Pharmacokinetics and Pharmacodynamics

Pharmacokinetics and Pharmacodynamics

Patient Case

Mrs. J is an 81-year-old African American who was diagnosed with hypertension. Her liver function tests showed impaired hepatic function, while her kidney function tests showed decreased renal function. The prescribed medications included metoprolol and lisinopril.

Factors Influencing Pharmacokinetics and Pharmacodynamics

A patient’s age can affect pharmacokinetics and pharmacodynamic processes (Thürmann, 2020). Mrs. J is an 84-year-old patient and is, therefore, considered geriatric. Elderly patients usually have decreased renal function, decreased enzymatic activity, and decreased hepatic function, as evidenced by the patient’s liver and kidney function tests. Metoprolol and lisinopril undergo hepatic metabolism; therefore, a decrease in hepatic function will increase the concentration of the drugs that accumulate in the systemic circulation (Olvera et al., 2022). Mrs. J was, therefore, highly susceptible to experiencing side effects and toxicity. Renal function is responsible for the excretion of drugs from the body system.

Decreased renal function in the elderly, as seen in Mrs. J’s renal function test, causes a decrease in drug excretion hence accumulation of the drug in the body. Lisinopril and metoprolol are excreted by the kidneys (Morris & Dunham, 2022). Consequently, Mrs. J was likely to experience exaggerated side effects. Additionally, ethnicity influences pharmacokinetics and pharmacodynamic processes. Mrs. J is an African American. Studies show that angiotensin-converting enzyme inhibitors such as lisinopril are less effective in African Americans; therefore, Mrs was scheduled for follow-up appointments to check on her blood pressure control (Holt et al., 2022).

Plan of Care

Changes in the pharmacokinetic and pharmacodynamic processes impact a patient’s recommended therapy. Mrs. J’s therapy aimed to control her blood pressure and prevent further organ damage. Dose adjustments for the prescribed drugs were necessary to ensure little or no side effects while achieving the therapeutic target. Adjustments were made by decreasing the dose of lisinopril and metoprolol and decreasing their frequency. Mrs. J was also advised on non-pharmacological interventions such as exercising, dietary changes, decreased sodium intake, and stress management and relaxation techniques.

References

Holt, H. K., Gildengorin, G., Karliner, L., Fontil, V., Pramanik, R., & Potter, M. B. (2022). Differences in Hypertension Medication Prescribing for Black Americans and Their Association with Hypertension Outcomes. Journal of the American Board of Family Medicine: JABFM, 35(1), 26–34. https://doi.org/10.3122/jabfm.2022.01.210276

Morris, J., & Dunham, A. (2022). Metoprolol. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532923/

Olvera Lopez, E., Parmar, M., Pendela VS, &, Terrel, J.M. (2022). Lisinopril. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482230/

Thürmann P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current opinion in anaesthesiology, 33(1), 109–113. https://doi.org/10.1097/ACO.0000000000000814

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Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to understand not only 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.

Pharmacokinetics and Pharmacodynamics

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.

To 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.