Drugs have many effects on the body. Pharmacokinetics and Pharmacodynamics are two terms which describe the reaction of drugs on the body. Pharmacodynamics, by definition, is the process through which drugs imitate the therapeutic or the toxic effect on the body. It can also describe the drugs' impact on the body. On the other side, pharmacokinetic is how the body affects or impacts the drug. It also describes the movement of medicine through the body. There are many times while discharging my duties when I have prescribed drugs, and I felt that my desired outcomes were less met. For the assignments, I have selected one of the patients whom I had an opportunity to manage his condition. The patient is 85 years old African-American male with a history of different medical issues, including bipolar disease. Using the patient as the case, I will explain the basic Pharmacodynamics and pharmacokinetic process, as well as my Plan for the care.
The patient case
The patient in the case is an 85 years old African American male patient with a history of a different medical condition such as diabetes, bipolar disorder, hypertension, gout and dyslipidemia. The patient got a transfer from clinical trial to our inpatient psychiatric hospital. My unit was the choice to manage and help with stabilization of the patient’s condition. The family provided vital pieces of information that were part of the management. The information reveals that the patient has a progressive decompensated, is willing to take her oral medication, but has refused to take his food for the last two days. It implies that the patient had poor insight and judgements, is isolative, and there is an increased in confusion.
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The patient was alert when the physicians admitted her to the facility, mostly towards the other, the spouse and himself. From her clinical observation and presentation, the patient showed an alternative level of consciousness, with stability in some of the vital signs of his conditions. From home, the patient was taking several drugs. The drugs include Metformin 75 Mg daily, Lithium 300 mg twice a day, ten units of Lantus insulin every night, hydrochlorothiazide 25mg daily and Crestor 20mg daily.
Basic Pharmacokinetic processes
The reaction between the body and a drug is a complex process which has four phases. The first phase is the drug absorption. After oral drug ingestion, a drug goes through the small intestine where absorption takes place. At this point, the lining of the organ known as the enterocytes is the chief determinant on the amount or the quantity of the drugs that permeate the liver. Distribution is the second phase. During distribution, the drugs leave the gastrointestinal system to the liver through channel channels such as the portal circulation channel. The drug travels unchangeably through the hepatic veins into the general circulation. In some cases, it may end up metabolized before entering the circulatory system(American Geriatric Society 2015). The next step is the metabolism, which takes place through glucuronidation and the oxidation. The last phase is the excretion (Drug.com, 2012). The excretion process takes place through the help of the liver through the glomerular filtration rate (GFR). In the case of the patient given, there are numerous factors which can determine the patient’s body response to the drugs. The patient is 85 years old. At this age, the rate of glomerular filtration reduces. Further, most of the organs function such as liver and kidney reduces by age, and this could be the main reason that this patient has a lot of health issues and lithium toxicity (Weitzel et al., 2014).
Basic Pharmacodynamics Processes
When a drugs ingested reaches the tissue of its target, it initiates pharmacodynamics. “The drug can have effects on the patient presynaptic or postsynaptic or may involve enzyme inhibition. Ultimately, the mechanism for these drugs to be in motion, involves drug-receptor binding, signal transduction, and cellular response" (Drug.com, 2012) The patient, in this case, takes Lithium 300mg twice a day. The patient, however, has not presented classical lithium toxicity such as nausea, coma, and confusion. However, the lab tests reveal that the lithium level was 3.1mmol/L. The normal lithium for a person oh his age should be between 0.4 to 0.9mmol/L. An individual at this age requires a lower therapeutic does to maintain serum of the needed level.
Personalized Plan of care
My personalized care for the patient, in this case, would be complete steps to cater for her condition. The first step would be to stop the patient from taking any more dose of lithium. Instead, I would encourage the patient to take more fluid and monitor his lithium level through the lab tests and assessment. I would also provide education on the family and the patient on how to manage the toxic lithium condition. This Plan would help in monitoring the lithium weekly until the serum level would reduce to a required level. The fluid, in this case, would be vital in restoring the glomerular filtration, normal urine output and reduce the level of lithium toxicity in the body. In case the patient age would be altered by reducing it by thirty, I would major on the psychiatric condition mainly because at this age, most of the body organs work well and there is no danger of lithium concentration. However, I would have steel recommended more fluid in case there was an alteration in age, but the patient had a comorbid condition such as renal failure.
References
American Geriatric Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. Retrieved February 25, 2019, from https.//www.sigol,org/allegato_docs/1057_Beers-Criteria,pdf
Drug.com. (2012) Retrieved August 22, 2012, from http//www.drug.com/
Weitzel, K W., Elsey, A E., Langaee, T Y., Benjamin, B, Nessi, D. R., Obeng A. W,.. Johnson, J. A (2014), Clinical pharmacogenetics implementation Approaches, Successes, and Challenges. American Journal of Medical Genetics , 0(1), 56-67.
