Advance Pharmacology


Please the assignment is to respond to the post below, with 4 references Thanks. Pharmacokinetics and pharmacodynamics are essential factors when planning care for all patient populations. Pharmacokinetics is the description of how drugs are absorbed, distributed, metabolized, and excreted in the body. Pharmacodynamics is the process of interaction at the cellular level between a drug and the body (Gersch et al., 2017). Understanding how medications interact with the body will help influence providers to prescribe medications while minimizing possible adverse side effects. An experience in my practice in the Emergency Department involved a 71-year-old white female presenting with nausea, vomiting, and complaining of abdominal pain. She arrived via EMS after a neighbor had come to check on her. She lived alone with only two close family members living in a different county of Missouri. The neighbor called to check on her and did relay that she lived alone and was forgetful at times with daily tasks. After obtaining a verbal detailed history from the patient and neighbor, she reported that she used acetaminophen to treat her arthritis and pain. She also reported that she takes digoxin for her cardiac condition but could not explain any further in detail why she takes it or any of her other recommended medications. Acetaminophen overuse can cause liver failure and death, especially in excess to elderly patients. The aging of organs and systems in adults will lead to an eventually diminished function. There was a discussion if polypharmacy was happening with the patient. Older individuals have been shown to take a disproportionate amount of drugs, with people age 65 and older taking on average two to six prescribed and one to three non-prescription drugs at any one time (Cecilia et al., 2018). Elderly patients have a decrease in hepatic metabolizing capacity and renal clearance which will affect the ability to clear therapeutic drugs out of the body. Based on the patient’s presenting symptoms, lab work was ordered that included liver function and renal function tests to determine if drug toxicity was present. Digoxin is distributed in the tissues of the body. High digoxin concentrations can be found in the kidneys and heart with the largest levels found in skeletal muscles. Upon asking the provider and pharmacist, both replied that digoxin toxicity can present as nausea, vomiting, and cardiac arrhythmias if their serum concentrations were larger than 2.0ng/ml. I enjoy working in the Emergency Department because there are always members of our medical team (MDs, RNs, Respiratory Therapists, and Pharmacists) coming through the department. It was through collaborative communication with the MD and pharmacist that I was able to understand the importance of digoxin dosing. Digoxin dosing in elderly people should be tested for changes in renal physiology secondary to aging and not merely their estimation of the glomerular filtration rate (eGFR) (Martin-Suarez et al., 2016). This was a valuable teaching lesson during the time of discovery. The patients influencing factors of low education on her daily medications, occasional forgetfulness, living alone at her age, cardiac history, and use of multiple prescribed and non-prescribed medications for coexisting medical problems is an excellent example of why each patient will greatly benefit from a personalized plan of care. The primary goal of this patient case within pharmacokinetics is to increase the efficacy and decrease the toxicity of her drug therapy. An established and current medication reconciliation must be present or easy to access from elderly patients. Keeping an updated laminated list nearby in their household or with a close neighbor can help recover medication lists more effectively during an emergency/hospitalized situation. The patient is elderly and lives alone and did not have any plans of moving to a nursing facility so they must be educated on the importance and pharmacokinetics of the medications they are taking. Low levels of health literacy can impair a patient’s ability to understand medication instructions and purpose. Many patients that have come into acute care have told me that they stopped taking their daily medications “Because I was feeling better and thought I didn’t need them anymore.” Medication education provides an opportunity to explain the significance of the medication and dispel any possible rumors about medications that often lead to treatment failure and non-compliance (Rosenthal & Burchum, 2021). It was unclear how much acetaminophen she was taking so the consideration of trying nonpharmacologic strategies to help alleviate her arthritis and pain would be a safer alternative to prevent drug-related problems associated with her symptoms of abdominal pain, etc. With continual communication and collaboration between patients and providers, we can empower them to better understand compliance to the medication regimen.

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