20 Aug Discussing a case from previous observation I have in mind an African American female approximately 44 years of age recently diagnosed with uterine cancer,
First post
Discussing a case from previous observation I have in mind an African American female approximately 44 years of age recently diagnosed with uterine cancer, has experience metastasis to bladder and kidneys. Pharmacokinetics explains the absorption and movement of drugs throughout the body and pharmacodynamics are the effects of the drug on the body. Both pharmacokinetics and pharmacodynamics relationships must be understood by the clinician. Patient safety is essential, as clinicians we must be aware of the use of medications and their side effects.
In this case of the 44-year-old female with ovarian cancer, she was receiving chemotherapy and also, she was prescribed anticoagulant therapy due to recent pulmonary embolism after being diagnosed and hospitalized with COVID-19. while taking the oral anticoagulants vaginal blood loss became an issue. Weighing the options to dissolve the pulmonary embolism with anticoagulant therapy or discontinue the anticoagulant due to vaginal bleeding. This scenario gives a valid description of the beneficial effects and possible harm caused by drug therapy.
Factors that influence pharmacokinetics with this patient are the elimination process of the anticoagulant. According to Rosenthal excretion is the movement of drugs and their metabolites throughout the body, the combination of metabolism and excretion is called elimination (Rosenthal et al., 2021).
Pharmaceutical response to the anticoagulant. The anticoagulant dissolves the pulmonary embolism, although the body’s response to the medication is causing increased vaginal bleeding. It is important for the physician to find a balance. Identifying the benefits and harm of anticoagulant therapy is vital in this patient’s case. Drugs have several effects besides the therapeutic effect and the toxic effects (Thomas et al., 2012).
A personalized care plan for this patient would consist of risk for bleeding, providing interventions such as checking stool for blood loss, use of soft bristle toothbrush, avoiding sharp objects like utensils when cooking, the risk for falls and injuries. Assessment of HCT and hemoglobin for anemia will be needed. Monitoring the amount vaginal blood loss is critical as well. Increased blood loss can lead to fatigue. The plan of care changes due to the patient’s diagnosis of cancer, she also has a weak heart and a decline in her kidney functions. These comorbidities affect the treatment options. Deciding to withhold anticoagulant therapy should be based on the patient’s risk of thrombosis and the severity of the bleeding issue with this patient (Speed et al., 2021).
Reference
Rosenthal, L. D., Burchum, J. R., & Lehne, R. A. (2021). In Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed., pp. 13–13). essay, Elsevier.
Speed, V., Patel, J. P., & Arya, R. (2021). Bleeding issues in women prescribed anticoagulation. Thrombosis Update, 5. https://doi.org/10.1016/j.tru.2021.100068
Understanding Foundational Pharmacodynamics. (2022). Australian Nursing & Midwifery Journal, 27(6), 24–26.
Second post
Among the cases I witnessed during my clinical practice about 2years ago is BN’s. BN was a 76-year-old Caucasian male that initially presented accompanied his grandson following a fall at home. He had no other underlying conditions. After examination, he was medically cleared and bruises on his elbow bandaged. He is a veteran, and his grandson, also a veteran, has visited him. During his visit, BN told him he had difficulty in sleeping, and his grandson, 26year-old GN, gave him some of his sleeping pills, zolpidem. He had been sleeping fine for three days, and although he felt groggy a bit groggy in the morning, he was glad he slept better.According to Rosenthal and Burchum (2021), age is one of the patient factors that impacts drugs’ pharmacodynamics and pharmacokinetics. Notably, older age is accompanied by a decline in organ functions that alters the pharmacokinetics and pharmacokinetic properties. Older adults are at an increased risk of drug sensitivity and variability in response. Prescribers must take into account altered pharmacokinetics and variable drug sensitivities in older adults. Still, the 2019 American Geriatrics Society Beers Criteria® identifies “Z-drugs,” among them zolpidem as drugs to avoid in older adults. The Criteria strongly recommends against the use of zolpidem due to increased risk of dependency, delirium, and falls with fractures, such as in BN’s case. The drug was discontinued. BN and his grandson were educated on the importance of consulting their care provider before taking any medication.According to Praharaj et al. (2018), initial treatment for insomnia in older adults include non-pharmacological interventions such as sleep hygiene, relaxation training, sleep restriction, and cognitive-behavioral therapy. Cognitive-behavioral therapy for insomnia (CBT-I) has been specifically developed for insomnia and incorporates both cognitive-behavioral and non-pharmacologic approaches in the treatment of insomnia. As such, a care plan in DM’s would include discontinuation of zolpidem and referral to a CBT-I therapist.
ReferencesBy the 2019 American Geriatrics Society 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. https://doi.org/10.1111/jgs.15767Praharaj, S. K., Gupta, R., & Gaur, N. (2018). Clinical Practice Guideline on Management of Sleep Disorders in the Elderly. Indian journal of psychiatry, 60(Suppl 3), S383–S396. https://doi.org/10.4103/0019-5545.224477Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO:
