Week One Discussion

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Nursing

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Nov 24, 2024

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1 Week One Discussion Pharmacokinetics and Pharmacodynamics Name Course Institution

2 Case Scenario After a successful open ventral hernia repair, a 43-year-old female patient was transferred to another room for recovery. Before the surgery, the patient had reported an existing medical history of hyperlipidemia, hypertension, diabetes, and lingering back pain. In addition, there was known history of her previous illegal drugs that she had used. After being attended by a physician specialized in pain management, she was given Vicodin and Fentanyl. After wearing off of the anesthesia, she reported pain and was given Dilaudid IV 2mg after every 10 minutes. After being assessed for 25 minutes, the pain got worse and increased in intensity. When the anesthesiologist was informed about the level of pain, he increased the dose to 4mg. In less than 15 minutes, the patient cried and shouted hysterically in pain. The dosage was further increased to 6mg, but the pain persisted, and the patient angrily demanded to be discharged since the pain was not being relieved In the above case, it is clear that some pharmacodynamics and pharmacokinetic factors altered the anticipated response to the administered drug. Specifically, due to the daily medication regimen, the patient, in my view, was experiencing drug tolerance. According to Arcangelo & Peterson (2013), tolerance can be defined as administrating more and more of the drug with the aim of achieving the same effect. Notably, pharmacodynamics tolerance is drug tolerance that usually develops for using a drug for so long that the body becomes less sensitive to its presence. On the other hand, pharmacokinetic tolerance develops when smaller amounts of the administered drug reach the targeted sites in the body (Van den Berg et al., 2017). Considering the covered facts, in this case, there is a need to have a personalized plan based on the patient’s tolerable pain level. Thus, I would first reveal the medical history of the patient and discuss their tolerable pain level before surgery. Personally, I would discuss the pain

3 management case with the patient and propose the need to use a low dose of Ketamine infusion that will wean slowly. It is crucial to note that Ketamine has proved to be effective in reducing postoperative pain for patients who experience chronic pain (Van den Berg et al., 2017). After this administration, I would resume the patient’s preoperative pain medication regimen and conduct some physical therapy.

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4 References Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd Ed.). Ambler, PA: Lippincott Williams & Wilkins. Van den Berg, J. P., Vereecke, H. E., Proost, J. H., Eleveld, D. J., Wietasch, J. G., Absalom, A. R., & Struys, M. M. (2017). Pharmacokinetic and pharmacodynamics interactions in anesthesia. A review of current knowledge and how it can be used to optimize anaesthetic drug administration. BJA: British Journal of Anaesthesia , 118 (1), 44-57.

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