Introduction
Analyzing pharmacokinetics and pharmacodynamics for specific patients can identify potential flaws in their care plans and help the advanced practice nurse improve treatment recommendations. For example, by studying factors that affect pharmacokinetics, one can understand how the patient’s body can affect the drug reaction. At the same time, the nurse can use knowledge of pharmacodynamics to prevent medical errors and complications. The following case considers an older adult patient undergoing rehabilitation after myocardial infarction (MI) while prescribed anticoagulant drugs.
Patient Case Description: Clinical Experiences and Observations
In my practice, I observed many older adult patients who needed additional support with their medication adherence. One of them was a woman who was prescribed warfarin as a way to prevent blood clots and other problems that could lead to another MI or a stroke (Rosenthal & Burchum, 2021). However, as she began recovery recently, she experienced many challenges and could not stick to taking her medication regularly. Warfarin is an anticoagulant that should be taken at specific times to prevent complications (Rosenthal & Burchum, 2021). It also increases the risk of adverse effects on one’s body. The patient’s case requires an individual approach to care and education to decrease the dangers related to anticoagulants.
Influencing Factors: Pharmacokinetics and Pharmacodynamics in Patient Care
Although warfarin is often prescribed to patients, it has many different effects on the body. In the patient’s scenario, the main factor was likely her advanced age – older people may experience different outcomes of drugs due to changes in body fat and mass, water retention, cardiac output, and more (Rosenthal & Burchum, 2021). In particular, the pharmacokinetics of warfarin are related to serum albumin levels (Rosenthal & Burchum, 2021). Older patients often have low levels of this protein, which makes the unbound drug distributed throughout the body (Rosenthal & Burchum, 2021). As a result, warfarin becomes more potent even if the dose is small.
The pharmacodynamics of warfarin also pose a challenge to older adults. Rosenthal and Burchum (2021) suggest that the drug’s strong effects can be explained by the body’s high number of receptors and their increased affinity. For example, the patient’s body may be highly responsive to anticoagulants, leading to an increased risk of bleeding. Other factors that enhance the drug’s response include genetics, vitamin K in the diet, and other anticoagulant drugs (Rosenthal & Burchum, 2021). Depending on these characteristics, the patient’s health may be in significant danger when taking warfarin.
Personalized Plan of Care: Tailoring Treatment to Patient History and Influencing Factors
To improve patient cardiovascular health and decrease the risk of adverse outcomes, the nurse has to develop a personalized care plan. Consulting with a pharmacist can help the provider prepare the patient for continuing therapy at home (Sabatino et al., 2017). For older patients, it is vital to educate them about various drug-drug interactions, dosage, adherence, and diet changes. The patient may continue taking a small warfarin dose if other options are unavailable.
However, she should be forbidden from taking aspirin or other blood-thinning medication at the same time (Drug Enforcement Administration, 2021). Moreover, the plan should incorporate testing for serum albumin levels and vitamin K to adjust the patient’s diet. Finally, patient education is crucial – the woman should be advised on how to take medication regularly and not to change the dose without consulting the provider.
Conclusion
In conclusion, pharmacodynamics and pharmacokinetics significantly affect treatment outcomes while affecting each person differently. Such factors as one’s age, genetics, or diet can change how a person responds to a drug. In the case of an older patient with previous cardiovascular problems, warfarin becomes a dangerous but often necessary medication. To avoid complications, the patient should stick to a schedule and remember common drug and food interactions.
References
Drug Enforcement Administration. (2021). CFR – Code of Federal Regulations Title 21. Web.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’spharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) Elsevier.
Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of Nurse Practitioners, 29(5), 248-254. Web.