Discussion: Pharmacokinetics and Pharmacodynamics

 Discussion: Pharmacokinetics and Pharmacodynamics

The community where I work has a large population of retired heavy drinkers. One main open heart post-surgical

Discussion Pharmacokinetics and Pharmacodynamics

cause of death is alcohol withdrawal. Alcohol withdrawal can increase a patient’s mortality by 50%. According to Wang et al. (2021), delirium developed in the inpatient setting is associated with severe consequences such as increased mortality, decreased long-term cognitive function, and increased hospital stay. Unfortunately, many individuals do not understand the severity of alcohol withdrawal, and they tend to not inform the physician of the correct amounts consumed. About a year ago, a post-surgical patient came into our unit. On his preoperative interview, he denied alcohol use with the surgeon and the anesthesiologist. The patient immediately began symptoms of withdrawal. When approaching the patient’s wife and daughter of the concerns, they denied the patient was a drinker. We insisted that they look around the house for signs of alcohol drinking they may not have been aware of. The daughter had called later that afternoon stating she had found a hidden empty bottle in the closet, behind doors, and in his office, even in his clothes hamper. Once we finally had the key to the puzzle piece, we treated the patient correctly and provided the medications needed. 

If the physician had known the patient was a drinker, he would have started him on an ethanol drip, along with placing the patient on the CIWA protocol to keep his withdrawal at bay. Our CIWA protocol includes a scale to provide Librium and Ativan when needed. According to Rosenthal and Burchum (2021), the management of withdrawal depends on the degree of dependence. According to Ahwazi & Abdijadid (2020), it is metabolized by the liver microsomal pathway, first by hepatic oxidation, then by glucuronidation. The elimination half-life of this medication is 24 to 48 hours, and its excretion is via the urine. Librium and Ativan decrease withdrawal symptoms, stabilize vital signs, and assist in preventing seizures and DT’s. 

When creating a personal plan for a patient, incorporating current medications, living style, including smoking and alcohol, must be considered. For this patient, the plan would have included starting on benzodiazepines before the surgery, out on the unit where the patient was receiving preop testing, along with adding a low dose ethanol gtt. drip after surgery. 

Reference

Ahwazi, H. H., & Abdijadid, S. (2020, November 22). Chlordiazepoxide. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547659/

Rosenthal, L. D., & Burchum, J. R. (2021). Lehnes pharmacotherapeutics for advanced practice nurses and physician assistants. St. Louis, MO: Elsevier.

Wang, A., Park, A., Albert, R., Barriga, A., Goodrich, L., Nguyen, B., . . . Preda, A. (2021). Iatrogenic Delirium in Patients on Symptom-Triggered Alcohol Withdrawal Protocol: A Case Series. Cureus. doi:10.7759/cureus.15373