NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts

Sample Answer for NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts Included After Question

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 pharamcodynamic 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. In this Discussion, you reflect on a case from your past clinical experiences and consider how a particular patient’s pharmacokinetic and pharmacodynamic processes altered his or her response to a drug. 

To prepare: 
Review this week’s media presentation with Dr. Terry Buttaro, as well as Chapter 2 of the Arcangelo and Peterson text, and the Weitzel et al (2014) article in the Learning Resources. Consider the principles of pharmacokinetics and pharmacodynamics. 
Reflect on your experiences, observations, and/or clinical practices from the last five years. Select a case from the last five years that involves a patient whose individual differences in pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient. 
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. 

With these thoughts in mind: 

By Day 3 

Post a description of the case you selected. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient from the case you selected. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. 

By Day 6 

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 pharmadynamic processes of the patients in their case studies. In addition, suggest how the personal care plan might change if the age of the patient were different and 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 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! 

Submission and Grading Information 
Grading Criteria  

In 2011, more than 3.7 billion drug prescriptions were filled at pharmacies in the United States (The Kaiser Family Foundation, 2011). With billions of drugs prescribed each year for the treatment and management of various disorders, it is essential for advanced practice nurses to familiarize themselves with common drug treatments and effects of these treatments on patients. When prescribing drugs, ensuring patient safety is the major concern. In many clinical settings, nurses work more closely with patients than any other health care provider, making it their responsibility to assist physicians with this task. As an advanced practice nurse maintaining patient safety, you must consider the many patient factors that impact pharmacotherapeutics. 

This week you explore factors that influence pharmacokinetic and pharmacodynamic processes in patients. You also examine patient factors that advanced practice nurses must consider when developing drug therapy plans. 

Learning Objectives 

By the end of this week, students will: 

Analyze factors that influence pharmacokinetic and pharmacodynamics processes in patients 
Assess patient factors and history to develop personalized plans of care 
Understand and apply key terms, concepts, and principles related to pharmacotherapeutics 
Understand and apply key terms, concepts, and principles related to prescribing drugs to treat geriatric patients 

Photo Credit: Daniel Kaesler/EyeEm/EyeEm/Getty Images 

NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Learning Resources 

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below. 

Required Readings 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

Chapter 2, “Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles” (pp. 17-31)
This chapter examines concepts related to pharmacokinetics and pharmacodynamics. It also explores patient factors that health care providers consider when prescribing drug therapy to patients.  
A Sample Answer For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts

​The patient scenario to be discussed for the purpose of this discussion post is a patient being treated with intravenousvancomycin for a Methicillin Resistant Staphylococcus Aureus (MRSA) infection in a spinal surgical incision. The patient had multiple comorbidities; however, the most pertinent comorbidity is end-stage chronic renal disease. Common practice in this setting is to order pharmacokinetic services to monitor and assist with management of vancomycin administration. The monitoring includes laboratory studies including blood chemistries and vancomycin levels. During the monitoring, it was discovered the patient had an extremely high level of vancomycin in the blood which required holding the next scheduled dose, and changing the amount of Vancomycin provided in the next dose.  

Factors Influencing Pharmacokinetics and Pharmacodynamics 

 Vancomycin is a glycopeptide antibiotic that is hydrophilic and cannot pass through the cells membranes through simple diffusion resulting in a need to be administered intravenously to achieve a systemic result (Zaric, et al., 2018). Vancomycin reaches a peak level, which is 63 mcg/mL, in the blood and falls to about 23 mcg/mL in about two hours after the infusion, and then continues to decrease to 8mcg/mL about 11 hours after the end of the infusion in an individual without any renal impairment (Connective Rx, 2018). The concentration of vancomycin in the blood is also impacted by the degree of inflammation (Connective Rx, 2018). The pharmacokinetics factors, which is what the body does with the drug (Arcanfelo, Peterson, & Reinhold, 2017), influencing the patient’s response to the medication are influenced by the impaired kidney function. Approximately 80%-90% of vancomycin is excreted in the urine (Zaric, et al., 2018).  

 Review of the pharmacodynamics, the way the drug impacts the body (Arcanfelo, Peterson, & Reinhold, 2017), reveals vancomycin inhibiting bacterial synthesis through binding to the precursor on bacterial cell walls (Connective Rx, 2018). Through the binding of vancomycin to the precursor unit of the bacterial cell wall, the outcome is RNA synthesis inhibition, alteration of the bacterial cell wall permeability, and bacterial cell death (Connective Rx, 2018). Severe adverse reactions related to the renal function include renal failure, azotemia, and interstitial nephritis (Connective Rx, 2018). Moderate adverse reactions include hypokalemia and hypotension (Connective Rx, 2018). Vertigo and dizziness are mild symptoms that can be related to kidney function (Connective Rx, 2018). In renal patients the doses have to be adjusted due to the possibility of accumulation of the medication causing nephrotoxicity (Connective Rx, 2018). Nephrotoxicity occurring as a result of monotherapy is usually reversible (Connective Rx, 2018).  

Personalized Plan of Care 

 ​The plan of care for this patient was for him to have vancomycin on the days he would have dialysis to assist with the excretion of the medication. Labs were drawn frequently to monitor the kidney function and vancomycin trough levels and dose adjustments were made accordingly. Collaboration with the pharmacokinetics pharmacist and the provider was also crucial to the management of the outcome of the patient. 

Conclusion 

 In conclusion, the above-mentioned patient was given vancomycin for a MRSA infection and he had a co-morbidity of ESRD. The ESRD impacted the excretion of the vancomycin resulting in toxic levels of vancomycin in the patient’s blood. The pharmacokinetics and pharmacodynamics significantly impact the action of the medication and magnitude of the impact on the body. The individualized plan of care for the specified patient created the possibility to limit any further renal impairment.  

 References 

 Arcanfelo, V. P., Peterson, A. M., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Ambler, PA: Lippincott Williams & Wilkins. 

 Connective Rx. (2018). Vancomycin Hydrochloride. Retrieved from PDR.net: https://www.pdr.net/drug-information/vancomycin-hydrochloride-for-injection?druglabelid=3535 

 Zaric, R. Z., Milovanovic, J., Rosic, N., Milovanovic, D., Zecevic, D. R., Folic, M., & Jankovic, S. (2018). Pharmacokinetics of vancomycin in patients with different renal function levels. Open Medicine, 512-519. 

A Sample Answer 2 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts

I had a family member with a history of CAD, and IDDM, who was in need of an aortic valve replacement.  The TAVR procedure was completed successfully and was sent home on a regimen of Coumadin/Warfarin for anticoagulant therapy.  This person had other underlying health problems (one of which was a herniated disc) of which he was unaware which resulted in weakness and frequent falling.  His falls resulted in multiple skin tears and bruising, bleeding was always present and he related that to the warfarin.  Upon speaking to him one day when he had a question about his meds, I noticed a bottle of Ibuprofen with his prescriptions.  He stated he had been taking Ibuprofen for the pain in his back.  I did explain that the Ibuprofen affected his Coumadin/Warfarin, and to speak with his PCP about an alternative. 

Pharmacokinetics /Pharmacodynamics 

In a study completed by Juel, Pedersen, Langfrits & Jensen, 2013, it was determined that there is a pharmacokinetic interaction between Coumadin/Warfarin and Ibuprofen which causes and inhibition of Coumadin/Warfarin metabolism.  The level of anticoagulation with warfarin is usually monitored with international normalized ratio (INR), every one-point increase, increases bleeding risk by 54% (Choi, Kim, Son, Kim, Kim, Ahn, & Lee, 2010). According to Choi et al., 2010, and Juel, et al., 2013 both medications are metabolized by cytochrome P450. 

Personalized Plan of Care 

For initial Coumadin/warfarin therapy the INR must be checked routinely and monitored closely, as this was not the case with my family member.  Perhaps an alternate anticoagulant should have been introduced.  There are many other oral anticoagulants that are utilized, which would have been more beneficial to this individual.  According to Arcangelo, Peterson, Wilbur & Reinhold (2017), direct-acting oral coagulants (DOACs) have a faster onset of action, have fewer drug-drug interactions, and have a predictable anticoagulant response.  Along with any anticoagulant therapy, patient teaching explaining the effects of OTC medication. This family member was unaware at the time, that he also had pancreatic cancer, which would have also affected the pharmaceutical plan. 

References: 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins 

Choi, K. H., Kim, A. J., Son, I. J., Kim, K. H., Kim, K. B., Ahn, H., & Lee, E. B. (2010). Risk factors of drug interaction between warfarin and nonsteroidal anti-inflammatory drugs in practical setting. Journal of Korean medical science, 25(3), 337-41. 

Juel, J., Pedersen, T., Langfrits, C., & Jensen, S. (2013). Administration of tramadol or ibuprofen increases the INR level in patients on warfarin. European Journal of Clinical Pharmacology, 69(2), 291–292. https://doi-org.ezp.waldenulibrary.org/10.1007/s00228-012-1325-3 

A Sample Answer 3 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Case Scenario 

            Over the years working as a nurse I have encountered many patients who state that sleep aids do not work for them.  They often complain that the treatment for insomnia has the opposite effect for them.  People who use these medications and fall fast asleep without difficulty would probably question how is this possible.  The first time I had someone tell me that sleep aids did not work for them I to in the back of my mind questioned why.  For the sake of privacy, I will call the patient that I am referring to Sam. 

            Sam was a male Caucasian patient in his mid-60’s who was brought into the ED by his wife for new onset of confusion.  Sam’s wife stated that he had been very forgetful lately doing things like driving to the store and not remembering the trip there, or where he parked, he seemed to have an increase in anxiety, and he was not sleeping many hours at all.  Being that this behavior was out of the patient’s norm and recently started, she was concerned enough to convince him to come to the Emergency room. 

 A neurologic workup was completed on Sam.  He had a minor health history, and he was a social drinker.  A week before the ED visit he functioned normal going to work, shopping, and driving without any issues.  Although a medication list was collected at the beginning of the visit new information came to light.  The patient told his wife that he was had been taking his Ambien in the morning with his other medications.  The patient was unaware that the Ambien was intended for sleep.  The ED physician contributed the patient’s new confusion to the Ambien that he just started taking before the confusion started.   

Pharmacokinetics and Pharmacodynamics 

            When prescribing medication, I understand that it is important to know how the drug works in the body and what effect it achieves.  Pharmacokinetics is defined as “how the drug is absorbed, distributed and eliminated from the body” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p.17).  Ambien is rapidly absorbed through the GI tract which means that taking the medication with food or while the stomach is full can slow down the onset of the medication.  The medication is distributed throughout the body by binding to protein carriers at 92% (Kizior, 2018).  Different medications are metabolized in different ways.  When it comes to how the Ambien is broken down, it is metabolized by the liver and eliminated through urination (Kizior, 2018).  The effectiveness of how the body receives the Ambien will determine how well it works for the Sam.  Also, the overall health, gender, and age of the patient can play a role in how well the medication is excreted by the body.  Sam is in his late 60’s, “older adults undergo physiologic changes that affect the absorption, distribution, and elimination of many agents” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p.30). 

 Pharmacodynamics is defined as “the set of processes by which drugs produce specific biochemical or physiologic changes in the body” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p. 27).  Many factors can play a factor in how a drug will affect a person such as age, race, gender, and genetics.  Due to Sam’s age and the fact that he is a drinker it is possible that the effect of the medication was intensified causing his confusion.   

Personalized Plan 

 When prescribing for Sam, I would take his not only his health history and social history into account but also his age.  From the beginning, it is clear to see that Sam did not understand why he was taking Ambien because he was taking it at the wrong time of day.  Thorough patient teaching would be performed so that Sam would understand to take the medication at night for his insomnia and not to drink while taking the medication.  Also, I would have him take it on an empty stomach.  I would decrease Sam’s dose if possible and include his wife in the education because he would need to be monitored while taking a hypnotic such as Ambien, “consistent monitoring of the elderly is needed when taking a long-acting hypnotic due to accumulation in the renal or hepatic system” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p.732).  I would suggest other options for relaxation prior to medication.  As a prescriber, I would take into consideration Sam’s age even if he seems healthy the body changes as it ages, “when prescribing you must be focused and attentive because every patient is different” (Laureate Education, 2012).      

Reference: 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).  

Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

Kizior, R. (2018). Saunders Nursing Drug Handbook 2019. Elsevier – Health Sciences Division. 

Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology.  

A Sample Answer 4 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts

     While working for surgeons who exclusively perform outpatient parathyroidectomies for patients with primary hyperparathyroid 

disease, calcium regulation in the immediate post-operative period is a standard part of patient care. It is essential that the serum 

calcium remains in range for the body to function normally (Ross, Taylor, Yaktine, & Del Valle, 2011).  For most patients, a daily loading 

dose of calcium supplementation for one week followed by a gradual titration is enough to maintain healthy calcium serum levels 

during this period, and this is part of standard post-operative care and discharge instructions. Rarely, patients will experience 

hypocalcemia. The following presents a brief explanation of the role of parathyroid hormone and calcium supplementation after 

parathyroidectomy, the pharmacokinetic and pharmacodynamic factors related to over the counter calcium supplementation, and a 

case of hypocalcemia which resulted in hospitalization. 

     Parathyroidectomy patients present postoperatively with dormant remaining parathyroid glands evidenced by parathyroid 

hormone (PTH) levels taken immediately after surgery. Because PTH is essential to calcium homeostasis by regulating resorption of 

bone, stimulating production of calcitriol by the kidneys, and affecting renal excretion of calcium (Ross et al., 2011) the anticipated 

drop in this hormone post-operatively also results in a decrease in serum calcium levels and dictates that calcium must be taken 

parenterally until the remaining glands wake-up and function regularly. Taken orally, calcium supplementation corrects 

deficiencies within minutes (Huether & McCance, 2017). 

     Even though the per os (PO) calcium supplementation recommended to patients is over the counter, it is imperative the nurse and 

practitioner taking care of post-parathyroidectomy patients understand the pharmacokinetics and pharmacodynamics of calcium 

supplementation; principles of recommending or managing a dietary supplement include knowing the efficacy, safety, dosage, 

indications, potential side effects, and expected therapeutic benefit (Bonakdar, 2010). Arcangelo, Peterson, Wilbur, and Reinhold 

(2017) define pharmacokinetics as how a “drug is administered, absorbed, distributed, and…eliminated from the body” (p. 17).  

Calcium regulation in the body is a complex process; a simple explanation of pharmacokinetics of calcium is that one-fifth to one-third 

of PO administration is absorbed in the small intestines through passive and active transport, the remainder is excreted in the stool, 

and the portion absorbed in the intestines is either reabsorbed or excreted by the kidneys (O’Toole, 2010 & Ross et al., 2011)). Any 

disease process that affects the absorption potential of the small intestines or kidney function has a potential to cause a change in 

the pharmacodynamics of supplemental calcium (Houillier, Froissart, Maruani, & Blanchard, 2006) 

     Calcium is essential to nerve and muscle function on the cellular level (Huether & McCance, 2017), vascular contraction and dilation 

(Ross et al., 2011), and even plays a significant role in cell proliferation and death (Wang, Yang, & Shen, 2015). The therapeutic effect, 

or purpose, of calcium administration in postoperative parathyroidectomy patients, is to prevent complications caused by 

hypocalcemia. 

     Sue (name changed for privacy), a postoperative patient in her seventies who had suffered from hyperparathyroid disease for 

many years, presented three days postoperatively with vague symptoms of malaise, fatigue, and dizziness. Traditionally the first signs 

of low calcium are tingling or numbness in the hands, feet, and lips (Huether & McCance, 2017), but experience has shown that 

atypical symptoms occasionally present first.  This patient was treated with increased calcium supplementation at the 

recommendations of her surgeon and developed an allergic reaction in the form of an all-over body rash to over-the-counter (OTC) 

Citracal Max (calcium citrate plus D, manganese, copper, and zinc). Treatment was focused on finding a form of calcium that relieved 

her symptoms and did not cause stomach upset (for this patient some forms of calcium caused loose stools, which may also have 

affected absorption). When the patient did not respond to increased calcium supplementation as anticipated (therapeutic response) 

she was sent for labs and found to have a serum calcium level in the low sevens; she was subsequently sent to the hospital for 

intravenous calcium administration. She was discharged from the hospital almost a week later with a stabilized serum calcium level, a 

prescription for calcitriol (activated Vitamin D) and increased amounts of daily calcium supplementation.   

     Pharmacogenetics, demonstrated by this patient’s allergic response to the standard OTC calcium supplementations, was a factor in 

this incidence of hypocalcemia. The patient did not immediately inform the surgeon of her response to the supplementation regimen. 

Also, after a form of calcium tolerated by the patient was identified, her symptoms did not improve.   She told me after her discharge 

that the endocrinologist caring for her in the hospital told her that a few things decreased her body’s ability to absorb the calcium she 

was taking: coffee (caffeine) consumption, and administration of torsemide and PreserVision. This would account for behavioral and 

pharmacodynamic elements that affected therapeutic response, but another factor for this patient is age.  Aging is correlated with 

decreased vitamin D receptor (VDR) resulting in decreased calcium absorption in the small intestine (Lieben et al., 2015). 

     In summary, the metabolism and effect of calcium supplementation in the human is a complex process that can be altered by 

many factors including genetic response (allergic reaction), behavior, and age. The practitioner caring for patients prescribed this 

supplement are responsible for understanding its pharmacokinetics and pharmacodynamics to ensure positive patient outcomes. 

References 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice a practical  

     approach (4th ed.). Philadelphia, PA: Wolters Kluwer. 

Bonakdar, R. A. (2010). The H.E.R.B.A.L. guide. Dietary supplement resources for the clinician. Philadelphia, PA: Wolters Kluwer| Lippincott 

     Williams & Wilkins. 

Drugs.com. (n.d.). Calcium citrate disease interactions. Retrieved November 27, 2018, from https://www.drugs.com/disease- 

     interactions/calcium-citrate.html#Phosphate_Calcifications 

Houillier, P., Froissart, M., Maruani, G., & Blanchard, A. (2006). What serum calcium can tell us and what it can’t. Nephrology Dialysis  

     Transplantation, 21(1), 29-32. https://doi.org/10.1093/ndt/gfi268 

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Elsevier. 

Lieben, L., Verlinden, L., Masuyama, R., Torrekens, S., Moermans, K., Schoonjans, L., … Carmeliet, G. (2015). Extra-intestinal calcium 

     handling contributes to normal serum calium levels when intestinal calcium absorption is suboptimal. Bone, 2015(81), 502-512. 

     https://doi.org/10.1016/j.bone.2015.08.023 

O’Toole, J. F. (2010). Disorders of calcium metabolism. Nephron Physiology, 2018(118), 22-27. https://doi.org/10.1159/000320884 

Ross, A. C., Taylor, C. L., Yaktine, A. L., & Del Valle, H. B. (Eds.). (2011). Overview of Calcium. Dietary reference intakes for calcium and  

     vitamin D. https://doi.org/ 10.17226/13050 

Wang, L., Yang, X., & Shen, Y. (2015). Molecular mechanism of mitochondrial calcium uptake. Cellular and Molecular Life Sciences, 

     2015(72), 1489-1498. https://doi.org/10.1007/s00018-014-1810-1 

A Sample Answer 5 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts

A.J., a 68-year-old white male with occasional alcohol use and a history of impaired kidney function was recently treated for peptic ulcers related to excessive use of NSAIDs. The patient did report dark stools, nausea at times with blood-tinged emesis, and lab values showed decreased hemoglobin and hematocrit. The diagnosis of H. pylori was ruled out through the breath test (Prabhu & Shivani, 2014). 

Pharmacodynamics 

The best choice for treatment for this particular patient was to terminate the patient’s use of NSAIDs and encourage cessation of alcohol use. Use of one over the counter medication and one prescription medication was effective in treatment.  Aluminum hydroxide dosed at thirty ml. pc as an adjunct therapy to neutralize gastric acid and to inactivate pepsin. Additionally, Cytotec (misoprostol) 100 mcg TID with meals and at HS was prescribed as an antiulcer agent indicated for the prevention of gastric mucosal injury (Vallerand & Sanoski, 2018). 

Aluminum hydroxide contributes to misoprostol induced diarrhea. Therefore concomitant use is avoided, and the misoprostol is taken with each meal, and the aluminum hydroxide is taken two hours after the meal (Prabhu & Shivani, 2014). The adverse reactions of misoprostol are head ache, abdominal pain, diarrhea, constipation, dyspepsia, flatulence, nausea and vomiting (Vallerand & Sanoski, 2018). 

Pharmacokinetics 

Aluminum hydroxide has a toxic potential as it binds to phosphate in the intestines and becomes insoluble and unabsorbable aluminum phosphate and calcium increases from the decreased phosphate absorption which is excreted in the stool. This patient, because of his age may have the pharmacogenetic disposition of a higher risk of aluminum toxicity related to impaired renal function (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Misoprostol is rapidly absorbed and creates an appropriate high plasma level over a forty-eight hour time frame (FDA, 2018). Misoprostol is excreted through the urine (Vallerand & Sanoski, 2018). 

References 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics  

            for advanced practice: a practical approach. Philadelphia: Wolters Kluwer. 

FDA. (2018). Cytotec dosage and administration. Retrieved from:  

            https://www.accessdata.fda.gov/drugsatfda_docs/label/2002/19268slr037.pdf. 

Prabhu, V., & Shivani, A. (2014). An overview of history, pathogenesis, and treatment of  

            perforated peptic ulcer disease and evaluation of prognostic scoring in adults. Annals of  

            Medical and Health Sciences Research, 4(1): 22-29 , doi: 10.4103/2141-9248.126604. 

Vallerand, A. H., & Sanoski, C. A. (2018). Davis’s Drug Guide for Nurses. Philadelphia: F.A.  

            Davis Company. 

A Sample Answer 6 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts

In 2013, a 46-year-old African American female arrived at the emergency room with a complaint of swelling to lips 20 mins before arrival. Vitals were stable, airways secured, she denied swelling and itching of the throat. The patient denied allergies to food or medications.  When asked for medication list, Lisinopril was listed for hypertension. Lisinopril is an ace inhibitor to treat high blood pressure and heart failure. Common names include Zestril and Prinival. The patient was given epinephrine 0.3mg, Benadryl 50mg, Solumedrol 125mg, and famotidine 20mg, then placed in our 24-hour observation unit.  

  Pharmacokinetics refers to how the drug is absorbed distributed and eliminated from the body (Arcangelo, Peterson, Wilbur, Reinhold, 2017). Pharmacodynamic is how the medication affects the body and the therapeutic or toxic effects (Arcangelo, Peterson, Wilbur, Reinhold, 2017). There is a significant variation of ace inhibitors causing angioedema among different races.  Ace inhibitors induce angioedema to have several risk factor including over the age of 65, females, Africans American, prior angioedema, smoking, and history of ace inhibitor-associated cough (Guyer, A., Banerji, A. 2017). There’s a 3 to 5 fold increase risk of angioedema in African American vs. White Americans (Guyer, A., Banerji, A. 2017). 

  Personalized plan for the 46-year-old African American ace-inhibitor angioedema patient would consist of discontinuation of the Lisinopril.  Change the ace inhibitor to a potential beta blocker or another antihypertensive medication.  Give the patient a healthcare literature handout on hypertension with changes in lifestyle and diet.  

Reference 

  Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A.  (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

  Guyer, A., Banerji, A. (2017). Ace inhibitor-induced angioedema. Retrieved from https://www.uptodate.com/contents/ace-inhibitor-induced-angioedema. 

  Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology. Baltimore, MD 

A Sample Answer 7 For the Assignment: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts
Title: NURS 6521 Week 1: Basic Pharmacotherapeutic C