NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics Example

NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics Example

As an Intensive Care Unit (ICU) nurse of 10 years, I have taken care of a variety of different people with a broad spectrum of illnesses and problems. Pharmacokinetics, or how the body processes a drug, must be carefully considered for the best treatment options (Rosenthal & Burchum, 2018). A typical patient diagnosis that can be particularly difficult to manage medically is drug and alcohol abusers. Their drug tolerances and organ impairment related to damage from abuse can make it especially challenging to treat their conditions.

I vividly remember taking care of a patient in their early 30s who was admitted to the medical intensive care unit that I worked in for alcohol withdrawal. He had no past medical history except for alcohol and benzodiazepine abuse. He was found by a family member in alcohol withdrawal and was immediately brought to the hospital. The clinical institute withdrawal assessment for alcohol scale (CIWA), was used to determine the severity of withdrawal. This scale views different symptoms of withdrawal such as nausea/vomiting, tremors, sweats, anxiety, agitation, visual and auditory disturbances, headache, and orientation (MERCK Manual Professional Version, 2020). His CIWA score was extremely high, which showed severe withdrawal.

Typical treatment for alcohol withdrawal includes the administration of benzodiazepines in order to get through the detox process. This drug helps lessen the withdrawal symptoms. When giving this patient a standard dose of benzodiazepines such as Ativan or Valium, there was no decrease in clinical symptoms. This was because of his history of benzodiazepine abuse and increased tolerance. Increased drug administration and frequency were ordered until the patient’s withdrawal symptoms were under control. However, the patient also had liver damage from alcoholic cirrhosis. Benzodiazepines are drugs that are metabolized by the liver (Brett & Murnion, 2015).  Since the liver was not functioning correctly, the medications administered to control alcohol withdrawal were not processed appropriately by the liver, causing a buildup of the drugs (Louvet & Mathurin, 2015). The patient became unresponsive, and an advanced airway was placed for airway protection.

I feel that this patient’s care could have been handled differently. Due to this patient’s history, a different plan of treatment should have been initiated. I feel that by following the standard protocol for alcohol withdrawal treatment, the outcome of this patient getting intubated was inevitable. However, the patient will remain unresponsive until his body cleared all of the benzodiazepine drugs. This could be a lengthy process and delay his care further. I would have suggested intubation and mechanical ventilation from admission, and to use sedation safe for the liver. By doing this, the patient would be able to overcome his detox safely and have his breathing tube removed sooner. This would decrease any other risks associated with prolonged mechanical ventilation NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics.

References

Brett, J., & Murnion, B. (2015, October). Management of benzodiazepine misuse and dependence. Australian Prescriber, 38(5), 152-155. http://dx.doi.org/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657308/

Louvet, A., & Mathurin, P. (2015, March 15). Alcoholic liver disease: mechanisms of injury and targeted treatment. Nature Reviews Gastroenterology, 12, 231-242. Retrieved from https://www.nature.com/articles/nrgastro.2015.35

MERCK Manual Professional Version. (2020). CIWA. Retrieved February 27, 2020, from https://www.merckmanuals.com/professional/multimedia/clinical-calculator/CIWA%20Ar%20Clinical%20Institute%20Withdrawal%20Assessment%20for%20Alcohol%20Scale

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics