How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.

This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.

Students will:

• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients
• Assess patient factors and history to develop personalized plans of care
• Evaluate ethical and legal implications related to prescribing drugs
• Analyze ethical and legal practices of prescribing drugs
• Analyze strategies to address disclosure and nondisclosure
• Justify advanced practice nurse strategies to guide prescription drug decision-making
• Analyze the process of writing prescriptions to avoid medication errors
• NURS 6521: Advanced Pharmacology Week 1-11

• 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.

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.

Week 1 Main Discussion Post: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurses, it’s important to understand the impact disorders have on the body as well as how prescribed medications and treatments effect the body (Rosenthal & Burchum, 2021). Each patient’s pharmacokinetics and pharmacodynamics vary based on their age, genetics, gender, ethnicity, behaviors, and disease process (Rosenthal & Burchum, 2021). Working in the Cardiac ICU there are several experiences and observations I have examined in my clinical practice. Each patient plan of care should be individualized to their person pharmacokinetic and pharmacodynamic factors. The purpose of this discussion is to describe a patient case from your experience, observation or clinical practice in the last five years and explain the influence and pharmacodynamic processes of the patient you identified with explanation on detail.

In the CCU there is often a  struggle with management of ICU delirium and sedation in the geriatric population. Many times, in our attempt to manage the patients symptoms we often exacerbate their confusion and delirium leading to increased ICU day stays and poor patient outcomes. Its important that we take a patient-centered approach when managing symptoms with current tools and best evidence-based practice (2019 American Geriatric Society Beers Criteria, 2019). When treating the geriatric population it’s important to remember the changes and  different functions of the body that occur naturally with aging. Studies have shown that oversedation in the ICU with benzodiazepines increase mechanical ventilatory days and increase rates of delirium with the geriatric populations (Synchev et al., 2021). There is a constant conflict between sedating and over sedating. When attempting to wean a patient off a ventilator there is often a struggle due to the long-lasting effects midazolam and other benzodiazepines not being excreted from the geriatric patient’s population (Synchev et al., 2021).  Factors that impact this are poor renal function and decreased hepatic function. This often leads to increase ICU days and inability to wean patients from ventilators NURS 6521: Advanced Pharmacology Week 1-11.

Pharmacokinetics and pharmacodynamics are impacted by the geriatrics population by decrease in cardiac output, decreased elasticity of vessels, decreased renal filtration capacity, decreased liver volume, a reduced functioning hepatocyte, and decreased hepatic blood flow (Synchev et al., 2021). As we age there is a decrease in our glomerular filtration rate and decreased renal performance (Synchev et al., 2021). Many sedatives are excreted though the kidneys and with reduced function we see higher plasma level of these medications days after discontinuing.  With decreased secretions this leads to the medications lasting longer in the patient’s system, which often leads to longer ventilatory days due to the patient unable to participate in pressure support measures. In addition, ICU delirium with benzodiazepines are seen due to the blocking of  γaminobutyric acid pump, affecting reuptake ( Zhang et al., 2021). This results in which thus results in increased levels of the inhibitory neurotransmitter (Zhang et al., 2021).

Strategies and patient-centered care models are important when managing the geriatric populations. (Kirsten et al., 2021). The nurse should also focus on the patient’s disease process and assess for a risk of delirium. Some of these conditions are patients with hypertension, DM, myocardial ischemia, atrial fabulation and heart failure (Ali MA et al., 2021). Its also important for the nurse to assess electrolyte disorders and abnormalities that could contribute and create a combination of ICU delirium (Ali MA et al., 2021) NURS 6521: Advanced Pharmacology Week 1-11. When plasma concentration drug levels were assessed in relation to delirium assessments it showed that medications such as lorazepam had a direct correlation of delirium the following day compared to medications such as dexmedetomidine. (Stollings et al., 2018). Strategies such as this can increase our effectiveness of treating patients based on their disease process and age considerations. In my personal practice I have found that early weaning and titrating off IV sedatives and replacing them with oral medications have increased the success rate of successfully preventing ICU delirium and successful extubating in the geriatric population. Incorporating practice models such as the AGS Beers Criteria has shown to increase outcomes when managing medications in older adults. The tool has shown as being valuable in the acute care setting and is based on a comprehensive approach and a valuable resource to improve medication therapy.

In conclusion, as future advanced practice nurses we need to understand the patient’s body, disease and the impact drugs have on our given patient population. Understanding how drugs are absorbed, distributed, metabolized and excreted are important when providing best patient outcomes.

References

Ali MA, Hashmi M, Ahmed W, et al Incidence and risk factors of delirium in surgical intensive care unit Trauma Surgery & Acute Care     

                Open 2021;6:e000564. doi: 10.1136/tsaco-2020- 000564

2019 American Geriatrics Society 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. /orders/doi.org/10.1111/jgs.15767

Kirsten Fiest, Tom Stelfox, Philippe Couillard, Colin Casault, & Chel Hee Lee. (2021). Sedation strategy and ICU delirium: a multicenter, population-based

propensity score-matched cohort study. BMJ Open, 11(7). /orders/doi.org/10.1136/bmjopen-2020-045087

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced         practice nurses and physician assistants

(2^nd ed.) St. Louis, MO: Elsevier.

Stollings JL, Thompson JL, Ferrell BA, et al. Sedative Plasma Concentrations and Delirium Risk in Critical Illness. Annals of Pharmacotherapy. 2018;52(6):513-521.

doi:10.1177/1060028017753480

Sychev, O. D. Ostroumova, A. P. Pereverzev, A. I. Kochetkov, T. M. Ostroumova, M. V.   Klepikova, & E. Yu. Ebzeeva. (2021). Advanced Age as a Risk Factor of

Drug-Induced Diseases. Безопасность и Риск Фармакотерапии, 9(1), 15–24.

/orders/doi.org/10.30895/2312-7821-2021-9-1-15-24

Zhang, H., Yuan, J., Chen, Q., Cao, Y., Wang, Z., Lu, W., & Bao, J. (2021). Development and validation of a predictive score for ICU delirium in critically ill

patients. BMC Anesthesiology, 21(1), 1–8.    /orders/doi.org/10.1186/s12871-021-01259-z

• Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
• Review the scenario assigned by your Instructor for this Assignment.
• Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
• Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

Write a 2- to 3-page paper that addresses the following:

• Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
• Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
• Explain the process of writing prescriptions, including strategies to minimize medication errors.

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK1Assgn2+last name+first initial.(extension)” as the name.
• Click the Week 1 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 1 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK1Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Week 2: Cardiovascular System

Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. In clinical settings, patients often present with symptoms of several cardiovascular disorders, making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options.

This week, you examine the impact of patient factors that may lead to changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.

Learning Objectives

Students will:

• Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes
• Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies
• Evaluate drug therapy plans for cardiovascular disorders

Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Assignment: Pharmacotherapy for Cardiovascular Disorders

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

Photo Credit: Getty Images/Science Photo Library RF

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from /orders/www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

• Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
• Review the case study assigned by your Instructor for this Assignment.
• Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
• Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
• Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
• Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

By Day 7 of Week 2

Write a 2- to 3-page paper that addresses the following:

• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at /orders/academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
• Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 2 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 2 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 2

To participate in this Assignment:

Week 2 Assignment

What’s Coming Up in Week 3?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will examine strategies for the treatment and management of respiratory disorders, including asthma. You will analyze asthma and stepwise management and consider the impact of this approach for patient health.

Next Week

To go to the next week:

Week 5: Endocrine System Disorders and the Treatment of Diabetes

Learning Objectives

Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Discussion: Diabetes and Drug Treatments

To Prepare

By Day 3 of Week 5

Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

By Day 6 of Week 5

NURS 6521: Advanced Pharmacology Week 1-11 Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 5 Discussion Rubric

Post by Day 3 of Week 5 and Respond by Day 6 of Week 5

To Participate in this Discussion:

Week 5 Discussion

What’s Coming Up in Module 5?

Looking Ahead: Midterm Exam

Next Week

To go to the next week:

Module 5 NURS 6521: Advanced Pharmacology Week 1-11