Drugs have different effects on the patient’s body (Arcangelo& Peterson, 2013). Drug reactions in the body are described as pharmacokinetics and pharmacodynamics. Pharmacokinetics is how the body affects the drug as it moves through the body. While pharmacodynamics is how the drug affects the body, or how the administered drug produces therapeutic effects in the body. Thus, it explains why when I administered a drug to the patient and the required outcome was not achieved. For an elaboration of these concepts, I chose a case study of a 75-year-old African-American female, presented with a bipolar disorder.

Patient Scenario

The 75-year-old African-American female patient, with bipolar disorder’s history, hypertension, gout as well as diabetes presented to inpatient psychiatric department of our hospital. The patient was referred to our facility from a clinical research health care for prolonged medication management and stabilization. The patient’s information obtained from her family shows that she was progressivelydecompensating, reduced oral food intake for the past 40 hours.        However, she accepts her medication, with poor judgment alongside poor insight; also the patient experienced increased confusion and isolative behaviors.

After admission, the patient was alert and self-orientated, but her clinical presentation shows an altered consciousness level alongside stability in vital signs.Home medications for the patient included 300mg of Lithium twice a day, daily 25mg of hydrochlorothiazide and 75mg of Metformin as well as daily 20mg of Crestor, and Lantus insulin’s ten units every night before sleep. So it is necessary to check the pharmacokinetic and pharmacodynamics processes that result from these drugs in the body.

Pharmacokinetic processes

Drugs usually go through these four significant processes; absorption, distribution, metabolism, and excretion from the body.Distribution process starts when the administered drug moves to the liver from the gastrointestinal tract through portal circulations. Also, drug moves unchangeably to general circulation via hepatic veins, and it can be metabolized before reaching the circulatory system. While drug metabolism happens through two processes known as oxidation and glucuronidation, and the metabolized drug is eliminated from the body by the kidneys through glomerular filtration rate (GFR). Therefore, the GFR usually decrease with the age of the patient; hence is it is dependent on age. Due to the age of the patient, at 75 years old most of the body organs are aging, and their functions are slow leading to Lithium toxicity because of accumulations, and regular metabolism checks are required.

Pharmacodynamics Processes

These processes occur immediately when the drug reaches the target tissue or organ. The drug effects can either be presynaptic or postsynaptic and may also involve inhibition of enzymes. Finally, the distribution of the administered drug comprises of binding of a drug to its specific receptor, transduction of signals as well as cellular responses. As narrated earlier by the patient’s family, the patient continued to take her medication including 300mg of Lithium twice daily. Though she didn’t show classic symptoms of lithium toxicity, a laboratory test for blood revealed high lithium level of 2.7mmol/L which is above the average values of 0.4-0.8mmol/L for older adults, so older patients require low therapeutic doses of lithium.

Care Plan

My care plan for this patient is to avoid further administration of Lithium dosage and promote fluid intake. Then there will be a weekly monitor for the Lithium level in the body until its level within the blood is stabilized. The increase of fluid restores the GFR that normalize urine output leading to clearance of lithium. Sometimes kidney dialysis is necessary to remove the toxic metabolites from the body system.

References

Arcangelo, V.P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice:

A practical approach (3^rded.). Ambler, PA: Lippincott Williams & Wilkins

Jacobson, S. (2013) Effects of Pharmacokinetic and Pharmacodynamic Changes in the Elderly

Journal of Psychiatric Times January 2013 Retrieved from Walden library databases

American Geriatrics Society Abstracted Clinical Practice Guideline for Postoperative Delirium

in Older Adults. (2015). Journal of the American Geriatrics Society, 63(1), 142-150 9p.

doi:10.1111/jgs.13281

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