Week 1 Main Post Discussion: Pharmacokinetics and Pharmacodynamics

Understanding how prescription and non-prescription influences the body, first a clear understanding is needed to the function of pharmacokinetics and pharmacodynamics and how these components how any drugs that maybe administered and interact in the body.  Pharmacokinetics refers to movement of drug into and out of the body by absorption, metabolism, excretion, and distribution the amount of time it takes for a drug to be utilized by the body.  Also, pharmacokinetics determines the onset, duration, and intensity of a drug effect Discussion: Pharmacokinetics and Pharmacodynamics.  Pharmacodynamics described what a drug does to the body once it attaches to the appropriate receptor site.  Pharmacodynamics also involves the molecular effect of the drug to bind with the receptors site of the cell to cause a reaction. (Farinde, 2019).

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A drug pharmacodynamic and pharmacokinetic effect centers around many factors concerning the patient for example, the age of the patient, hepatic, and renal function, other drug – drug interaction competing for receptor binding sites.  Looking at the current pandemic of Coronavirus many different anti-viral medications was used to reverse the effect of acute respiratory syndrome that affect the patient from the coronavirus.  Some of these medications such as lopinavir, remdesivir, azithromycin, and chloroquine was used to help combat or reverse the effect of coronavirus Discussion: Pharmacokinetics and Pharmacodynamics.

The pharmacokinetic process for each of these drugs are the same but the pharmacodynamics may differ depending on their molecular structure and the receptors site which they bind and how they cross the cell membrane.  As stated by Srivalli & Lakshmi, (2012) these drugs are substrates of P-glycoprotein an efflux membrane transporter and a member of the ATP-binding transporter found primarily in epithelial cells which are inhibitors.  Which means these drugs stop the progress of the coronavirus from attacking the cells or other cell which mostly affect respiratory function.

During this pandemic I worked in the ICU and saw the affects the positive and not so positive effects that chloroquine has in response to patients being removed from the ventilators with a lower peep and FIO2 level.   Depending on the co-morbidity’s patient has and how soon the antiviral medication was started the patient had a fair chance for being extubated.  If a child was given an overdose of antiviral medication to combat the coronavirus that was meant for adult many rapid action steps need to be executed.  Looking at azithromycin administration in children is given by body for 3-5 days an overdose of this medication causes prolongation of QT complex, Torsade de point, and unresponsiveness.  Reason, azithromycin in the tissue has an extreme high plasma and high lipid solubility and its half-life is 68 hours and excretion or elimination is characteristic of this drug remain unchanged. (Tijjani, Ishola 2020).     The APRN must take in account that a children body surface is must smaller than an adult and over medicating disaster can occur quickly.  Administering any medications understanding the pharmacokinetic and pharmacodynamic properties is a must to assure patient safety and ethical practice.

References

Farinde, A. (2019). Overview of Pharmacodynamics – Clinical Pharmacology: Merck Manual Professional Version Retrieved from: Merck Manuals >professional > overview

Srivalli, K. Lakshmi, P. (2012). Overview of P-glycoprotein inhibitors: A rational outlook. Brazilian Journal of Pharmaceutical Science 48(3) 353-367

Tijjani, H. Ishola, A. (2020). Repurposing of choloroquine and some clinically approved antiviral  drugs as effective therapeutics to prevent cellular entry and replication of coronavirus Retrieved from: https://www.researchgate.net/publication/341601496

 

Response

Good post

Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used in the treatment of malaria. Moreover, their antiviral properties have been previously studied, including against coronaviruses, where evidence of efficacy has been found. In the current race against time triggered by the COVID-19 pandemic, the search for new antivirals is very important. However, consideration are given to old drugs with known anti-coronavirus activity, such as CQ and HCQ. These could be integrated into current treatment strategies while novel treatments are awaited, also in light of the fact that they display an anticoagulant effect that facilitates the activity of low-molecular-weight heparin, aimed at preventing acute respiratory distress syndrome (ARDS)-associated thrombotic events.

There has been significant research on the possible antiviral actions of CQ/HCQ. Their safety aspects have been studied extensively for over 50 years, but the evidence is not necessarily applicable to those most at risk of mortality from COVID-19 (e.g. frail older people), who at the same time are most vulnerable to drug side effects. The challenge that SARS-CoV-2 launches into science is to create new specific drugs. However, because COVID-19 causes cardiac problems, the cardiac toxicity of HCQ can be enhanced in the short-term.

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References

Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020;6:16. doi: 10.1038/s41421-020-0156-0. 

Zhu RF, Gao RI, Robert SH, Gao JP, Yang SG, Zhu C. Systematic review of the registered clinical trials of coronavirus disease 2019 (COVID-19) medRxiv. 2020 Mar 17 doi: 10.1101/2020.03.01.20029611. 

 

Discussion: Pharmacokinetics and Pharmacodynamics

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic 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.

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

To Prepare

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• 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. Discussion: Pharmacokinetics and Pharmacodynamics
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case Discussion: Pharmacokinetics and Pharmacodynamics. Be specific and provide examples.

By Day 6 of Week 1

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 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. Discussion: Pharmacokinetics and Pharmacodynamics.

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!