Nurs 6521: Advanced Pharmacology Main question Patient scenario Recently, in the Intensive Care Unit (ICU) on which I am employed, I took care of an 84- year-old white female. She weighed 43 kilograms and was currently under a "nothing by mouth" instruction due to a partial bowel resection after necrotic bowel was detected. She had a history of atrial fibrillation (AF) as well as chronic kidney disease (CKI). She was currently admitted to the ICU with sepsis, acute kidney injury on CKI, as well as AF with a rapid ventricular response rate (RVR). Factors influencing pharmacokinetic and pharmacodynamic processes The manner in which drugs move throughout the body (pharmacokinetics) as well as the biochemical and physiologic effects of drugs on the body and how those effects are produced (pharmacodynamics) are both greatly affected by multiple factors, such as physiologic changes, age, genetics, gender, and ethnicity (Rosenthal & Burchum, 2018). Each individual may, therefore, respond differently to medication (Rosenthal & Burchum, 2018). Understanding the effects of different factors on the pharmacokinetic and pharmacodynamic processes of the patient enables the health care provider to safely and effectively administer medication (Rosenthal & Burchum, 2018). The described patient I recently took care of was prescribed several drugs, such as antibiotics to treat sepsis, an anti-arrhythmic drug as well as anticoagulation in the treatment of AF with RVR, and pain medication post bowel surgery. Several factors influenced the prescribed medications. The first factor that is extremely important to take into consideration is the patient's age. She was 84 years old and thus part of the elderly population. Both the liver and kidneys
play a vital role in pharmacokinetics as well as pharmacodynamics (most drug metabolism occurs in the liver while the kidneys perform most drug excretion) (Rosenthal & Burchum, 2018). Ageing, however, causes a decline in the functioning of the liver as well as the kidneys (Tan, Eastment, Poudel, & Hubbard, 2015; Wang, Bonventre, & Parrish, 2014). The reduced size of the liver as well as the reduced blood flow to the liver causes a failure to effectively clear drugs which can lead to a pro-inflammatory state which further downregulates drug metabolism which can cause adverse drug reactions (Tan et al., 2015). Similarly, the elderly have kidneys that are reduced in size as well as contain a decreased amount of nephrons which results in decreased blood filtration and decreased renal excretion of drugs (Rosenthal & Burchum, 2018). Furthermore, certain drugs have been found to have an increased nephrotoxic effect on the kidneys in the elderly, furthering decreased renal excretion of drugs which leads to an increase of the duration and intensity of drug responses (Rosenthal & Burchum, 2018; Wang et al., 2014).
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