As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand 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. 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. By Day 3 of Week 1 Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples. By Day 6 of Week 1 Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure. Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to compl ...

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

2. 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.
By Day 3 of Week 1
Post
a description of the patient case from your experiences,
observations, and/or clinical practice from the last 5 years.
Then, describe factors that might have influenced
pharmacokinetic and pharmacodynamic processes of the patient
you identified. Finally, explain details of the personalized plan
of care that you would develop based on influencing factors and
patient history in your case. Be specific and provide examples.
By Day 6 of Week 1
Read
a selection of your colleagues’ responses and
respond
to
at least two
of your colleagues on
two different days
by suggesting additional patient factors that might have
interfered with the pharmacokinetic and pharmacodynamic
processes of the patients they described. In addition, suggest
how the personalized plan of care might change if the age of the
patient were different and/or if the patient had a comorbid
condition, such as renal failure, heart failure, or liver failure.

3. Note:
For this Discussion, you are required to complete your initial
post before you will be able to view and respond to your
colleagues’ postings. Begin by clicking on the “Post to
Discussion Question” link, and then select “Create Thread” to
complete your initial post. Remember, once you click on
Submit, you cannot delete or edit your own posts, and you
cannot post anonymously. Please check your post carefully
before clicking on
Submit!
Discussion 1 NG
Introduction
This post is an attempt to discuss risk factors associated with
prescribing medications to the elderly population. It is also an
attempt to understand the challenges clinicians encounter with
age-related concerns with pharmacokinetic and
pharmacodynamic processes. Additionally, it will also explain
that a personalized plan of care necessitates medication
adherence.
Chief Complaint
A 72-year-old male patient with CC of worsening psychosis and
not cooperative with assessment. Patient has history of CHF,
alcohol abuse, and smoking about a pack of cigarettes a day. On
physical assessment, SBP 164/78 HR 99 RR 19 PaO2 96%. Per
ED report, patient was found lying on the floor with half bottle
of vodka next to him. Patient’s neighbor called 911. Per EMS,

4. patient has not been compliant with taking his medications. Last
hospital encounter was for alcohol intoxication.
Risk Factors
Possible risk factors that influence pharmacokinetic and
pharmacodynamic processes include patient’s age, sex, severe
alcohol use, comorbidities related to heart, renal and hepatic
function with age-related changes. When prescribing
medication, clinicians should be aware of the adverse effects
related to hepatic and renal function of the elderly. An example
is with SSRIs, these medications are hepatically metabolized
and highly protein bound. Despite these properties, the
pharmacokinetics of SSRIs may differ in elderly patients due to
decreased drug clearance as a result from the natural decline in
renal function with age, even with the absence of renal disease
(Cossart, Isbel, Scuderi, Campbell, & Staatz (2021). Another
risk factor that may also play a major role is the individual
response to a given pharmacologic agent is the genetic makeup
of the patient (Kassimis, & Alexopoulos, 2018). Essentially,
genetic makeup of the patient refers to the role of genetic
variation in response to a drug (Kassimis et al., 2018). These
risk factors play a crucial role with a drug's absorption,
distribution, metabolism, and elimination, all of which affect
the drug's effect by altering the drug's concentration at its site
of action (Cossart et al., 2021). An increased volume of
distribution may result from the proportional increase in body
fat relative to skeletal muscle with aging (Alhawassi, Alatawi &
Alwhaibi. 2019). Larger drug storage reservoirs and decreased
clearance prolong drug half-lives and lead to increased plasma
drug concentrations in older people (Alhawassi, 2019). Lastly,
pharmacodynamics refers to the patient’s body's therapeutic
response to a drug (Cossart et al., 2021). This generally is
determined by the drug's affinity and activity at its site of
action, which is often a receptor (Cossart et al., 2021).

5. Personalized Plan of Care
The process of prescribing a medication is complex because of
the difficult challenges that a clinician face when prescribing a
medicine for older adults. These challenges may include
deciding that a drug is indicated, choosing the best drug,
determining a dose, and scheduling an appropriate time pending
on the patient's physiologic status. These complexities may also
present unique challenges when prescribing for an elderly
patient due to care with monitoring for effectiveness and
toxicity, educating the patient about expected side effects, and
encouraging the patient to look for indications that may render
medical consultation (Cossart et al., 2021). The care in
prescribing medicine become even more cumbersome when
premarketing drug trials often exclude geriatric patients because
they may not be appropriate for older adults (Cossart et al.,
2021). As such, many medications need to be used with special
caution because of age-related changes in pharmacokinetics and
pharmacodynamics (Kuchel, 2018). An example is the
clearance rate for
lithium
is reduced, in older adults (Nagamine, 2020). The same dose of
medication would lead to higher plasma concentrations in an
older, compared with younger, patient (Nagamine, 2020.)
Hepatic function also declines with advancing age, and age-
related changes in hepatic function may account for significant
variability in drug metabolism among older adults. Especially
when polypharmacy is a factor, decreasing hepatic function may
lead to adverse drug reactions (Alhawassi, 2019). During the
assessment, we can determine that patient has a history with not
taking his medications. Use of multiple medications can lead to
problems with adherence in older adults, especially,
compounded by a complex drug regimen (Sutema, Jaya & Bakta,
2018). The clinician recognizes that patient preference and
treatment availability may be overriding factors in selecting a
treatment modality. For patients who lack motivation for

6. treatment, motivational interviewing can be a useful initial
intervention (Weng, Ding, Min, Tang, Yang, Guo & Xing,
2019). This may include a brief motivational alcohol
counseling as a starting point for patients with an alcohol use
disorder (Weng et al., 2019). In selecting psychosocial
interventions, the clinician should make the patient aware of the
menu of options and his best clinical advice and allow the
patient to choose among them (Weng et al., 2019).
Conclusion
The issue of polypharmacy is of particular concern in older
people who tend to have more disease conditions for which
medications are prescribed. The use of greater numbers of drug
therapies has been independently associated with an increased
risk for an adverse drug event with respect to age-related
challenges in the elderly. As such, the clinician should take
caution in prescribing medications for the elderly population.
References
Amelia R. Cossart, Nicole M. Isbel, Carla Scuderi, Scott B.
Campbell, & Christine E. Staatz. (2021). Pharmacokinetic and
Pharmacodynamic Considerations in Relation to Calcineurin
Usage in Elderly Kidney Transplant Recipients.
Frontiers in Pharmacology
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12
.
https://doi-
org.ezp.waldenulibrary.org/10.3389/fphar.2021.635165
Ida Ayu Manik Partha Sutema, Made Krisna Adi Jaya, & I Made
Bakta. (2018). Medicine reminder to improve treatment
compliance on geriatric patients with diabetic neuropathy at
Sanglah Central Hospital, Bali-Indonesia.

7. Bali Medical Journal
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7
(2), 516–520. https://doi-
org.ezp.waldenulibrary.org/10.15562/bmj.v7i2.1070
Kassimis, G., & Alexopoulos, D. (2018). CYP2C19 Genetic
Polymorphism and Pharmacodynamics of Prasugrel Maintenance
Dose in Patients Undergoing Percutaneous Coronary
Intervention.
Cardiology
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140
(4), 237–238.
Kuchel, G. A. (2018). Frailty and Resilience as Outcome
Measures in Clinical Trials and Geriatric Care: Are We Getting
Any Closer?
Journal of the American Geriatrics Society
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66
(8), 1451–1454.
https://doi-org.ezp.waldenulibrary.org/10.1111/jgs.15441
Nagamine, T. (2020). Lithium intoxication in the elderly: A
possible interaction between azilsartan, fluvoxamine, and
lithium. Innovations in Clinical Neuroscience, 17(4–6), 45–46.
Tariq M. Alhawassi, Wafa Alatawi, & Monira Alwhaibi. (2019).
Prevalence of potentially inappropriate medications use among
older adults and risk factors using the 2015 American Geriatrics
Society Beers criteria. BMC Geriatrics, 19(1), 1–8.
https://doi-org.ezp.waldenulibrary.org/10.1186/s12877-019-
1168-1
Weng, W., Ding, S., Min, J., Tang, H., Yang, H., Guo, P., &

8. Xing, S. (2019). Logistic regression analysis of drug
compliance and influencing factors in elderly osteoporosis
patients. Pakistan Journal of Pharmaceutical
Sciences, 32(5(Special)), 2399–2403.
Discussion 2 SD
NURS 6521 Week 1 Initial Discussion Post
As a hospice nurse, the patients I care for are dealing with
advanced stages of disease, some from multiple disease
processes. Most of my patients have issues with metabolism.
However, some, such as COPD patients, would have decreased
distribution due to their inability to take a deep enough breath
to administer an inhaled medication appropriately.
Pharmacokinetics refers to the effects the body has on a drug
through the processes of absorption, distribution, metabolism,
and excretion. Pharmacodynamics is the effects of the drug on
the body (Rosenthal & Burchum, 2021). The most interesting
patients, as they relate to pharmacokinetics and
pharmacodynamics, are liver failure patients. These patients
come to hospice at a late stage of the disease process and are
frequently in a lot of pain. Opioid pain medications are
commonly prescribed. Liver failure patients are at a higher risk
of toxicity from opioids due to reduced hepatic function and the
effects on metabolic pathways. Decreased albumin levels in
liver failure lead to increased serum drug levels and
bioavailability. Reduction in serum albumin level also changes
the quality of opioid distribution. When opioids accumulate in
the plasma, the half-life increases, increasing the severity of
adverse reactions such as encephalopathy or respiratory
depression (Soleimanpour et al., 2016). In hospice, the main
goal of patient care is symptom relief and comfort. As a
hospice nurse, I have honestly not considered the

9. pharmacokinetics and pharmacodynamics of the medications
provided, just the benefit of pain relief for the patient. In
patients who are not in a transitioning or actively dying state,
the dosage of opioid medication and dosing intervals should be
adjusted according to the severity of the disease process. Some
medications should be avoided entirely, such as meperidine and
codeine (Oliverio, Malone, & Rosielle, 2015).
Behavioral factors that may affect a liver failure patient's
pharmacokinetic and pharmacodynamic processes are often a
history of alcohol or drug abuse that may be ongoing. The
nutritional status of these patients is often not optimal either
due to decreased appetite, pain, and ascites. Most commonly,
liver failure patients are males over age 50, who have abused
alcohol, and or have diabetes Type II. Liver failure patients are
at higher risk of developing liver cancer (niddk.nih.gov, 2018).
In a study done by Hernaez et al. (2019), African American
males were at higher risk of developing end-stage liver disease.
Pharmacogenetics, or pharmacogenomics, studies how genetics
affects a person's response to drugs. The goal is to treat each
patient individually based on their specific genetic makeup. For
example, some people have many copies of a particular liver
enzyme active in metabolizing codeine into morphine. These
people metabolize the drug so wholly and fast that a standard
dose for a "normal" patient could be an overdose for them
(nigms.nih.gov, n.d.). Taking pharmacogenetics into
consideration, that could further alter the way opioid
medications affect a patient with liver failure.
A plan of care for pain management specific to a liver failure
patient would consider where the patient is in the disease
process. By the time a patient is referred to hospice, they are
generally in advanced stages of the disease. Active alcohol or
illicit drug use is also considered, as pharmacodynamic
interactions between alcohol and prescription drugs are common

10. (Fraser, 2012). Dosage should be decreased, and time intervals
increased to lower the risk of adverse reaction while still
providing pain relief. Drug selection is also considered, as
meperidine and codeine are contraindicated in liver failure
(Oliverio, Malone, & Rosielle, 2015).
References
.
Definition & facts for cirrhosis
. (2018, March). NIH National Institute of Diabetes and
Digestive and Kidney Diseases. Retrieved June 2, 2021, from
https://www.niddk.nih.gov/health-information/liver-
disease/cirrhosis/definition-facts
Hernaez, R., Kramer, J. R., Liu, Y., Tansel, A., Natarajan, Y.,
Hussain, K. B., Ginès, P., Solà, E., Moreau, R., Gerbes, A., El -
Serag, H. B., & Kanwal, F. (2019). Prevalence and short-term
mortality of acute-on-chronic liver failure: A national cohort
study from the USA.
Journal of Hepatology
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70
(4), 639–647.
https://doi.org/10.1016/j.jhep.2018.12.018
Oliverio, C., Malone, N., & Rosielle, D. (2015, September).
Opioid use in liver failure
. Palliative Care Network of Wisconsin. Retrieved June 2, 2021,
from
https://www.mypcnow.org/fast-fact/opioid-use-in-liver-failure/
Pharmacogenomics
. (n.d.). NIH National Institute of General Medical Sciences.
Retrieved June 2, 2021, from

11. https://www.nigms.nih.gov/education/fact-
sheets/Pages/pharmacogenomics.aspx
Rosenthal, L. & Burchum, J. (2021).
Lehne's pharmacotherapeutics for advanced practice nurses and
physician assistants
(2nd ed.). Saunders.
Soleimanpour, H., Safari, S., Shahsavari Nia, K., Sanaie, S., &
Alavian, S. (2016). Opioid drugs in patients with liver disease:
A systematic review.
Hepatitis Monthly
,
16
(4).
https://doi.org/10.5812/hepatmon.32636