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– Read a selection of your colleagues’ responses and respond to at least two of your colleagues 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.
– 200 words (minimum) required for each reply. – Please use at least 2 current scholarly resources (FREE of charge), and write in APA format 1) Post By: Gude B. Marl
DISCUSSION: PHARMACOKINETICS AND PHARMACODYNAMICS.
Pharmacokinetics is currently defined as the study of the time course of drug absorption, distribution, metabolism, and excretion. Clinical pharmacokinetics is the application of pharmacokinetic principles to the safe and effective therapeutic management of drugs in an individual patient treatment plan. Pharmacodynamics refers to the relationship between drug concentration at the site of action and the resulting effect, including the time course and intensity of therapeutic and adverse effects. The effect of a drug present at the site of action is determined by that drug’s binding with a receptor. Receptors may be present on neurons in the central nervous system (i.e., opiate receptors) to depress pain sensation, on cardiac muscle to affect the intensity of contraction, or even within bacteria to disrupt the maintenance of the bacterial cell wall.
I have been a nurse since 2001, and I have seen some cases I only believe possible because I have seen it myself. A recent case I was part of the interdisciplinary health care team in 2022 was simple; however, eye-opening. The patient was a 53 years old Caucasian male; a successful attorney that recently marry a 42 years old female successful physical instructor and had their whole life planned out with exciting activities, traveling, and a perfect lifestyle. No past medical history, athletic, active social lifestyle, occasional drink intake on holidays, daily wine drink in the evenings and during dinner, and very comfortable lifestyle. The patient suddenly begin having pain in bilateral lower extremities, difficulty with ambulation and endurance, increased weakness and left foot swelling, tenderness when placing weight, and numbness. The patient intended to continue his normal life till he woke up one day with generalized pain, swelling of BLE’s arms and hands, and unable to get out of bed. His wife is a small frame and could not help him as he is 6 ft. 180 lbs. before the swelling. The wife activates EMS, the patient gets transported and admitted to the hospital with an elevated blood pressure of 144/92, heart rate of 93 to 116 irregular beats, and all other vital signs within range, and an elevated Synovial fluid WBC count. The patient is found to have an acute gout attack, with an abscess to the left foot requiring surgical intervention, positive for infection. The patient was placed on IV antibiotics, steroids, diuretics, antihypertensive medications, opioid medication for pain, and a sedative hypnotic for sleep. The patient was now temporarily wheelchair dependent due to pain and inability to bear weight, as well as BLE’s 2+ edema and 1+ edema to bilateral arms and hands. The patient became depressed and his wife became overwhelmed with the increased amount of care her husband required now; their marriage was recent and they did not expect anything major health complications. The patient voiced fears about the effects this health complication will have on their marriage and the wife expressed her fears about her inability to care for her husband at home.
Gout is a disease that is a complex form of arthritis; which causes pain and discomfort in the joints, sudden and severe attacks of painful swelling, redness, and tenderness of the joints. It especially affects the feet and toes joints, and metatarsophalangeal joint (the big toe), and is called podagra. Other common joints that may be involved in a gout attack most frequently sites are the feet, ankles, knees, and elbows. (Wang, H. et.al. 2023). An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve. Full recovery from a gout attack takes approximately 7-14 days. (Wu, X., & You, C.(2023). My patient had been on IV antibiotics for two weeks and remained unchanged, refusing to even move much due to joint pain and swelling. I begin to question the fact that treatment concentrated on infection, pain, and edema relief; however, the root cause was gout. I brought up the possibility of using gout medications such as Xanthone oxidase inhibitor Allopurinol that can reduce the production of uric acid in the body and reduce inflammation too. And anti-gout agents such as Colchicine that is a Uricosuric, anti-inflammatory, immune-modulating agent that works by stopping the natural body process that causes swelling. However, I got no response from the provider. During a teaching and instruction section with the patient and wife, I instructed them on gout, its causes, treatments, risk factors, diet, lifestyle changes needed, and all medications the patient was taking. I also mentioned the fact that the patient was not on any gout prevention treatment and the high risk for possible recurrent gout episodes; and how this treatment has been effective on other patients with similar gout issues. The patient and wife had a meeting with the provider during rounds and the wife requested the need to try the combination drug of Allopurinol and Colchicine. The provider surprisingly did prescribe the medications. The patient started making great rehabilitation progress, swelling decreased, the pain got under control and his mobility was impressive. The patient was discharged home and the wife was very pleased; she call me at work to let me know the patient was back to work and has been discontinued from all IV antibiotics, diuretics, and pain relievers. The patient was only taking his beta-blocker, anti-gout combination, and a multivitamin. She also told me I was in the right profession, and she believed this was my calling. Of course, I was very happy too.
The Pharmacokinetics of this patient’s case was impressive in how his body’s drug absorption, distribution, metabolism, and excretion of the uric acid out of his body was safe and effective therapeutic management of drugs in this patient’s treatment plan. Pharmacodynamics is the relation between the drug concentrations at the site of action; thus, resulting in positive effects, including the time course and intensity of the therapeutic effects in the patient’s body. The effect of the drug present at the site of action is determined by that drug’s binding with the body receptors. Gout is more common in males than females, African Americans, ages 30 -50 years of age, and women after menopause. Risk factors such as dietary intake high on red meats and seafood, increased alcohol intake, obesity, high blood pressure, diabetes, kidney disease, kidney stones, and family genetics can play a role in the development of gout. (Luo TD. Et.al. 2020).
In conclusion, implementing the nursing process and utilization of evidenced-based research, clinical expertise, and patient individual signs and symptoms to assist the interdisciplinary healthcare team to implement the treatment plan for the diagnosis and treatment of diseases and disorders can have effective results. Understanding the principles of pharmacokinetics and pharmacodynamics, the impact of disorders on the body, and the drug treatment effects of individualized patient treatment for the patient’s specific body characteristics play a major role in the restoration and rehabilitation of the patient’s health status. The personalized patient plan of care should be based on the influencing factors, lifestyle, and history; therefore, providing the patient and family with the information needed to follow the treatment plan, and lifestyle changes necessary for the patient to maintain a healthy life and prevent further health complications. References:
Luo TD, Jarvis DL, Yancey HB, Zuskov A, Tipton SC, Langfitt MK, Plate JF. (2020). Synovial Cell Count Poorly Predicts Septic Arthritis in the Presence
of Crystalline Arthropathy. J Bone Jt Infect. 2020 Apr 22;5(3):118-124. doi: 10.7150/jbji.44815. PMID: 32566449; PMCID: PMC7295646.
Wang, H., Yan, C., Wu, Q., Zeng, H., Zhang, Z., Wang, W., & Sun, X. (2023). Acute gout attacks during the perioperative period and risk factors of
recurrence after orthopedic surgery among untreated gout patients. Journal of Orthopaedic Surgery & Research, 18(1), 1–9. https://doi.org/10.1186/s13018-023-03536-8
Wu, X., & You, C. (2023). The biomarkers discovery of hyperuricemia and gout: proteomics and metabolomics. PeerJ, 11, e14554. https://doi.org/10.7717/peerj.14554
Zhang, Y., Yang, R., Dove, A., Li, X., Yang, H., Li, S., Wang, J., Li, W.-D., Zhao, H., Xu, W., & Wang, Y. (2022). Healthy lifestyle counteracts the risk effect
of genetic factors on incident gout: a large population-based longitudinal study. BMC Medicine, 20(1),38. https://doi.org/10.1186/s12916-022- 02341-0References 2) Post by Melis A Mair
Sexual abuse, illegal prescribing of painkillers, and unneeded procedures are just a few examples of the kind of serious ethical breaches in medicine that hurt patients and erode public trust in the medical community. Nearly all (97%) of the incidents involved repeated (99%) wrongdoing by men (95%), happened in non-academic (95%) medical settings (95%), raised questions about oversight (89%), and were done for selfish reasons, like money or sex (90%).More than half of the offenders had a mental health problem, such as a personality disorder or addiction. Yet, despite these obvious trends, no identifiable risk factors have been identified, making prevention challenging. Significant policy reforms are needed to ensure early identification and intervention in situations, with patient safety taking precedence over physician concerns about privacy, fair processes, and proportionate disciplinary penalties(DuBois et al., 2019).
Hardware and software used in telemedicine don’t raise any ethical concerns by themselves. Ethical dilemmas may arise from the ways in which this technology is applied. Ethical responsibilities between a patient and provider are outlined by the American Medical Association (AMA) along a spectrum that reflects the type of telemedicine employed (levels of accountability). At one extreme of this continuum are web pages that offer no direct communication between the patient and the doctor. Although the medical expert bears some responsibility for the correctness of the information supplied, he or she bears less direct duty or accountability for the ways in which the knowledge presented is actually used by the reader. Concerns about doctors prescribing narcotics to people they’ve never met have increased alongside the popularity of telemedicine. Internet-based prescribing restrictions vary by state, which is especially problematic when the prescriber is located elsewhere. Before starting a telemedicine program in any state, it is important to check the policies of the medical board and the pharmacy board. As with a number of the previously mentioned topics, federal law supersedes state policy. These transactions are governed by the Ryan Haight Internet Pharmacy Consumer Protection Act of 2008. The new legislation expanded the Controlled Substances Act with measures aimed at preventing the illegal sale and distribution of banned narcotics online. The overarching message is that no prescription is required for controlled substance delivery, distribution, or dispensing via the Internet. The prescriber, or a covering prescriber, must conduct at least one in-person medical evaluation of the patient in order for the prescription to be considered valid(Fields, 2020).
The act acknowledges that telemedicine is an exception to this requirement, but it falls short of outlining a special registration procedure that would allow telemedicine practitioners to prescribe via the Internet without an in-person evaluation. According to the law, it is possible to get a specific license to perform telemedicine from the Attorney General. Despite the fact that this unique registration procedure was never put into place, shifts are coming.
New developments in pharmacogenomics show promise for personalized medicine in psychiatry, such as adjusting therapeutic doses, predicting responses, reducing side effects, achieving early diagnosis, and planning for a person’s health. The possibilities are exciting, but these new techniques face important scientific, ethical, legal, and social problems that need to be solved before they can be used in a responsible way.Personalized medicine in psychiatry strikes a balance between ethical challenges and opportunities in terms of adequacy, cost-benefit ratio, and therapeutic equity. People say that the fact that these therapeutic possibilities are so promising makes it even more important not to get too excited and that a complex social infrastructure needs to be built to make sure that personalized medicine in psychiatry is used in a realistic and responsible way. In the past, the drugs that were made were “one size fits all.” This means that they were standardized drugs that treated symptoms or syndromes that many diseases share, rather than being made for a specific disease or even a specific patient. Even though health care is by definition personalized in that the patient’s needs largely determine the type and amount of treatment recommended. People are very different biologically and socially, and a common problem in medicine is that two people with the same symptoms or illness can react very differently to the same drug. Even if the data show that a certain drug should be prescribed, the effects of this drug can be very different for each person. One person may benefit a lot from the drug, while another may not notice much of a difference. Also, one patient may have serious side effects, while another does not. From the patient’s point of view, it is important to know if they are in the group (usually the majority) that the drug helps or if they are in the minority that it doesn’t help. It is also important to know if they will have side effects and, if so, what kind and how bad they will be. Adverse drug reactions (ADRs) are a big health and money problem for society. ADRs cause thousands of deaths and serious injuries every year. Some people think that ADRs are between the fourth and sixth leading cause of death in the US, which would put them ahead of pneumonia and diabetes. So, it’s understandable that many people worry about what side effects they might have. Even a quick look at the most common or important side effects can be pretty scary. Psychopharmacological drugs can have serious side effects, such as loss of muscle coordination, slower reactions, addiction, and psychiatric conditions other than the one the drug is meant to treat (eg, depression or anxiety) (Evers, 2009).
In conclusion, In terms of adequacy, cost, and therapeutic equity, the ethical issues that have been looked at here do not raise any problems with the development of personalized medicine. Instead, they emphasize the need to build a social infrastructure with clear rules to make sure it is used in a responsible way. Telemedicine is different in a number of ways. Prescribers may need to think about the rules of more than one state and deal with details like multistate licensing and credentialing. Real or imagined conflicts of interest should be avoided, protected health information (PHI) should be kept safe, and the highest ethical standards should be upheld. With the realization that there are more similarities than differences, there will be better ways to streamline licensing and credentialing requirements between states, and online prescribing rules that currently stop telemedicine-based care will be loosened.
References
DuBois, J. M., Anderson, E. E., Chibnall, J. T., Mozersky, J., & Walsh, H. A. (2019). Serious ethical violations in medicine: A statistical and ethical analysis of 280 cases in the United States from 2008–2016. The American Journal of Bioethics, 19(1), 16–34. https://doi.org/10.1080/15265161.2018.1544305Links to an external site.
Evers, K. (2009). Personalized Medicine in Psychiatry: Ethical Challenges and Opportunities. Dialogues in Clinical Neuroscience, 11(4), 427–434. https://doi.org/10.31887/dcns.2009.11.4/kevers
Fields, B. G. (2020). Regulatory, legal, and ethical considerations of Telemedicine. Sleep Medicine Clinics, 15(3), 409–416. https://doi.org/10.1016/j.jsmc.2020.06.004 LEARNING RESOURCES
Required Readings
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Chapter 1, “Prescriptive Authority” (pp. 1–3)
Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)
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 Download Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767
American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.
Drug Enforcement Administration. (2021). CFR – Code of Federal Regulations Title 21Links to an external site.. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs…
This website outlines the code of federal regulations for prescription drugs.
Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by stateLinks to an external site.. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/praction…
This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.
Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designationsLinks to an external site.. Retrieved from https://www.ismp.org/recommendations/error-prone-a…
This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.
Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner studentsLinks to an external site.. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446