• As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.

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.
• 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.

Pharmacokinetics and Pharmacodynamics

Rosenthal and Burchum (2018) point out that drug has varied effects on a person’s body. How a medication affects the body can be described in two main terms pharmacokinetics and pharmacodynamics. Pharmacodynamics is how the drug impacts the body, while pharmacokinetics is how medicine moves in the body. There have been several times when I have administered medication and not obtained the needed results. For this study, an 80-year old African American female with a history of bipolar and other issues is chosen for the study. Some of the symptoms exhibited by the patient are the inability to focus on a single activity, manic excitement, cognitive impairment, and severe anxiety. She is on Lithium 900 mg daily to manage her symptoms.

Pharmacokinetics

When taken by the patient, Lithium is quickly absorbed between one to four hours. Given that it does not have clinical protein binding properties, it does not have metabolites. As a result, it is excreted by the kidneys, sweat glands, and feces. A considerable percentage of filtered Lithium is reabsorbed. Its elimination from the patient’s body takes place within 18 to 24 hours. However, given that the patient is old, she will take much longer because of the drop in Glomerular Filtration Rate.

Pharmacodynamics

           Lithium may also alter intercellular signaling via actions on other messenger frameworks. Precisely, it prevents inositol monophosphate impacting neurotransmission through phosphatidylinositol second messenger model. Lithium further prevents protein kinase activity, affecting the genomic expression linked with neurotransmission. The use of Lithium further aids in raising cytoprotective protein. Furthermore, it helps in triggering signaling cascade and increasing the level of gray matter content. One other mechanism that the drug uses is that it manages synaptic transmission mediated by monoamine neurotransmitters.

Care Plan

Since the patient has signs of mania, shared care between secondary and primary services will be engaged. Secondary services entail a Care Program Approach. The patient will be kept in areas with low stimulation, even when under stimulation (Sabatino et al., 2017). The nurse will further encourage rest periods in the day. At night, the nurse will assist and allow the patient to take warm baths with soothing music and administer drugs as ordered by the doctor (Institute for Safe Medication Practices, 2017). The patient will be given fiber-rich foods and a close monitor on sodium intake.

References

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

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 students. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446