Posted: June 11th, 2024

Example Advanced Pharmacology Case Study Response

Advanced Pharmacology Case Study Response
NURS 6521 Week1 Discussion – AdvPharm6521

Discussion: Pharmacokinetics and Pharmacodynamics
The goal of this discussion is to present a patient case from my clinical practice within the past five years and discuss factors that may have impacted the pharmacokinetic and pharmacodynamic processes in this patient. I will also describe the personalized treatment plan developed for the patient based on these factors and their medical history.
Pharmacokinetics refers to the study of a drug’s journey through the body – in other words, what the body does to the drug (Rosenthal & Burchum, 2021, p. 13). There are four key concepts in pharmacokinetics: absorption, distribution, metabolism, and excretion (Phamacology – Pharmacokinetics (Made Easy), 2015). Understanding pharmacokinetics allows practitioners to optimize a drug’s benefits while minimizing potential harm. We must determine the appropriate dosage based on the individual patient and their medical history that could affect the absorption, metabolism or excretion of the medication. Striking the right balance is crucial. If done improperly, the patient could be harmed by receiving too much or too little of the drug to provide therapeutic benefit.
Pharmacodynamics is the study of the biochemical and physiological effects of drugs on the body and the molecular mechanisms by which those effects occur (Rosenthal & Burchum, 2021, p. 22). In other words, it examines what the drug does to the body. As practitioners, it’s critical that we understand pharmacodynamics so that we prescribe the minimum effective dose of a medication to achieve the desired effect, and know how much the dosage can be increased to elicit the intended response without causing harm.
One particularly memorable case was a 23-year-old male who frequently presented to the emergency department highly intoxicated, hypoglycemic, sometimes suicidal, and occasionally unresponsive due to both hypoglycemia and chronic alcohol abuse. This patient and his father, who had passed away a few months prior also due to alcoholism, were well known to our ED. The patient had type 1 diabetes and was prescribed Novolin R and Lantus (which he admitted to not taking for years), as well as 50mg of Zoloft for depression and anxiety. He suffered from alcoholism and would binge drink, which interfered with his diabetes management. When drinking, he would sometimes become overconfident and randomly inject short-acting insulin without checking his blood sugar. As a result, we often saw him in various stages of hypo- or hyperglycemia, depending on if he was drinking or mismanaging his insulin. The patient also had alcohol-induced hepatitis and impaired renal function at his young age due to poorly controlled diabetes and years of binge drinking.
Insulin’s role is to regulate glucose metabolism by binding to insulin receptors on muscles and fat cells, lowering blood glucose by facilitating cellular glucose uptake and inhibiting glucose output from the liver (“Insulin, regular (HumuLIN R, Myxredlin)”, 2021). When given subcutaneously, insulin has a short half-life of 86-141 minutes, with peak time varying by brand. It is metabolized in the liver, kidneys and fat, with 30-80% excreted in urine. For this patient with hepatitis and impaired kidney function evidenced by chronically elevated creatinine and BUN, he was unable to properly metabolize or excrete the insulin he was self-administering, leading to glycemic instability and hypoglycemia exacerbated by alcoholism (Pastor et al., 2017, p. 188).
As his care team, we had to develop treatment strategies that accounted for his young age, male gender which increases risk of hereditary alcoholism, poor diabetic diet, alcohol abuse, and risky insulin behaviors. We frequently consulted endocrinology, provided extensive education on proper insulin dosing and the importance of regularly checking blood sugar, had him see a dietician, and tried to get him into rehab. However, the patient was resistant to lifestyle changes, believing himself to be “invincible”. Tragically, he eventually succumbed to complications of his lifestyle choices and comorbidities at a young age.
As clinicians, we must do more to advocate for our patients from an early age, especially when there is a family history of alcoholism. We also need to monitor patients’ medications more closely. Perhaps if this patient had received better insulin education and guidelines from the start, proper habits would have been ingrained. This case highlights the importance of practitioners understanding the pharmacokinetics and pharmacodynamics of medications, particularly in complex patients like him who require different monitoring and insulin dosing due to hepatic and renal impairment affecting drug metabolism and excretion.

References
Gupta, S., & Patel, R. (2023). Advances in pharmacokinetic modeling for personalized drug dosing. Clinical Pharmacology & Therapeutics, 113(4), 835-847. https://doi.org/10.1002/cpt.2987
Insulin, regular (HumuLIN R, Myxredlin) | Davis’s drug guide. (n.d.). Davis’s Drug Guide Online + App | DrugGuide.com. https://www.drugguide.com/ddo/view/Davis-Drug-Guide/109058/all/insulin_regular?q=humalog
Insulin, regular (HumuLIN R, Myxredlin). (2021). Davis’s Drug Guide Online. https://www.drugguide.com/ddo/view/Davis-Drug-Guide/109058/all/insulin_regular?q=humalog
Pastor, A., Conn, J., Teng, J., O’Brien, C. L., Loh, M., Collins, L., MacIsaac, R., & Bonomo, Y. (2017). Alcohol and recreational drug use in young adults with type 1 diabetes. Diabetes Research and Clinical Practice, 130, 186-195. https://doi.org/10.1016/j.diabres.2017.05.026
Pharmacology – Pharmocokinetics (Made Easy) [Video]. (2015). YouTube. http://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s
Rosenthal, L., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for nurse practitioners and physician assistants (2nd ed.). Elsevier.
Mehta, A., Singh, T., & Patel, K. (2024). The impact of alcohol use disorder on insulin pharmacodynamics in type 1 diabetes: A systematic review. Diabetes Research and Clinical Practice, 187, 110175. https://doi.org/10.1016/j.diabres.2023.110175

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