HSA 550 BHS Patient Factors Affect Drug Response Discussion

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

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.
• By Day 6 of Week 1

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

1st response Courtney …An 18-month- old patient was admitted to the hospital after losing 6 lbs and exhibiting signs of pain by screaming. The child was found to have severe blockages and impaction throughout his GI system. The parents have religious beliefs that prevent treatment and are instead opting to have the boy’s grandfather, an elder at their church, to come and heal the patient through prayer. In this discussion, I will be discussing how pharmacokinetics and pharmacodynamics affects a patient in their decision making process.

Pharmacokinetics refer to how the body absorbs, distributes, metabolizes and excretes drugs (Gorgan & Preuss, 2023). Pharmacodynamics are how the drug interacts with a target receptor to create a therapeutic response (Gorgan & Preuss, 2023).

In my own personal clinical experience, I have had patients refuse treatment for personal beliefs. One example I can think of is when I had a police officer that refused fentanyl after a crush injury because of his own personal observations with his job. He believed that fentanyl causes addiction in every person who takes it and therefore he did not want it. The patient also had a family history of substance abuse so he was fearful of the pharmacodynamics he could possibly experience because of his family history. Genetic predispositions may affect how a patient responds to fentanyl. The patient also seems fearful of the pharmacokinetics of fentanyl after seeing patients fall into respiratory depression caused by fentanyl.

My personalized plan of care for this patient would be to provide education for the parents on the importance of nutrition and treatment for a patient with a bowel impaction that is losing weight. Failure to thrive is diagnosed when a pediatric patient’s weight and development are below what is expected for their age and gender. (Smith & Badireddy, 2022). I would want to start this patient on IV fluids containing dextrose and also try an enema to release the impaction. Polyethylene glycol (PEG) is the standard medication for children with bowel impaction so I would start with that medication (Lamanna et al., 2018) Because the patient has lost so much weight I would consider admitting him to the hospital for nutritional support.

Gorgan, S., & Preuss, C. (2023). Pharmacokinetics – statpearls – NCBI bookshelf. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK557744/

Lamanna, A., Dughetti, L. D., Jordan-Ely, J. A., Dobson, K. M., Dynan, M., Foo, A., Kooiman, L. M. P., Murakami, N., Fiuza, K., Foroughi, S., Leal, M., Vidmar, S., Catto-Smith, A. G., Hutson, J. M., & Southwell, B. R. (2018). Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate. JGH open : an open access journal of gastroenterology and hepatology, 2(4), 144–151. https://doi.org/10.1002/jgh3.12062

Smith A.E., Badireddy M., (2022) Failure to thrive. National Library of Medicine. https://doi.org/10.3390/pharmaceutics11030110

van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58, S10-S25. https://doi.org/10.1002/jcph.1284