pharmacokinetics and Pharmacodynamics Discussion

Understanding the impact drugs can have on patients is vital when prescribing medications. Patient factors can influence the pharmacokinetic and pharmacodynamic processes, leading to an altered drug function. In this discussion, I will discuss an experienced clinical case. I will then identify any factors that influenced the patient’s pharmacokinetic and pharmacodynamic processes. Lastly, I will describe a plan of care for the patient.  Advanced Pharmacology Discussion Paper

Experienced Patient Case

Working on an orthopedic floor at a level 1 Trauma center has provided me the opportunity to work with orthopedic trauma patients and elective orthopedic patients. With elective orthopedic surgical patients, the focus is to manage their pain for same-day ambulation. This protocol has multiple benefits for the patients, such as the prevention of post-operation complications. One orthopedic surgeon initiates a protocol that provides patients with three intravenous doses of 30 mg of Toradol. Many patients do not develop adverse reactions to the Toradol, but it can occur. I received a report of a patient in her 70s with a history of hyperlipidemia, hypertension, and obesity. She had undergone an elective total hip replacement and was post-operative day one. She had no complaints of pain, which indicates that the Toradol was helping to manage her pain with limited narcotic use. The night shift informed me that the patient had not voided overnight, and the nurse had discontinued the intravenous fluids. Among examining her lab results, I noticed her creatinine had increased by two points compared to pre-surgery lab results. I notified the physician assistant (PA) of the changes. I informed the PA that I was withholding the scheduled lisinopril due to her hypotension and Toradol. I then bladder scanned the patient and identified that the patient did not have adequate urine production. We consulted a nephrologist for management of the elevated creatinine and poor urine output. The patient received intravenous fluids, and the nephrologist discontinued the lisinopril and Toradol.

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Factors Influencing Patient’s Pharmacokinetic and Pharmacodynamic Processes

Pharmacokinetic describes how the drug moves throughout the body, such as absorption, distribution, metabolism, and excretion. Pharmacodynamics describes the biochemical and physiological effect drugs have on the body and molecular mechanisms to produce a response (Rosenthal & Burchum, 2018). Toradol is a non-steroidal anti-inflammatory drug that inhibits cyclo-oxygenase isoenzymes. The isoenzymes are responsible for the production of prostaglandins, which induce inflammation and pain. The prostaglandins protect the kidneys (McNicol et al., 2021). Therefore, the inhibited prostacyclin’s vasodilation effect leads to reduced renal perfusion (Gurunathan et al., 2019). The absorption of Toradol was quick as it was introduced intravenously for faster distribution to tissue cells. The patient’s age contributes to her liver not effectively metabolizing and kidneys not properly excreting. The kidneys are responsible for expelling most drugs. The elderly experience a decline in renal function due to smaller kidneys and reduced number of nephrons leading to a decrease in blood filtration. Her history of hypertension and hyperlipidemia contribute to the development of vessel atherosclerosis which reduces blood flow. Therefore, the medication begins to accumulate within the body because the kidneys cannot properly excrete (Rosenthal & Burchum, 2018). She developed acute kidney injury, which her use of angiotensin-converting enzyme inhibitors (ACE inhibitors) and hypovolemia due to blood loss and dehydration from the surgery further exacerbated (Warth et al., 2016). Her prolonged use of ACE inhibitors promotes reduced levels of angiotensin II and increased bradykinin levels. Inhibition of angiotensin II causes dilation of blood vessels and interact with the kidneys to decrease blood volume. However, the drastic reduction in angiotensin II levels leads to decreased urine production due to mechanisms failing to support glomerular filtration. The ACE inhibitor effects were impaired when interacting with the Toradol, which leads to vasoconstriction of renal blood vessels (Rosenthal & Burchum, 2018). Therefore, the plan of care focused on reversing acute kidney injury.

Plan of Care

This patient needed a higher level of care than my floor provides. So, she transferred to the intensive-care unit for more intense monitoring. However, the plan of care for this patient would focus on monitoring adequate fluid intake and output, lab work, and vital signs. Providing adequate intravenous fluids helps reverse the patient’s hypovolemic state, and assessing her vital signs, such as blood pressure and heart rate, would identify proper compensation. Strictly monitoring her urine output would allow us to determine whether her kidneys are functioning. Monitoring her glomerular filtration rate, BUN, and creatinine levels would provide information regarding her renal function and perfusion. As for the dosage, those over the age of 65 should receive the lower dose of Toradol, which is 15mg, every six hours for no longer than five days (Rosenthal & Burchum, 2018). Therefore, the prescriber should have considered the patient’s age, medical history, and medication use when ordering the higher dose of Toradol. Being mindful of the potential renal adverse effects certain medications can have may have helped prevent this patient’s development of acute kidney injury.

Conclusion

Having the ability to prescribe medications comes with great responsibility. Prescribers need to be aware of how a drug impacts the body and understand the potential risk factors associated with the medication. Patient medical history and medication use are vital. The information helps determine the impact medications have on their physiological functioning. Patient factors may impact the pharmacokinetic and pharmacodynamic of a drug. Therefore, prescribers need to be aware of this to help them determine whether the benefits outweigh the risks.

Advanced Pharmacology: Discussion Response

Your discussion post presents an informative analysis on pharmacokinetics and pharmacodynamics. I like that you present an introduction that offers an overview of the issues addressed in the discussion. In addition, I like that your case scenario is relevant to the topic, presenting the case details and the care response at the time. Besides that, I like that you present a description of pharmacokinetics and pharmacodynamics as health care concepts even as you link them to the case scenario. Also, I like that you discuss a plan of care that realistically takes into account the case details as well as the presented pharmacokinetics and pharmacodynamics concepts. Additionally, I like that you present a conclusion that summarized what has been discussed. Still, I feel that the discussion can be improved. Firstly, I feel that there is no justification for the patient being placed in the intensive care unit. To be more precise, the patient only requires intensive monitoring, but does not require life support. Placing the patient in intensive care unit implies that unnecessary bed space is occupied and equipment is used, all resources that could be more useful for other patients. Besides that, placing the patient in intensive care unit would incur higher costs. Rather than this, the patient should be noted for intensive monitoring (DeNisco & Beauvais, 2020). Secondly, there is a need to explore the use of alternative to Toradol in the plan for care. Toradol is a nonsteroidal anti-inflammatory drug (NSAID) that interacts with ACE inhibitors, which the patient is taking. NSAID alternative to Toradol that could be discussed is Motrin (ibuprofen) that is similarly used to treat mild to moderate pain (Lilley, Collins & Snyder, 2020). Overall, your discussion post has been well presented, but could be improved by including the two mentioned points.

References

DeNisco, S. M. & Beauvais, A. M. (2020). Advanced Practice Nursing: Essential Knowledge for the Profession (4^th ed.). Jones & Bartlett Learning, LLC.

Lilley, L. L., Collins, S. R., & Snyder, J. S. (2020). Pharmacology and the Nursing Process (9^th ed.). Elsevier.  Advanced Pharmacology Discussion Paper