Read a selection of your colleagues responses and respond to your colleagues by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.
Colleagues’s post: I had an elderly male patient in his 80’s that came into the ICU after her was found unresponsive on the tele floor. He was admitted for shortness of breath and R/O pneumonia. On top of all this he was very restless, anxious, confused, agitated, and combative. I called the doctor for ativan which he gave me an order for ativan 1mg. IV x1. I gave the ativan as ordered and an hour later he was more agitated and combative than before which we then had to restrain him which compounded the situation even more. I called the doctor back and explained to him the situation and he gave me an order for haldol 5 mg. IM every 6 hours as needed. After I gave the patient the haldol he settled down and was much better. In the meantime his wife was at the bedside and was very upset to see her husband like this and upset for the doctor giving her husband a medication that he reacted differently to. This patient was elderly and not in the best of health. His history included COPD, ex smoker and HTN. He had no history of dementia or alzheimers which could have made the situation worse. He also didn’t have a family history of dementia. He was not a drinker and he quit smoking. If he had been smoking or was drinking, these environmental factors could have been an influence (Lebet, R.; Joseph, P.; Aroke, E. 2019). His pathophysiological processes could have been related to his low oxygen level or the CO2 off.
IV ativan is absorbrd faster in the bloodstream than the PO method. It comes orally, IV, or IM. With IM it reaches the maximum within three hours. It is metabolized in the liver and is excreted either through the stool or through the kidneys although it is mainly excreted through the kidneys( Rosenthal, L.; Rosenjack-Burcham,J. 2021).
The pharmacodynamics part of ativan is supposed to help you relax and for anxiety. Is also used as an anticonvulsant In this case the medicine that was intended to help him relax did the total opposite of what is was intended to do.
Pharmacogenetics is the combination of genetics and new theories and technologies( Lebet, R.; Joseph,P.; Aroke, E. 2019). It is what’s known as precision medicine. It’s how patients can have an individualized and precise drug therapy program. First, the nurse gets a detailed history from the patient including and medical issues, any surgeries, familiy history including if they are alive or deceased and what they died from, and what medicines they are taking including any over the oounter. They can then plug this information in and get results. Researchers developed an algorhythm for patients for patients that present to the ER or the clinic. The data is collected and put in the computer and that is how biomarkers are identified.
Pharmacogeonomics is similiar to pharmacogenetics. They both deal with how genetics affects people and how the drugs react in the system ( Kudzma, E.; Carey, E. 2009). It also how their metabolism is ( whether it is rapid or slow, how the meds interact with each other, and how poeple would react to certain meds for cancer or statin therapy.
Ethnopharmocology deals with the persons’ culture and lifestyle. Each person and culture are very different and should be treated as such. People of low income or not educated may not have the ability to take the medicines as prescribed so they don’t get them (Munoz, C.; Hilgenberg, C. 2005).