NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing Sample 2

NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing Sample 2

While working at a medical ward in my 4th year of practice, I encountered a 72-year-old male named Mr. Smith. The patient had been in the ward for over a month and presented with hypertension and chronic kidney disease. His blood pressure was through the roof as he had a history of non-compliance with medication regimens and a significant genetic predisposition to drug metabolism variations. The patient has been on antihypertensives but has no detectable elevated blood pressure changes.

Factors That May Have Influenced Mr. Smith’s Pharmacokinetic and Pharmacodynamic Responses

1. Genetics and Pharmacogenetics: Mr. Smith may have had changed drug metabolism and clearance rates due to genetic differences in drug-metabolizing enzymes, such as cytochrome P450 enzymes. Higher medication concentrations and a higher likelihood of negative consequences may follow (Rosenthal & Burchum, 2021).
2. Age: Given Mr. Smith’s age of 65, changes in drug absorption, distribution, metabolism, and excretion due to aging may take place. For instance, decreased renal function in CKD may impact medication clearance, potentially causing drug buildup and protracted effects.
3. Pathophysiological Changes: Mr. Smith’s chronic kidney disease may have changed his pharmacokinetic characteristics, particularly for medications whose main route of elimination are the kidneys. Medication clearance may be lowered, and medication exposure may rise due to impaired renal function (American Geriatrics Society, 2019).
4. Non-Compliance: The effectiveness of Mr. Smith’s prescription antihypertensive medicine may have been harmed by his prior history of non-compliance with medication regimens. Drug levels in the body can fluctuate due to inconsistent drug use, which can lessen the intended therapeutic effects.

Individualized Plan of Care:

Mr. Smith could have the individualized plan of care listed below based on the patient’s medical history and contributing factors:

1. Pharmacogenetic testing should be carried out to find particular genetic variants that could affect medication metabolism. The likelihood of adverse drug reactions can be decreased by using this information to help with dosage modifications and medication selection.
2. Individualized Dosing: Change the antihypertensive drug dosage based on Mr. Smith’s renal function and pharmacokinetic data. Regular medication level monitoring and renal function testing are essential for appropriate dosing.
3. Patient Education and Counseling: Stress to Mr. Smith the value of drug compliance. Inform him of the dangers of disobeying instructions and the advantages of constantly following his prescribed drugs (Rosenthal & Burchum, 2021).
4. Use a multidisciplinary approach to manage Mr. Smith’s chronic kidney illness and monitor his renal function. The effectiveness of the treatment should be checked frequently, and the prescription schedule should be changed as necessary.

References

American Geriatrics Society (2019). Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society Download Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767