HCS 260 Week 3 Individual Assignment Case Study Gastrointestinal and Endocrine Systems
HCS 260 Week 3 Individual Assignment Case Study Gastrointestinal and Endocrine Systems Recent
Case Study – Gastrointestinal and Endocrine Systems
A 16-year-old female athlete with asthma, hypothyroidism, and a history of anorexia nervosa is admitted for dehydration after a track meet. She has recently been binging and purging, and she competed in a track meet today in 100 °F heat.
Her medications include the following:
• Albuterol 2 puffs q 4 hours prn
• Maxair™ 2 puffs q 4 hours prn
• Synthroid® 100 mc po qd
She is 5 feet 5 in. tall and weighs 94 pounds. A central line was placed, and the patient is on TPN.
Answer the following questions:
• What are the pharmacokinetics (precautions, adverse effects, interactions, absorption, distribution, metabolism, and excretion)and pharmacodynamics of each medication?
• How will the side effects of each medication listed influence your physical assessment of the patient?
• Describe nursing interventions to enhance the therapeutic effects and decrease adverse effects of the drugs. Indicate at least two safety issues per medication pertinent to the patient’s diagnosis. Assume that you have adhered to the five rights of medication administration. Include your rationale for your decision.
• What educational information should you provide to the patient and her family about gastrointestinal and endocrine drugs?
Pharmacokinetics and Pharmacodynamics
When prescribing medication, it is crucial to consider several individual patient factors that might affect the pharmacokinetic and pharmacodynamic process (Reeve et al., 2017). For instance, while working with the geriatric population, I encountered an 85-year-old female patient with a history of atrial fibrillation and serum creatine of 1.8mg/dl. The patient was prescribed digoxin to help manage the rapid heart rate. A maintenance dose of 125mcg tabs once a day was decided based on the patient’s pharmacodynamic and pharmacokinetic processes.
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Advanced age is characterized by reduced functionality of several regular body processes responsible for functional integration between different cells and organs. The 85-year-old patient displayed several pharmacokinetic changes, with the main ones being a reduction in hepatic and renal clearance and decreased distribution volume of water-soluble drugs leading to higher serum levels (Drenth‐van Maanen et al., 2019). Consequently, some of the pharmacokinetic changes associated with the patient’s advanced age include increased sensitivity to drugs like digoxin.
Serum creatine of 1.8mg/dl is quite high indicating that the patient’s kidneys are not functioning properly. However, since approximately 67% of digoxin undergoes renal clearance, it was necessary to calculate the standard renal clearance of the drug, which is 6 liters per hour per 70 kg body weight, with a creatinine clearance of 100 mL/min (Holford, 2017). The patient’s creatinine clearance is however reduced hence the need to administer a lower dose of the drug. A once-daily dosing frequency is thus recommended with a bioavailability of 0.7 that requires 127 mcg/day as the daily maintenance dose. The dose should however be monitored closely for further changes.
References
Drenth‐van Maanen, A. C., Wilting, I., & Jansen, P. A. F. (2019). Prescribing medicines to older people—How to consider the impact of aging on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921–1930. https://doi.org/10.1111/bcp.14094
Holford N.G. (2017). Pharmacokinetics & pharmacodynamics: rational dosing & the time course of drug action. Katzung B.G.(Ed.), Basic & Clinical Pharmacology, 14e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2249§ionid=175215748
Reeve, E., Trenaman, S. C., Rockwood, K., & Hilmer, S. N. (2017). Pharmacokinetic and pharmacodynamic alterations in older people with dementia. Expert Opinion on Drug Metabolism & Toxicology, 13(6), 651–668. https://doi.org/10.1080/17425255.2017.1325873
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