MYRENE POST

Introduction

           According to Grogan and Preuss (2022), pharmacokinetics is the study of how
a medication moves through the body and how the body interacts with the
administered medication.  Burchum & Rosenthal (2021) enumerated the four
pharmacokinetics processes: absorption, distribution, metabolism, and excretion. 
Meanwhile, pharmacokinetics was defined as the study of physiological effects or
actions of medication in the body (Marino, et al., 2022). Grogan and Preuss (2022)
stated that in the absorption process, the duration and concentration of drugs
could be affected depending on how a person’s body processes the medication.
The processes could be affected by aging, drug-to-drug interactions, route of
administration, different illnesses, or organ problems.

Patient Case Scenario

           I currently work at a skilled nurse facility, and we have a patient that is an 88-
year-old female who is a s/p fall, left hip fracture with a history of HTN, DM, DVT,
multiple falls at home, osteoporosis, and HLD. The patient is alert and oriented x 1,
combative, always attempts to get up from her bed, and asks to bring her home.
Pad alarm was consented and applied. Even after multiple times of reminding the
patient to stay on her bed and to use the call light for help, she will still try to get up
and will shout for help. Per family, at home, the patient is given Melatonin 10mg,
which sometimes helps and sometimes does not. MD was informed about the
situation, and while waiting for orders that night, the patient fell from her bed. No
injuries, no active bleeding, and normal vital signs were noted. MD ordered Ativan
0.5mg PO. Medication was administered, and still patient has not calmed down. The
next night, the patient was shouting in the room, asking for help and wanting to go
home. A sitter was requested, and MD added 0.5mg of Ativan to administer. In the
morning, the sitter was about to feed the patient, and the sitter panicked. The
patient was difficult to arouse. Staff went into the room. Vital signs were checked,
and it was within normal limits. The patient was still sleeping at that time of the day,
which was unusual. The patient was put under close monitoring, and later that day,
the patient woke up. Vital signs were stable, and the patient returned to attempting
to get up and shouting. Ativan was responsible for the difficulty of arousing the
patient. MD lowered the Ativan back to 0.5mg, and the next nights, the patient was
responding well.

Conclusion
           Healthcare professionals should be careful of using benzodiazepines,
especially with the older age populations. According to Ghiasi, et al. (2022) Ativan
toxicity can cause CNS and respiratory depression, such as extreme drowsiness,
muscle weakness, confusion, hypotension, and coma. Ghiasi, et al. (2022) suggested
tapering Ativan, but in the case scenario above, Ativan was increased the next night
as medication did not help immediately on the first day. In Beers Criteria, the
American Geriatrics Society (2019) stated that healthcare professionals should be
aware of the increased sensitivity of older adults to benzodiazepines, especially of
the decreased metabolism on long-acting agents. American Geriatrics Society
(2019) suggested that benzodiazepines should be avoided by older adults as much
as possible.

References:

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

Ghiasi, N., Bhansali, R., & Marwaha, R. (2022). Lorazepam.

https://www.ncbi.nlm.nih.gov/books/NBK532890/

Grogan, S. & Preuss, C. (2022). Pharmacokinetics.

https://www.ncbi.nlm.nih.gov/books/NBK557744
Marino, M., Jamal, Z. & Zito, P. (2022). Pharmacodynamics.

https://www.ncbi.nlm.nih.gov/books/NBK507791/

Rosenthal, L. & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced

practice nurses

and physician assistants  (2nd ed.) St. Louis, MO: Elsevier.

NICOLE
 Pharmacokinetic and Pharmacodynamics

     Pharmacokinetics-the absorption, distribution, metabolism, and excretion of drugs by the

body (Rebar et. al., 2022). Pharmacodynamics- the biological and physical effects of drugs and

the mechanisms of drug actions (Rebar et. al., 2022). A recent study was done on FNP students

and Pharmacists to evaluate errors, the most preventable errors started from the prescribing

stage. Medication selection and dose were the most common types of prescribing error, with the

most error-prone factors being incorrect drug selection, contraindications such as medication

allergies, incorrect dosing, and including insufficient information on the prescription (Sabatino et

al., 2017).
Patient Case

I recently had a patient present with weakness, dizziness, and a fall. He is an 87-year-old

man admitted for hypotension, weakness, dehydration, and malnutrition The patient blood

pressure upon admission was 80/54. The patient was on an antihypertensive drug called

Lisinopril 10 mg. Also taking a beta blocker Metoprolol 75 mg. Patient history of MI, dementia,

and hypertension. The patient weighs 121 lbs and is 5 ft 8 in tall. The patient was unable to recall

exactly how much medication he has taken. The patient was dehydrated upon admission. He has

been traveling with his wife and had come to Minnesota from Florida.

Factors that influenced Pharmacokinetic and Pharmacodynamic Process

This patient is taking a beta-adrenergic antagonist and ACE inhibitor. Hypotension may

occur, accompanied by dizziness and increased heart rate (Rebar et al., 2022). This hypotension

was the probable cause of his fall and dizziness. The pharmacokinetics of metoprolol are

absorbed in the GI tract (Rebar et al., 2022). Metoprolol is metabolized in the liver and its

metabolites are excreted in urine (Rebar et al., 2022). Patients should be hydrated well while

taking this medication to effectively work well in the body. In patients taking ACE inhibitors,

Lisinopril is also absorbed in the GI tract, metabolized in the liver, and excreted by the kidneys.
ACE inhibitors promote the excretion of sodium and water, reducing the amount of blood the

heart needs to pump and reducing blood pressure (Rebar et al., 2022).

Plan of Care

Withhold the dose if the patient’s heart rate is less than 60 bpm or his systolic blood

pressure drops below 90 mm Hg (Rebar et al., 2022). Evaluate the patient after lowering the dose

of medications, maintain fluid balance and teach the family drug administration and

understanding of symptoms. Patients should have a home blood pressure monitor and notify the

primary care provider if any adverse reactions occur. The patient will need to have medications

set up for him at home and drink an adequate amount of water and maintain a healthy diet.
 
References

Rebar, C. R., Heimgartner, N. M., Gersch, C., & Willis, L. M. (2022). Pharmacology Made

Incredibly Easy (4th ed.). Wolters Kluwer.

Rossenthal, L.D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced

Practice Nurses and Physician Assistants (2nd ed.). St. Louis, MO: Elsevier.
Sabatino, J. A. , Pruchnicki, M. C. , Sevin, A. M. , Barker, E. , Green, C. G. & Porter,
 
K. (2017). Improving prescribing practices. Journal of the American
Association of Nurse
 
Practitioners, 29 (5), 248-254. doi: 10.1002/2327-6924.12446