Week One: Basic Pharmacotherapeutic Concepts
Prescribing appropriate medications is an essential role of health care providers and practitioners in the treatment of medical conditions, preventing negative health status and promoting health. As advanced practice registered nurses (APRN), understanding the process of how drugs and human body interacts is critical in managing our patients properly. As stated by the National Council of State Boards of Nursing, APRNs are prepared by education and certification to assess, diagnose, and manage patient problems, order tests, and prescribe medications (n.d.). Competence in drug therapy is one of the fundamental functions of APRNs particularly, nurse practitioners. The purpose of this week’s discussion will analyze how patient factors influence the processes of pharmacokinetic and pharmacodynamics in individuals to develop an effective plan of care.
Pharmacokinetics and Pharmacodynamics
Pharmacokinetics refers to the movement of the drug through the body while pharmacodynamics indicates how the drug is affecting the body (Arcangelo, Peterson, Reinhold, & Wilbur, 2017, p. 17). Both processes involve the interaction of the medication and human body functions. Several factors such as age, gender, ethnicity, behavior, genetics, and pathophysiological conditions can influence the processes of pharmacokinetics and pharmacodynamics of an individual. An example is the physiologic changes that occur during the aging process which can lead to several alterations in the absorption, distribution, metabolism, including excretion of drugs and the modifications in pharmacokinetics often affect drug properties such as concentration or rate of clearance, deviations in pharmacodynamics resulting changes in drug’s magnitude of effects and subsequent likelihood of adverse consequences (Sera & Uritsky, 2016). Every individual can have different ways of processing drugs and unique means of getting the medication effects. Comprehensively understanding influences that can affect the drug-body interaction is crucial in achieving the desired outcome and preventing unwanted complications.
The Case of Age and Pathophysiological Changes Effects on Drug Interactions
Reduced muscle strength, increased inactivity, more severe chronic health conditions, and increased use of prescription medications are risk factors for falls among older Americans and fall injury rates are almost seven times higher for older adults with poor health than for those with excellent health (Centers for Disease Control and Prevention, 2016). Due to physiologic changes associated with aging, use of certain medications can increase the risks of fall incident among the elderly population. In the past years that I have worked as a registered nurse in long-term care facilities and acute hospitals, I have witnessed the prevalence of the negative consequences of fall incidents among the elderly population. Although age itself creates a risk for adverse drug reactions, polypharmacy and the multiplicity of drugs taken by older adults present the higher risk which can result in significant health outcomes, such as falls and fractures (Arcangelo, Peterson, Reinhold, & Wilbur, 2017, p. 77). Polypharmacy is defined as the use of multiple drugs by a patient, such as the use of more medications than indicated, the indication of inappropriate prescriptions, the use of two or more drugs to treat the same disease or same therapeutic class (Bellostas Muñoz, Caudevilla Martinez, Crespo Avellana, Diez-Manglano, Gomez Aguirre, & Velilla Marco, 2017). As older population may experience multiple complex conditions, they are at risks of taking various medications prescribed by different specialists, providers, and practitioners causing increased risks of adverse drug reactions from polypharmacy. Furthermore, many of the elderly population have been in various hospitals and transitional care facilities resulting to the accumulation of prescribed medications. As studied in an article, polypharmacy is independently associated with adverse outcomes in frailty particularly where there is a decline in nutritional status, functional ability, and cognitive capacity particularly, increasing the risk of falls in the elderly population (Heard, Jubraj, Marvin, Poots, Rajagopalan, & Ward, 2017). Due to the complexity of their medical condition and physiologic changes, multiple drug prescriptions can result in drug-body interaction causing adverse effects such as cognitive decline, behavioral changes, alterations in their activities of daily living and reduction in functional status.
Personalized Plan of Care
Proper prescribing consists of selecting drugs that have clear evidence for their indicated use, which is appropriate for the patient’s circumstances, are well tolerated and cost-effective and whose benefits outweigh the risks including periodic reviews of prescriptions, especially when the patient changes doctor and during health care transitions (Bellostas Muñoz, Caudevilla Martinez, Crespo Avellana, Diez-Manglano, Gomez Aguirre, & Velilla Marco, 2017). As advanced practice nurses, reviewing the medications prescribed to the patient before adding new prescriptions needs to be exercised to avoid unnecessary use of certain drugs. Also, educating patients and their caregivers to immediately report changes in signs and symptoms that can be related to drug interactions should be encouraged to evaluate the elderly’s medications timely before an adverse event can occur.
Arcangelo, V. P., Peterson, A. M., Reinhold, J. A., & Wilbur, V. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Bellostas Muñoz, L., Caudevilla Martinez, A., Crespo Avellana, M., Diez-Manglano, J., Gomez Aguirre, N., & Velilla Marco, J. (2017). Symposium. Polypathology: Polypathology, polypharmacy, medication regimen complexity and drug therapy appropriateness. Revista Clínica Española (English Edition), 217289-295. doi:10.1016/j.rceng.2016.12.008. Retrieved from https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S2254887417300115?
Centers for Disease Control and Prevention. (2016, September). Falls are leading cause of injury and death in older Americans. Retrieved from https://www.cdc.gov/media/releases/2016/p0922-older-adult-falls.html
Heard, K., Jubraj, B., Marvin, V., Poots, A. J., Rajagopalan, A., & Ward, E. (2017). Deprescribing medicines in the acute setting to reduce the risk of falls. European Journal of Hospital Pharmacy-Science and Practice, 24(1), 10-15. Retrieved from http://ejhp.bmj.com.ezp.waldenulibrary.org/content/24/1/10
National Council of State Boards of Nursing. (n.d.). APRNs in the U.S. Retrieved from https://ncsbn.org/aprn.htm
Sera, L., & Uritsky, T. (2016). Pharmacokinetic and pharmacodynamics changes in older adults and implications for palliative care. Progress in Palliative Care, 24(5), 255-261. doi:10.1080/09699260.2016.1192319. Retrieved from https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=6&sid=a5084331-cc2f-4444-b694-778f0a63d346%40sessionmgr4009
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