What is therapeutic drug monitoring in personalized plan of care?

  

According to Rosenthal & Burchum, 2022, the reaction of drugs in the body is described in two teams known as pharmacokinetics and pharmacodynamics. Pharmacokinetics is defined as the movement of the drug through the body, or how the body affects the drug. And pharmacodynamics is how the drug affects the body, or how the drug initiates a therapeutic or toxic effect in the body. There have been several times when I have given a drug and I experienced the desired outcome was not met. For this discussion, I have chosen to center my discussion on was a 75-year-old woman who was admitted to the hospital with pneumonia. She was started on a course of antibiotics, but she did not respond well to treatment. She continued to have fever, cough, and shortness of breath. The doctor ordered a blood test to check the patient’s drug levels. The results showed that the patient’s blood levels of the antibiotic were very low. This was because the patient’s liver was not able to metabolize the drug as well as a younger person’s liver, the doctor ordered a blood test to check the patient’s drug levels. The results showed that the patient’s blood levels of the antibiotic were very low. This was because the patient’s liver was not able to metabolize the drug as well as a younger person’s liver. I will explain basic pharmacokinetic processes, basic pharmacodynamics processes. Finally, I will explain personalized Plan of care.
Factors Influencing Pharmacokinetic and Pharmacodynamic Processes:
Age:
The age of the patient plays a significant role in pharmacokinetics and pharmacodynamics. As individuals age, physiological changes occur, such as a decrease in liver and kidney function. In this case, the patient’s liver function might have been compromised, leading to a decreased ability to metabolize the antibiotic. Older adults also tend to have a higher percentage of body fat and a lower percentage of lean body mass, which affects drug distribution and elimination.
Gender:
Gender differences can influence drug response due to variations in body composition and hormonal factors. Women generally have a lower body weight compared to men, which can affect drug distribution. Hormonal fluctuations during the menstrual cycle can also influence drug metabolism and clearance. However, specific gender-related factors were not explicitly mentioned in the case.
Diet:
The patient’s diet can impact drug absorption. For example, certain foods, like grapefruit juice, contain compounds that inhibit the activity of drug-metabolizing enzymes, leading to altered drug concentrations in the body. It is essential to assess the patient’s dietary habits and provide guidance on potential drug-food interactions.
Pathophysiological Changes:
The patient’s pneumonia might have influenced her liver and kidney function. Inflammation and infection can impair the liver’s ability to metabolize drugs, resulting in altered drug levels. Similarly, kidney dysfunction can affect drug elimination, leading to increased drug concentrations in the body. It is crucial to consider the patient’s underlying disease and its impact on drug metabolism and elimination (Balaram & Balachandran, 2022).
Personalized Plan of Care:
Therapeutic Drug Monitoring:
Regular monitoring of the patient’s drug levels was crucial to ensure therapeutic efficacy and minimize adverse effects. In this case, the low blood levels of the initial antibiotic prompted a change in medication. Monitoring the blood levels of the new antibiotic will help determine if the dose is appropriate for the patient.
Dose Adjustment:
Considering the patient’s age, gender, diet, and underlying disease, dosage adjustments may be necessary to optimize treatment outcomes. For example, a reduced dose might be warranted in older adults due to decreased drug metabolism and clearance. Individualized dosing regimens should be established to achieve optimal drug concentrations while minimizing the risk of toxicity (Isitan, & Hohler, 2017)
Patient Education:
Effective patient education is essential for medication adherence and safety. The patient should be educated about the importance of taking medications as prescribed, including the correct timing, dosage, and potential side effects. In this case, the patient should be informed about the need for regular blood tests and the rationale behind switching antibiotics.
Comprehensive Treatment of Underlying Health Conditions:
Collaborating with the patient’s physician, a comprehensive plan should be developed to address the patient’s pneumonia and any other underlying health conditions. This may involve additional therapies, such as respiratory treatments, chest physiotherapy, or supplemental oxygen, to improve the patient’s overall health and response to treatment.( Parnham & Kricker, 2022).
Multidisciplinary Approach:
To ensure the best outcomes for the patient, a multidisciplinary approach involving healthcare professionals from various specialties, such as physicians, pharmacists, and nurses, should be employed. Collaboration between these professionals facilitates comprehensive patient assessment, individualized treatment plans, and ongoing monitoring of the patient’s progress.
Conclusion:
In this discussion that feature a case of elderly with pneumonia who is taking antibiotics, several factors influenced the pharmacokinetic and pharmacodynamic processes, including age, gender, diet, and pathophysiological changes due to pneumonia. A personalized plan of care was developed, which included therapeutic drug monitoring, dose adjustments, patient education, and a comprehensive approach to treat the underlying health condition. By considering these influencing factors and tailoring the plan of care accordingly, healthcare professionals can optimize treatment outcomes and ensure the safety and well-being of elderly patients.
Reference:
Balaram, K., & Balachandran, S. (2022). Psychopharmacology in the Elderly: Why Does Age Matter?.Psychiatric Clinics.
Isitan, C, & Hohler, A. D. (2017). Cefepime induced neurotoxicity: A case series and
review of the literature. Eneurologicalsci8, 40-43. Retrieved from https://doiorg.ezp.waldenulibrary.org/10.1016/j.ensci.2017.08.001Links to an external site..
Le, J. (2019). Overview of pharmacokinetics. Merck Manual. Retrieved fromhttps://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/overview-of-pharmacokinetic
Parnham, M. J., & Kricker, J. A. (2022). Factors determining plasticity of responses to drugs.International Journal of Molecular Sciences,23(4), 2068.
Rosenthal, L. D., & Burchum, J. R. (2021).Lehnes pharmacotherapeutics for advanced practice nurses and physician assistants(2nd ed.) St. Louis, MO: Elsevier.

Introduction:

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The administration of drugs and their effectiveness in treating patients can vary depending on various factors. Two of the most critical teams responsible for the reaction of drugs to the body are known as pharmacokinetics and pharmacodynamics. While pharmacokinetics focuses on how the drug moves through the body, pharmacodynamics determines how the drug affects the body. However, the effectiveness of drugs can be influenced by many factors, and failure to recognize these factors can result in the treatment not being as successful as intended. In this discussion, we will explore how age, gender, diet, and pathophysiological changes can impact pharmacokinetic and pharmacodynamic processes and how a personalized plan of care can optimize drug treatment outcomes.

Description:

This discussion focuses on a case study of a 75-year-old woman admitted to the hospital with pneumonia who did not respond well to antibiotic treatment. The primary reason for this was attributed to the compromised liver function of the patient, which resulted in a decreased ability to metabolize the antibiotic. We explore the impact of various factors such as age, gender, diet, and pathophysiological changes on the effectiveness of drug treatment. We emphasize the importance of tailoring a personalized plan of care that considers these factors to optimize drug administration and treatment efficacy. This plan will include periodic monitoring of drug levels, assessing dietary habits, and considering the impact of underlying conditions on drug metabolism and elimination. By recognizing how these various factors can influence drug treatment, healthcare professionals can deliver personalized treatment plans that increase the likelihood of achieving positive health outcomes for patients.

OBJECTIVES:
– To explain the basic pharmacokinetic processes involved in drug reaction in the body
– To discuss the basic pharmacodynamics processes that determine drug efficacy and toxicity
– To propose a personalized plan of care based on the factors influencing pharmacokinetic and pharmacodynamic processes

LEARNING OUTCOMES:
At the end of this discussion, learners will be able to:
– Describe the movement of drugs through the body and the factors that influence their absorption, distribution, metabolism, and elimination.
– Understand how drugs affect the body at the molecular and cellular level and the factors that determine their therapeutic or toxic effects.
– Analyze the case of a 75-year-old woman with pneumonia, noting how age-related and pathophysiological changes influenced her drug response.
– Develop a personalized plan of care for a patient based on the factors that influence pharmacokinetic and pharmacodynamic processes, including regular monitoring and adjustment of drug doses.
– Identify potential drug-food interactions and provide guidance to patients on how to manage them.

of the patient’s antibiotic blood levels is crucial to ensure that therapeutic levels are achieved. This test enables the healthcare provider to adjust the patient’s drug dosage as necessary to achieve optimal drug concentrations. The frequency of drug level monitoring may depend on several factors such as age, renal and hepatic function, and the type of drug. Close monitoring is vital to ensure therapeutic efficacy and prevent toxicity.

Solution 1: Based on the above discussion, the first solution is to adjust the patient’s antibiotic dose based on therapeutic drug monitoring. Since the patient’s liver function is compromised, a lower dose might be appropriate to avoid toxicity. Regular monitoring of the patient’s drug levels is essential to evaluate the efficacy of the therapy. The healthcare provider can also explore alternative antibiotics that are metabolized differently by the liver and kidneys.

Solution 2: The second solution is to conduct a thorough assessment of the patient’s diet and medication regimen to identify potential drug-food interactions and medication duplications. The patient’s medication list should be reviewed for drugs that are metabolized by the same liver enzymes. Also, medication reconciliation should be performed to ensure that the prescribed antibiotics do not interact negatively with other medications the patient is taking. Nutritional counseling can be provided to the patient to ensure that she avoids foods and beverages that interfere with the absorption and metabolism of the antibiotic.

of drug levels in the patient’s blood can help ensure that therapeutic levels are maintained. This can be especially important in older adults or patients with liver or kidney function impairment. Adjusting Dosage: Adjusting the dosage of the drug based on the patient’s individual factors can help optimize drug efficacy and prevent toxicity. For example, in this case, lowering the dosage of the antibiotic or extending the dosing interval may be necessary in an older adult with compromised liver function. Education and Counseling: Providing education and counseling on medication management, including potential drug interactions and side effects, can improve medication adherence and prevent adverse events. It is important to involve the patient in the decision-making process and address any concerns or questions they may have (Pai, 2021).

Suggested Resources/Books:

1. Pharmacology for Nurses: A Pathophysiologic Approach by Michael P. Adams and Norman Holland
2. Pharmacotherapy: A Pathophysiologic Approach by Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, and Gary R. Matzke
3. Basic and Clinical Pharmacology by Bertram G. Katzung and Anthony J. Trevor

Similar Asked Questions:

1. How does age influence pharmacokinetics and pharmacodynamics?
2. What factors can influence drug response in men and women differently?
3. How can one’s diet affect drug absorption?
4. How do pathophysiological changes impact drug metabolism and elimination?
5. What personalized plan of care can be implemented to optimize medication therapy?

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