How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?
Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.
This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.
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, 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. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm
This website outlines the code of federal regulations for prescription drugs.
Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.
Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.
Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html
This website details key aspects of drug registration.
Fowler, M. D. M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, Maryland: American Nurses Association.
This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.
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
This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.
Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17
This article provides NPs with information regarding state-based laws for NP prescribing.
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 ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446
The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.
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.
At least 2 citations APA format 7th edition
FU
One patient case from my experience that addresses the principles of pharmacokinetics and pharmacodynamics is where my patient was a 55 years old female, of African American decent, had a history of diabetes, hyperlipidemia, and hypertension. The patient was presented to our hospital with severe nausea, vomiting and abdominal pain. Assessment and lab work showed the patient’s blood glucose was 605mg/dL, HgA1C 8.5%, cholesterol 180 mg/dl, weight 290 lbs, height 68inches, BP 90/75, pulse 118, Respiration 23 bpm. Patient stated she had been very stressed lately and had mostly been dining out at fast-food restaurants and has not had the time to exercise. Patient had been prescribed insulin however, she stated she has not been checking her blood glucose level like she should have.
This patient was presenting with symptoms of diabetic ketoacidosis (DKA). DKA is a medical emergency that occurs when the body is unable to produce adequate insulin to decrease blood glucose level and leads to the production of high levels of acids in the blood called ketones (Alshammari et. al., 2017). This was a medical emergency that required immediate intervention of fluid repletion and the administration of insulin. It also involved the frequent monitoring of patient’s vital signs, glucose levels, and electrolyte levels.
Factors that might have influenced pharmacokinetics of insulin the patient was receiving are diet (eating fatty foods or foods high in carbohydrates increases glucose levels in the body), stress (cortisol increases insulin resistance), and lack of exercise. Eating a balanced diet decreases the likelihood that the patient will consume mostly foods high in fats and carbohydrates. When someone is stressed, the body produces stress hormones called cortisol which to a diabetic patient can significantly affect their health because it causes the body to release more glucose and to become resistant to the insulin the patient needs to reduce that blood glucose to a healthy level (Alshammari et. al., 2017). Exercise redistributes and lowers the blood glucose level. It could cause patients to go into hypoglycemia that is why it is important to check glucose levels before, during, and after exercise.
The personalized care plan that I would develop for this patient would include; a Dietary and lifestyle change plan – here the patient will be educated on how to count her carbohydrates and caloric intake. The Center for Disease Control has dietary guidelines for the different age groups. The site also provides “My Food Diary” (CDC, 2019) a flow sheet to help individuals keep a day-to-day record of how much food is consumed for breakfast, snacks, lunch, and dinner. I would also recommend she exercise regularly but that to check her blood glucose before, during and after exercise. “The adoption and maintenance of physical activity are critical foci for blood glucose management and overall health in individuals with diabetes” (Colberg, 2016). Also, I would suggest she check her blood glucose before each insulin administration, as this may affect the dosage to be administered.
References
Alshammari, A. A., Alahdal, L. M., Jawi, J. T., Alnofaie, H. A., Aldossari, N. A., AbdulazizAlassaf, H. M., Ramel, A. I., Almshikhess, S. H., Felemban, A. S., Alanazi, S. A., Joharji, R. N., Alzahrani, A. M. B., Almaghamsi, S. A. D., Alalawi, M. S. M., Alasmari, H. I., Abduljabbar, A. M., & alzahrani, A. fahad. (2017). First Line Management of Adult Diabetic Ketoacidosis Patients. Egyptian Journal of Hospital Medicine, 67(2), 571–577. https://doi-org.ezp.waldenulibrary.org/10.12816/0037808
Centers fo Disease Control and Prevention [CDC], 2019. Eating Out. Retrieved from https://www.cdc.gov/diabetes/managing/eat-well.html
Colberg, S.R., Sigal, R. J., Yardley, J. E., Riddle, M.C., Dunstan, D.W., Dempsey, P.C., … & Tate, D.F. (2016). Physical activities/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes care, 39(11), 2065-2079
