The document discusses pharmacokinetics and pharmacodynamics as they relate to medication use by advanced practice nurses. It specifically examines the case of a 76-year-old female patient admitted for sepsis who developed confusion after being given cefepime and vancomycin intravenously. Factors like the patient's age, impaired kidney and liver function, and pathophysiological changes from sepsis affected the pharmacokinetics and pharmacodynamics of cefepime by delaying its metabolism and excretion, likely causing her confusion. The plan of care was to immediately stop cefepime therapy and monitor labs for worsening organ function, giving alternative antibiotics to high-risk patients.

1. NURS 6521 Week 1 Discussion Post
Pharmacokinetics and Pharmacodynamics
The advanced practice nurse (APN) needs to understand the
pharmacokinetics and pharmacodynamics of medications.
Pharmacokinetics is the study of how a drug moves through the
body, whereas pharmacodynamics is the study how a drug
affects the body (Rosenthal & Burchum, 2018). According to
Le (2019), the pharmacokinetics of a medication is dependent
on patient factors (sex, age, genetics, and renal function) as
well as the chemical properties of the drug. Pharmacokinetics
involves the administration, distribution, metabolism, and
excretion of a drug (Le, 2019). According to Farinde (2019),
pharmacodynamics and pharmacokinetics together assist in
describing the relationship between the dose and response of a
drug. The purpose of this discussion post is to select patient
case that was observed and how factors influenced the
pharmacokinetics and pharmacodynamics processes. The
discussion will also review the plan of care for the selected
patient case.
Description of Patient Case
The patient case selected is for a 76-year-old female who was
admitted for sepsis of unknown origin. The medical emergency
response team was activated to evaluate patient for potential
stroke and new onset confusion. The neurologist assessed the
patient and ruled out a stroke, but patient was newly confused
without explanation. After reviewing the chart, within twenty-
four hours, the patient had received their normal medications
from home, as well as two doses of vancomycin and one dose of
cefepime both given intravenously. The patient had no history
of confusion and did not receive any medications for sleep,
pain, or sedation. The patient has a slightly elevated creatinine
of 1.9 and liver function panel was slightly elevated, but it was
not a great concern to team to cause encephalopathy.
Factors Affecting Pharmacokinetic and Pharmacodynamic

2. Processes
The factors that can have an effect both the pharmacokinetics
and pharmacodynamics of cefepime are the patient’s age and
pathophysiological changes that occur from sepsis. Accordi ng
to (Isitan, Ferree, & Hohler, 2017), cefepime is a fourth-
generation cephalosporin antibiotic also known as a beta-
lactams and is used treat broad spectrum of organisms.
Cephalosporins are known to be nephrotoxic due to drug
concentrations being high intracellularly (Oliveira, Chaterjee, &
Burns, 2016). The time a patient develops encephalopathy is
between one and ten days after starting a cephalosporin so
clinicians to should be aware of the toxic effects of
cephalosporins especially if the patient has known renal failure
(Oliveira et al., 2016). The patient is 76 years old and kidney
function is impaired delaying the metabolism and elimination of
cefepime causing her confusion. The patient also had slightly
elevated liver function tests which inhibits the ability to
metabolize and excrete cefepime as well. Clinicians should be
paying attention to the dosing of cephalosporins in relation to a
patient’s kidney and liver function as well as age and have a
suspicion of neurotoxicity if patient presents with new
confusion (Isitan et al., 2017).
Personalized Plan of Care
The plan of care developed for this patient would be to
immediately stop cephalosporin therapy. According to Oliveira
et al. (2016), withholding cephalosporin treatment when
neurotoxicity is discovered usually treats the condition
immediately but if cases are much worse hemodialysis may need
to be initiated. The patient’s labs should be monitored for
worsening renal and liver dysfunction. For patients at high risk
of developing neurotoxicity from exposure to cephalosporin,
should be evaluated and given alternative antibiotics (Payne et
al., 2017). Interruption in drug therapy can often resolve the
adverse reaction of confusion but can take up to five days to
improvements (Payne et al., 2017). From a nursing perspective,
the focus would be on ensuring the patient is safe and

3. comfortable and the family has an understanding of the
circumstances.
References
Farinde, A. (2019). Overview of pharmacodynamics. Merck
Manual. Retrieved from
https://www.merckmanuals.com/professional/clinical-
pharmacology/pharmacodynamics/overview-of-
pharmacodynamics.
Isitan, C., Ferree, A., & Hohler, A. D. (2017). Cefepime
induced neurotoxicity: A case series and review of the
literature. Eneurologicalsci, 8, 40-43. Retrieved from
https://doi-
org.ezp.waldenulibrary.org/10.1016/j.ensci.2017.08.001.
Le, J. (2019). Overview of pharmacokinetics. Merck Manual.
Retrieved from
https://www.merckmanuals.com/professional/clinical-
pharmacology/pharmacokinetics/overview-of-pharmacokinetics.
Oliveira, B., Chaterjee, S., & Burns, A. (2016). Lesson of the
month 2: An easily missed cause of confusion. Clinical
Medicine, 16(5), 491-493. Retrieved from https://search-
ebscohost-
com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edswsc
&AN=000385339100021&site=eds-live&scope=site.
Payne, L. E., Gagnon, D. J., Riker, R. R., Seder, D. B., Glisic,
E. K., Morris, J. G., & Fraser, G. L. (2017). Cefepime-induced
neurotoxicity: A systematic review. Critical Care, 21(1), 1-8.
Retrieved from https://doi-
org.ezp.waldenulibrary.org/10.1186/s13054-017-1856-1
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne's
pharmacotherapeutics for advanced practice providers. St.
Louis, MO: Elsevier.
Post 1
Without the studies and research that attempts to quantify how

4. and why animals make us healthier, contributing to an increase
in our wellbeing, we have known that pets make us more human
for a long time if not from the beginning of time. We live in a
world though that asks us to prove that what we know is truly
factual so I think that anytime we are able to quantity the
measurable effects on our lives, both personally and
professionally, the better. Much research has already been done,
"filling nine-thousand entries at the Human Animal Bond
Research Institute (HABRI at Purdue University, (pg.113). The
question is not that animals perform an endless count of
services for us and that we rely on both the attributes inherent
in each animal but a great deal of our food supply originates
from animals, both live and as a result of the loss of their lives,
the questions then rests with understanding the economic impact
and dependence we have on animals to make the case for their
survival and later, which I believe will happen, rights afforded
to animals because they too have emotional intelligence.
Critics argue that in some studies, since sample size was not
adequate to establish a human animal bond and bias has to be
factored in any scientific study, there is not enough evidence to
establish a link. Such reluctance requires that animal services in
general use data and are able to cite research especially as
budgets become constrained on the county level and coalitions
are relied upon to bring in additional funding. Making a solid
case, both emotionally, intellectually and scientifically with
local businesses and others showing how local interests are
served, funds used appropriately and effectively. I think too,
animal services will continue to branch out into activities that
service more specific animal groups, people who rely on service
animals will need more specialized support. In fact, this year's
legislature agenda includes a bill that continues to recognize
"support
animals", https://le.utah.gov/~2020/bills/static/HJR006.html (Li
nks to an external site.) .
This additional bill provides parameters for "euthanasia" but
does not prevent the destruction of healthy, adoptable animals

5. after five days of being in a
shelter https://le.utah.gov/~2020/bills/static/HB0446.html (Link
s to an external site.) . It does not mention any "no-kill"
resolutions, or percentage goals related to lifesaving. This bill
is another example of how what happens at the state level may
not reflect what is actually happening and depending on the
community, may be meeting or exceeding minimum standards
established by legislation.
In the middle of a pandemic, I have seen news reports featuring
dogs that have been trained to detect a person's exposure to
Covid. They are currently unable to state unequivocally that
these dogs can detect each and every case, it is however,
another example of the amazing ability of dogs to smell and
sense a variety of conditions in humans.
Post 2
This chapter was a really fun read for me and it gave great
insight on a topic that I wanted to learn more about. I’ve always
thought that the bond that humans and animals have was
fascinating and went well beyond the stats, but I definitely
learned a few things throughout the reading that I hadn't seen
before. It’s fascinating how much research has been done on the
human-animal bond, and there’s no doubt that studies will
continue to take place (and for good reason). I certainly believe
that animals will take on an even larger role in the future in
American communities.
I like how this chapter mentioned a variety of animals and
presented various studies done relating to the animal human
bond. I really enjoyed the studies regarding training horses as
part of a therapy program, and the stress reduction and
companionship relation between dogs and cats and autistic
children or adults. The general outlook on pets helping humans
has definitely changed over the years, thanks to studies and
personal experiences people have had with their pets. Along
with pets in our everyday lives making people happy, animals

6. are also a part of many treatment programs at hospitals. After
reading about therapy dogs helping those in need, dogs
detecting low blood sugar, fish helping with feeding schedules,
etc., it’s clear that pets are having an impact on humans health
and it’s being noticed and utilized throughout America.
I have had so many great experiences with pets throughout my
life, and I know many people who can say the same. Having a
pet has helped me form bonds with other people and their pets
and has led to some great friendship. Along with that, my dog
has definitely made me and my family's life happier and
healthier. I'm excited to continue seeing studies on the human
animal bond and watching the impact it has throughout the
world..