Pharmacokinetics describes the movement of drugs throughout the body. It involves four processes, including absorption, metabolism, distribution, and excretion. The processes describe drug movement from the site of administration through blood and cells to the point of elimination from the body. Knowledge of pharmacokinetics helps to maximize the benefits of a drug and minimize its side effects. Pharmacodynamics, on the contrary, describes the physiologic and biochemical impact of drugs on the body. It also defines the molecular processes that produce the associated effects (Rosenthal & Burchum, 2021). Nurses must also understand the pharmacodynamics of drugs to acknowledge the contribution of each drug toward the overall therapeutic objective.
Multiple factors influence the movement and effect of drugs in the body. Examples include gender, genetics, behavior, and age. I have witnessed this phenomenon in one of my clinical experiences over the last five years. A 58-year-old male patient was presented to the emergency room with symptoms that led to the diagnosis of alcohol withdrawal. An assessment of the patient revealed a medical history of benzodiazepine and alcohol abuse. A withdrawal assessment was done to determine the severity of the condition (Newman et al., 2021). The assessment showed that the withdrawal level was moderate, with a 50% chance of progressing to delirium tremens.
The patient was administered lithium to lessen the withdrawal symptoms. While closely monitoring the patient, I realized that the drug had no impact on his symptoms. Since the patient had a medical history of benzodiazepine abuse, he developed an increased tolerance to the drug (Day & Daly, 2022). I reviewed the patient’s drug prescription and reported the issue to the psychiatrist. Initially, the psychiatrist proposed that the patient would recover with time but later advised that we increase the dosage and frequency of the drug to achieve better outcomes. Increasing the dosage and frequency of administration put the symptoms under control. I left the patient in stable condition and went home for the night. When I resumed work the following day, I found that the patient’s condition had deteriorated, and he had been transferred to the medical floor for further assessment and treatment. In the medical unit, an advanced airway was given to him for airway protection. I wondered why the situation had escalated to such levels. However, on doing research, I found that the patient had liver cirrhosis which negatively impacted the drug metabolism in the body. Hence, it was wrong to prescribe the medication to the patient (Sabatino et al., 2017). Since the liver plays a central role in metabolizing benzodiazepines such as lithium, its damage meant that drug metabolism could not occur appropriately. This led to a build-up of drugs and led to the patient’s unresponsive situation.
Based on the patient’s medical history and morbidities, I believe that an alternative treatment and care plan would have produced better outcomes. First, since the patient was at risk of progressing to severe levels of alcohol withdrawal, the patient would have been intubated and given time for the body to get rid of all the liver benzodiazepine drugs. The intubation was to be initiated immediately upon admission. The patient should also have been placed on mechanical ventilation after assessment and diagnosis. The psychiatrist should then administer a sedative drug that is safe for the liver. The plan would have enabled the patient to detox safely and advance to a stable state within a short time. It would also enable to stay without the breathing tube a few hours after admission.
References
Day, E., & Daly, C. (2022). Clinical management of the alcohol withdrawal syndrome. Addiction, 117(3), 804-814. https://doi.org/10.1111/add.15647
Newman, R. K., Gallagher, M. A. S., & Gomez, A. E. (2021). Alcohol withdrawal. In StatPearls [Internet]. StatPearls Publishing.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: 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. https://doi.org/10.1002/2327-6924.12446
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