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Multifactorial Approach to Medication Selection and Management

Pharmacokinetics and Pharmacodynamics

Needs reply for the following post. ( response for another student post) Attaching the peer post below:

Medical professionals must take a multifactorial approach when treating a patient, and especially choosing a medication. Patient’s condition, diagnoses, comorbidities, age, race, and wt play a crucial role in how medications work and provide intended effects.

The desired outcome can assist in making a decision. Choosing medications for acute illnesses while in-patient, and for chronic conditions while out-patient requires meticulous planning. Pharmacokinetics and Pharmacodynamics The process of drug movement in the body and how it penetrates the body is pharmacokinetics.

Four parts of this process are absorption, distribution, metabolism, and excretion (Rosenthal & Burchum, 2021, p. 13). Pharmacokinetics play an important role in medication selection and especially when patients have other comorbidities.

Pharmacodynamics is how a drug works in the body, how it is processed and responds. Understanding pharmacodynamics allows dose adjustment of medication, which is very important in obtaining therapeutic drug levels and effects (Rosenthal & Burchum, 2021, p. 22).

There are two components to pharmacodynamic, maximal efficacy and relative potency. Generating the most effect from medication is called maximum efficacy.

Reaching the optimal dose level to obtain the desired results is called Relative potency. Drugs can provide intended results and unintended side effects (Speed Pharmacology-Diuretics, 2017).

Case Study:

I work as a case manager with an insurance company. I remember working with a patient who was in and out of the hospital every few weeks. This patient X was a 62 yr/u caucasian female with an extensive medical history, Hypertension, CHF, Hyperlipidemia, Nonalcoholic Cirrhosis, and Hepatic Insufficiency. She was on multiple medications beta-blocker, HCTZ, Fenofibrate, Ursodiol, Lasix, and Kcl.

Her biggest issue was fluid retention from CHF and Cirrhosis. She tended to gain 15-20 lbs wt within 6-8 days and would end up getting admitted via ER. While in the hospital, once she would be diuresed, her labs/wt would normalize, and she would be sent home on Metolazone since Lasix and HCTZ were not effective enough to control her fluid retention.

Once she would get home on Metolazone, within few days, she would start having progressive s/sx of dehydration, lightheadedness, dizziness, weakness, fall, severe heartburn, nausea, vomiting, heart palpitation, and low blood pressure prompting an ER.Adding to all the complications, the patient was not 100% compliant with medications due to issues with affordability while on a fixed income from her husband’s retirement.

This patient’s HTN & CHF required treatment with diuretic and antiarrhythmic medications. Cirrhosis of the liver eliminated the use of many medications to treat her CHF and HTN. Despite multiple dose adjustments, Metolazone was proving to be toxic for this patient.

She was not able to get a handle on her dehydration and other side effects. Over the 6 months that I worked with this patient, she was admitted 6-7 times for 5-10 days at a time. Eventually, this patient was referred to the University medical center to the transplant team for a liver transplant.

Treatment Plan The ideal treatment plan for this patient would include the right combination of medications which would have kept this patient out of the hospital and allowed her to live a reasonably normal lifestyle.

The treatment plan for this patient should include Lasix, Spironolactone, no salt diet, daily weight, and bp monitoring, daily fluid restriction, HCP should be alerted for wt gain of more than 5lbs in 3-4 days and have added as needed Lasix for wt gain with BP/wt parameters and every 1-2 week follow up with provider.

According to the study published by the American Geriatrics Society for Beers criteria (2019), certain medications must be used with caution among the geriatric population. This list includes drugs from almost every category including, RAS inhibitors, ARBs, and diuretics. This patient was on medication from all of these categories.

Conclusion Medication adherence with maintenance medications plays a significant role in patients’ health. Prescribers must consider patients’ ability to remember, take and afford medications, along with their cultural beliefs. Ongoing evaluation for the effectiveness of drugs and the intended outcome must be done by MDs and Advanced Health Care Providers (AHCP) daily while inpatient, and at the regular interval while outpatient.

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