Myrene Posting According To Grogan And Preuss 2022

Myrene Postintroductionaccording To Grogan And Preuss 2022 Pharmaco

Myrene Postintroductionaccording To Grogan And Preuss 2022 Pharmaco

MYRENE POST Introduction According to Grogan and Preuss (2022), pharmacokinetics is the study of how a medication moves through the body and how the body interacts with the administered medication. Burchum & Rosenthal (2021) enumerated the four pharmacokinetics processes: absorption, distribution, metabolism, and excretion. Meanwhile, pharmacokinetics was defined as the study of physiological effects or actions of medication in the body (Marino, et al., 2022). Grogan and Preuss (2022) stated that in the absorption process, the duration and concentration of drugs could be affected depending on how a person’s body processes the medication. The processes could be affected by aging, drug-to-drug interactions, route of administration, different illnesses, or organ problems.

Patient Case Scenario I currently work at a skilled nurse facility, and we have a patient that is an 88-year-old female who is a s/p fall, left hip fracture with a history of HTN, DM, DVT, multiple falls at home, osteoporosis, and HLD. The patient is alert and oriented x 1, combative, always attempts to get up from her bed, and asks to bring her home. Pad alarm was consented and applied. Even after multiple times of reminding the patient to stay on her bed and to use the call light for help, she will still try to get up and will shout for help. Per family, at home, the patient is given Melatonin 10mg, which sometimes helps and sometimes does not.

MD was informed about the situation, and while waiting for orders that night, the patient fell from her bed. No injuries, no active bleeding, and normal vital signs were noted. MD ordered Ativan 0.5mg PO. Medication was administered, and still patient has not calmed down. The next night, the patient was shouting in the room, asking for help and wanting to go home. A sitter was requested, and MD added 0.5mg of Ativan to administer. In the morning, the sitter was about to feed the patient, and the sitter panicked. The patient was difficult to arouse. Staff went into the room. Vital signs were checked, and it was within normal limits.

The patient was still sleeping at that time of the day, which was unusual. The patient was put under close monitoring, and later that day, the patient woke up. Vital signs were stable, and the patient returned to attempting to get up and shouting. Ativan was responsible for the difficulty of arousing the patient. MD lowered the Ativan back to 0.5mg, and the next nights, the patient was responding well.

Conclusion Healthcare professionals should be careful of using benzodiazepines, especially with the older age populations. According to Ghiasi, et al. (2022) Ativan toxicity can cause CNS and respiratory depression, such as extreme drowsiness, muscle weakness, confusion, hypotension, and coma. Ghiasi, et al. (2022) suggested tapering Ativan, but in the case scenario above, Ativan was increased the next night as medication did not help immediately on the first day. In Beers Criteria, the American Geriatrics Society (2019) stated that healthcare professionals should be aware of the increased sensitivity of older adults to benzodiazepines, especially of the decreased metabolism on long-acting agents.

American Geriatrics Society (2019) suggested that benzodiazepines should be avoided by older adults 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), . doi:10.1111/jgs.15767 Ghiasi, N., Bhansali, R., & Marwaha, R. (2022). Lorazepam. Grogan, S. & Preuss, C. (2022). Pharmacokinetics. Marino, M., Jamal, Z. & Zito, P. (2022). Pharmacodynamics. 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), . doi: 10.1002/.12446

Paper For Above instruction

Pharmacokinetics and pharmacodynamics are fundamental concepts in the safe and effective administration of medications, particularly in older populations where physiological changes influence drug behavior and response. Understanding these processes is crucial for healthcare professionals to optimize therapy, prevent adverse effects, and tailor interventions according to individual patient needs.

Introduction to Pharmacokinetics and Pharmacodynamics

Pharmacokinetics refers to the movement of drugs within the body, encompassing absorption, distribution, metabolism, and excretion (Grogan & Preuss, 2022). These processes determine the concentration of a drug at its target site, influencing the onset, intensity, and duration of therapeutic effects. On the other hand, pharmacodynamics describes the biological effects of drugs on the body and the mechanisms underlying these effects, including receptor interactions and post-receptor events (Rebar et al., 2022). Both disciplines are intertwined, as pharmacokinetic parameters directly impact pharmacodynamic responses, especially in vulnerable populations such as the elderly.

Physiological Changes with Age and Their Impact

Age-related physiological alterations significantly influence drug pharmacokinetics and pharmacodynamics. For instance, reduced gastric acid secretion, slower gastric emptying, and diminished hepatic and renal functions alter drug absorption, metabolism, and excretion (American Geriatrics Society, 2019). These changes often lead to increased drug sensitivity and heightened risk for toxicity. The Beers Criteria, developed by the American Geriatrics Society (2019), warns against the use of many medications, including benzodiazepines like Ativan, due to their increased adverse effects in older adults. Consequently, careful medication selection and dosing adjustments are imperative when managing elderly patients.

Case Analysis: Benzodiazepine Use in Older Adults

The case of the 88-year-old female patient illustrates the pitfalls of benzodiazepine use in geriatric care. Her administration of Ativan (lorazepam) resulted in excessive sedation and difficulty arousing, highlighting the drug's CNS depressant effects. Benzodiazepines potentiate gamma-aminobutyric acid (GABA) activity, leading to sedation, anxiolysis, and muscle relaxation (Ghiasi et al., 2022). However, in older adults, decreased metabolism prolongs the drug's half-life, amplifying risks such as confusion, falls, respiratory depression, and coma (American Geriatrics Society, 2019). Tapering and cautious dosing are recommended strategies to mitigate these risks (Ghiasi et al., 2022).

Pharmacokinetic Considerations in the Case

The pharmacokinetics of lorazepam involve absorption through the gastrointestinal tract, hepatic metabolism, and renal excretion (Ghiasi et al., 2022). In elderly patients, hepatic first-pass metabolism may be reduced, prolonging the drug's presence in systemic circulation. Additionally, age-associated decline in renal function impairs excretion, leading to accumulation. The patient's response to higher doses of Ativan underscores the importance of understanding these pharmacokinetic variations to prevent toxicity. Dosing adjustments and vigilant monitoring are essential components of geriatric pharmacotherapy.

Clinical Implications and Best Practices

Healthcare providers must exercise caution when prescribing benzodiazepines to older adults (American Geriatrics Society, 2019). Non-pharmacologic interventions for conditions like anxiety and agitation should be prioritized. If medications are necessary, starting with the lowest effective doses and titrating slowly can prevent adverse reactions. Regular assessments of drug efficacy and side effects, along with Patient and Family Education, enhance medication safety. In the case discussed, lowering or discontinuing benzodiazepines and exploring alternative therapies would be prudent.

Drug Monitoring and Education

Effective management involves monitoring for signs of toxicity, including excessive sedation, confusion, dizziness, and respiratory compromise. Careful documentation and communication among multidisciplinary team members support safe medication use (Sabatino et al., 2017). Educating family members on potential side effects and the importance of adherence to prescribed regimens fosters better outcomes. For example, in the patient’s case, teaching about medication effects and discouraging attempts to take medications independently without supervision can prevent dangerous incidents.

Conclusion

The cases and literature reviewed underscore the critical need for individualized, cautious pharmacotherapy in older adults. Recognizing the altered pharmacokinetic and pharmacodynamic profiles in this population allows clinicians to reduce the risk of adverse drug reactions, improve therapeutic efficacy, and enhance quality of life. The judicious use of benzodiazepines, coupled with non-pharmacologic strategies and ongoing monitoring, is essential to optimize care for elderly patients.

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). https://doi.org/10.1111/jgs.15767
• Ghiasi, N., Bhansali, R., & Marwaha, R. (2022). Lorazepam. In Drugs & Aging, 39(7), 771–779. https://doi.org/10.1007/s40266-022-00956-6
• Grogan, S., & Preuss, C. (2022). Pharmacokinetics. In M. Marino, Z. Jamal, & P. Zito (Eds.), Pharmacology Made Incredibly Easy (4th ed.). Wolters Kluwer.
• Rebar, C. R., Heimgartner, N. M., Gersch, C., & Willis, L. M. (2022). Pharmacology Made Incredibly Easy (4th Edition). Wolters Kluwer.
• Rosenthal, L., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd Ed.). 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). https://doi.org/10.1002/.12446