Discussion: Pharmacokinetics and Pharmacodynamics

Week 1 Main Post Discussion: Pharmacokinetics and Pharmacodynamics

Understanding how prescription and non-prescription influences the body, first a clear understanding is needed to the function of pharmacokinetics and pharmacodynamics and how these components how any drugs that maybe administered and interact in the body.  Pharmacokinetics refers to movement of drug into and out of the body by absorption, metabolism, excretion, and distribution the amount of time it takes for a drug to be utilized by the body.  Also, pharmacokinetics determines the onset, duration, and intensity of a drug effect Discussion: Pharmacokinetics and Pharmacodynamics.  Pharmacodynamics described what a drug does to the body once it attaches to the appropriate receptor site.  Pharmacodynamics also involves the molecular effect of the drug to bind with the receptors site of the cell to cause a reaction. (Farinde, 2019).

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A drug pharmacodynamic and pharmacokinetic effect centers around many factors concerning the patient for example, the age of the patient, hepatic, and renal function, other drug – drug interaction competing for receptor binding sites.  Looking at the current pandemic of Coronavirus many different anti-viral medications was used to reverse the effect of acute respiratory syndrome that affect the patient from the coronavirus.  Some of these medications such as lopinavir, remdesivir, azithromycin, and chloroquine was used to help combat or reverse the effect of coronavirus Discussion: Pharmacokinetics and Pharmacodynamics.

The pharmacokinetic process for each of these drugs are the same but the pharmacodynamics may differ depending on their molecular structure and the receptors site which they bind and how they cross the cell membrane.  As stated by Srivalli & Lakshmi, (2012) these drugs are substrates of P-glycoprotein an efflux membrane transporter and a member of the ATP-binding transporter found primarily in epithelial cells which are inhibitors.  Which means these drugs stop the progress of the coronavirus from attacking the cells or other cell which mostly affect respiratory function.

During this pandemic I worked in the ICU and saw the affects the positive and not so positive effects that chloroquine has in response to patients being removed from the ventilators with a lower peep and FIO2 level.   Depending on the co-morbidity’s patient has and how soon the antiviral medication was started the patient had a fair chance for being extubated.  If a child was given an overdose of antiviral medication to combat the coronavirus that was meant for adult many rapid action steps need to be executed.  Looking at azithromycin administration in children is given by body for 3-5 days an overdose of this medication causes prolongation of QT complex, Torsade de point, and unresponsiveness.  Reason, azithromycin in the tissue has an extreme high plasma and high lipid solubility and its half-life is 68 hours and excretion or elimination is characteristic of this drug remain unchanged. (Tijjani, Ishola 2020).     The APRN must take in account that a children body surface is must smaller than an adult and over medicating disaster can occur quickly.  Administering any medications understanding the pharmacokinetic and pharmacodynamic properties is a must to assure patient safety and ethical practice.

References

Farinde, A. (2019). Overview of Pharmacodynamics – Clinical Pharmacology: Merck Manual Professional Version Retrieved from: Merck Manuals >professional > overview

Srivalli, K. Lakshmi, P. (2012). Overview of P-glycoprotein inhibitors: A rational outlook. Brazilian Journal of Pharmaceutical Science 48(3) 353-367

Tijjani, H. Ishola, A. (2020). Repurposing of choloroquine and some clinically approved antiviral  drugs as effective therapeutics to prevent cellular entry and replication of coronavirus Retrieved from: https://www.researchgate.net/publication/341601496

 

Response

Good post

Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used in the treatment of malaria. Moreover, their antiviral properties have been previously studied, including against coronaviruses, where evidence of efficacy has been found. In the current race against time triggered by the COVID-19 pandemic, the search for new antivirals is very important. However, consideration are given to old drugs with known anti-coronavirus activity, such as CQ and HCQ. These could be integrated into current treatment strategies while novel treatments are awaited, also in light of the fact that they display an anticoagulant effect that facilitates the activity of low-molecular-weight heparin, aimed at preventing acute respiratory distress syndrome (ARDS)-associated thrombotic events.

There has been significant research on the possible antiviral actions of CQ/HCQ. Their safety aspects have been studied extensively for over 50 years, but the evidence is not necessarily applicable to those most at risk of mortality from COVID-19 (e.g. frail older people), who at the same time are most vulnerable to drug side effects. The challenge that SARS-CoV-2 launches into science is to create new specific drugs. However, because COVID-19 causes cardiac problems, the cardiac toxicity of HCQ can be enhanced in the short-term.

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References

Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020;6:16. doi: 10.1038/s41421-020-0156-0. 

Zhu RF, Gao RI, Robert SH, Gao JP, Yang SG, Zhu C. Systematic review of the registered clinical trials of coronavirus disease 2019 (COVID-19) medRxiv. 2020 Mar 17 doi: 10.1101/2020.03.01.20029611. 

 

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 pharmacodynamics 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 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. Discussion: Pharmacokinetics and Pharmacodynamics
  • 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 Discussion: Pharmacokinetics and Pharmacodynamics. Be specific and provide examples.

By Day 6 of Week 1

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. Discussion: Pharmacokinetics and Pharmacodynamics.

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!

 

 

Week 1 Discussion post

Case: A person on medication for weight loss. States she has taken it for numerous years to get her through the hard times and curbed her appetite so she can continue to look the way she does.

Prescription medicine has the potential to change the practice of medicine by tailoring treatments to individuals (Grottick, A., Whelan, K., Sanabria, E., Behan, D., Morgan, M., & Sage, C. (2015). We have all been taught the medication rights- right medication, dose, route, time, and reason. Even though this client is a friend, and I have known her to be on this medication for years Discussion: Pharmacokinetics and Pharmacodynamics. I have watched her take it, also know she has a ton of underlying medical problems such as thyroid disease, PCOS, lupus, and has pulmonary hypertension that is poorly managed. I realize that Adipex is a medication that has both positive and negative effects (depending on the person and the situation). It may be used to help with concentration, decrease appetite, and used as a stimulant, but is often given to individuals that have not had a complete physical. For someone that has chronic illnesses, filtration and absorption mechanisms are vastly reduced and have multiple allergies to medications due to autoimmune disorders- supplying the medication without continued to follow up, a proper assessment would be negligent. Discussion: Pharmacokinetics and Pharmacodynamics This patient has an issue with fluid retention at baseline, takes Bumex twice a day, and has a difficult time urinating at times. Shortness of breath is part of her daily life, and increasing heart rate, on a pump that already fails would be disastrous.

Pharmacokinetics and pharmacodynamics determine the clinical effects of drug therapy. It is necessary to know what the body specifically does to the drug, how it is absorbed, distributed, metabolized, and eliminated. To further understand medication choice, usage, and dosage, the physiological effects on the body must be known. If an individual has chronic medical conditions, including those listed on the contraindications and or side effects sections, prescribing with caution would be the best practice or not prescribing at all. We as providers must deliver care with accuracy, precision, and efficiency (Grottick, A., Whelan, K., Sanabria, E., Behan, D., Morgan, M., & Sage, C., 2015). Practitioners are being held to high standards based on prescribing guidelines that have been made more readily accessible thanks to upgraded technology (Durney, P. M., & Lebov, H. L., 2019) Discussion: Pharmacokinetics and Pharmacodynamics.

Things that we, as prescribers should consider when writing for medications: documenting medication indications on the prescription. Cross-checking through computer data bases also allow for further verification of the medication, dosing, and determine if the medication is questionable with other prescribed medications. This will be a more efficient way to tailor patient-centered care, and to perform safety checks (Kron, Myers, Volk, Nathan, Neri, Salazar, Amato, Wright, Karmiy, McCord, Seoane-Vazquez, Eguale, Rodriguez-Monguio, Bates, & Schiff, 2018)

 

Durney, P. M., & Lebov, H. L. (2019). The Perils of Prescribing Medication and the Goldilocks
Principle: Defending Related Claims of Malpractice. Defense Counsel Journal86(4), 1–
20.

Grottick, A., Whelan, K., Sanabria, E., Behan, D., Morgan, M., & Sage, C. (2015). Investigating
interactions between phentermine, dexfenfluramine, and 5-HT agonists, on food intake in
the rat. Psychopharmacology232(11), 1973–1982. Discussion: Pharmacokinetics and Pharmacodynamics

Kron, K., Myers, S., Volk, L., Nathan, A., Neri, P., Salazar, A., Amato, M. G., Wright, A.,
Karmiy, S., McCord, S., Seoane-Vazquez, E., Eguale, T., Rodriguez-Monguio, R., Bates,
D. W., & Schiff, G. (2018). Incorporating medication indications into the prescribing
process. American Journal of Health-SystemPharmacy : AJHP : Official Journal of the
American Society of Health-System Pharmacists
75(11), 774–783.

response 1

I enjoyed reading your post.  I do not know too much about weight loss medication, but I do know that they can affect how other medications are absorbed within the body.  Makiani, Nasiripour, Hosseini, & Mahbubi (2017) state that “knowing about medications mechanisms of action and where and how they are absorbed is important, especially when other medications are being given at the same time”.  I know the medication that you speak of is not over the counter, however, some weight loss supplements are and can affect the patient’s other medications.  One thing that really came to mind for me was that CAM therapies can have negative effects on patients and their medications. Discussion: Pharmacokinetics and Pharmacodynamics National Cancer Institute (2019) states “not all-natural materials are safe; vitamins can have unwanted effects within your body.”  There are also food and drinks that can alter medications for example, Rosenthal & Burchum (2020), state that “grapefruits can cause major issues with patients and their medications”.  I really enjoyed your post, did you feel that because of this discussion board you were forced to think through patient medication the next time you worked?  Thanks for creating a great discussion.

 

References

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Makiani, M., Nasiripour, S., Hosseini, M., & Mahbubi, A. (2017). Drug-drug Interactions: The Importance of Medication Reconciliation. Retrieved September 05, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348861/

National Cancer Institute. (2019). Complementary and Alternative Medicine (CAM). Retrieved September 05, 2020, from https://www.cancer.gov/about-cancer/treatment/cam

National Caregivers Library. (2019). Caregivers Resources. Retrieved September 05, 2020, from http://www.caregiverslibrary.org/Caregivers-Resources/GRP-Home-Care/HSGRP-Medications/Understanding-Drug-Interactions-Article Discussion: Pharmacokinetics and Pharmacodynamics

 

response 2

I’ve enjoyed reading your discussion. The most commonly used weight‐loss medication in the United States is phentermine, a sympathomimetic amine that acts by inhibiting appetite and that was originally approved for weight loss in 1959 (Ard et., 2019). Like you, I’ve also known many individuals who’ve taken phentermine. Several months later, the weight was regained. This caused them to remain on the medication longer, or use it “off and on. “Given the physical and psychological harms related to weight regain, weight cycling should be considered as an adverse effect of therapy (Murali, 2019). Discussion: Pharmacokinetics and Pharmacodynamics Recently, many studies have shown that longer‐term phentermine users experienced greater weight loss without apparent increases in cardiovascular risk as mentioned by (Ard et al., 2019). Addressing chronic illnesses and disease care maintenance is critical for medication safety. Existing pharmacotherapies continue to focus on winning the battle of weight loss while progress toward winning the war of weight loss maintenance remains stagnant (Murali, 2019). Discussion: Pharmacokinetics and Pharmacodynamics

References

Ard, J., Lewis, K. H., Arterburn, D. E., Fischer, H., Barton, L., Koebnick, C., Yamamoto, A., Young, D. R., Bessesen, D. H., Daley, M. F., Desai, J., Fitzpatrick, S. L., Horberg, M., & Oshiro, C. (2019). Safety and Effectiveness of Longer-Term Phentermine Use: Clinical Outcomes from an Electronic Health Record Cohort. Obesity (19307381), 27(4), 591–602. https://doi-org.ezp.waldenulibrary.org/10.1002/oby.22430

Murali, S. (2019). Knowledge Gaps in Long-Term Phentermine Use: Making the Case for Maintenance. Obesity (19307381), 27(8), 1219. https://doi-org.ezp.waldenulibrary.org/10.1002/oby.22516 Discussion: Pharmacokinetics and Pharmacodynamics

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