for the past several years, I have been involved in caring and the treatment of patients. The most prevalent mental and neurological disorders among those aged 60 years or older are risk factors for anxiety, depression, and dementia. Most older adults are reluctant to seek help regarding mental illness, which leads to reasons behind the inadequate recognition and treatment of mental disorders among older adults (Tampi & Tampi,2020). The relationship between body, drug, and disease is impacted by age, gender, ethicality, and some pathophysiological changes that occur due to an illness. The purpose of this discussion is to reflect on a patient’s case from past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug. Also, to develop a personalized plan of care based on influencing factors and patient history.

The case that I am presenting involves a 65-year-old Caucasian male with recent diagnosis of Neurocognitive disorder. No known allergy. History of hypertension and benign prostate hyperplasia. The patient has a family history of Alzheimer’s from his mother’s side. The patient lives alone with wife of 40 years and has grown children. Patients’ wife reported an increase in anxiety, agitation, and confusion. Prescribed medication includes Seroquel 12.5 mg PO bid, Norvasc 5mg once daily, Flomax 0.4once daily. Namenda 5 mg PO daily and Remeron 7.5 PO PRN at bedtime. Upon assessment, the patient was very agitated and aggressive at the beginning of the shift, including physical aggression towards staff and other patients. He was redirected to his room and was give his scheduled medication, fluid intake, and some snacks. An hour later, the patient’s response was the same, which pose a severe risk to the milieu as a whole. The patient’s recent Urine analysis was negative for urinary tract infection (UTI). An on-call physician was notified, and the patient was ordered to have Zyprexa Zaydis 5mg PRN every 6hours as needed.   Shortly after administration. The patient became sleepy and was noted to have unsteady gait; he was assisted to room, bed low and lock, and the bed alarm was activated. The patient remained on close Observation.   

The neurocognitive disorder is most common in older adults; it affects the cognitive capacity, which causes a problem with intricate attention, learning, memory, perceptual-motor abilities and causes significant changes in behavior (Jenson & Padilla,2017). Pharmacokinetics and pharmacodynamics are the relationships between drugs and the body. Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion. In contrast, pharmacodynamics describes what the drug does to the body (Rosenthal & Burchum, 2021). Older adults have a slow metabolism. Therefore, a decrease in gastric emptying increases gastric PH, which changes drug absorption in most older adults.

Furthermore, the effects of similar drug concentrations at the site of action in older adults may be greater or smaller than those in younger people.  In older adults with delirium, H2‐receptor antagonists remain on the list of medications to avoid. Besides, nonbenzodiazepine, benzodiazepine receptor agonist hypnotics should be avoided in older adults with delirium (Frick et al.,2019).

The Plan of care for the patient includes ongoing monitoring and reassessment. Initiating the fall protocols by accompanying the patient to the bathroom, and communication of fall status among staff. Assessment of the patient for sedation and antipsychotic adverse effects. Additionally, initiating a therapeutic environment by providing other non-pharmacological methods to address agitations and lessen the patient’s aggressive behavior for the safety of the patient and others.

References

Fick, D. M., Semla, T. P., Steinman, M., Beizer, J., Brandt, N., Dombrowski, R.,

DuBeau, C. E., Pezzullo, L., Epplin, J. J., Flanagan, N., Morden, E., Hanlon, J., Hollmann, P., Laird, R., Linnebur, S., & Sandhu, S. (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. https://doi-org.ezp.waldenulibrary.org/10.1111/jgs.15767

Jensen, L., & Padilla, R. (2017). Effectiveness of Environment-Based Interventions

That Address Behavior, Perception, and Falls in People with Alzheimer’s Disease and Related Major Neurocognitive Disorders: A Systematic Review. American Journal of Occupational Therapy, 71(5), 1–10. https://doi-org.ezp.waldenulibrary.org/10.5014/ajot.2017.027409

Nightingale, G., Schwartz, R., Kachur, E., Dixon, B. N., Cote, C., Barlow, A.,

Barlow, B., & Medina, P. (2019). Clinical pharmacology of oncology agents in older adults: A comprehensive review of how chronologic and functional age can influence treatment-related effects. Journal of Geriatric Oncology, 10(1), 4–30. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jgo.2018.06.008

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for

advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Tampi, R. R., & Tampi, D. J. (2020). The Most Prevalent Psychiatric Disorder in

Older Adults. Psychiatric Times, 37(7), 44–45.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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