Chronic Kidney Disease (CKD) Pharmacokinetics and Pharmacodynamics Essay

Chronic Kidney Disease (CKD) Pharmacokinetics and Pharmacodynamics Essay

Pharmacology

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified Chronic Kidney Disease (CKD) Pharmacokinetics and Pharmacodynamics Essay. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

Pharmacokinetics and Pharmacodynamics

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Introduction

During the last five years of my professional experience, I encountered a fascinating case involving a 68-year-old patient diagnosed with chronic kidney disease (CKD) undergoing dialysis. This individual, an African American male in middle age, had a lengthy history of uncontrolled Type 2 diabetes mellitus (T2DM), and one of his prescribed medications was gabapentin in the context of Chronic Kidney Disease (CKD) Pharmacokinetics and Pharmacodynamics Essay.

Pharmacokinetics and Pharmacodynamics

The prevalence of Chronic Kidney Disease (CKD) in patients with diabetes mellitus is on the rise, and it significantly alters the pharmacokinetics and pharmacodynamics of medications. Consequently, when prescribing drugs to CKD patients, prescribers must possess a thorough understanding of the medication, the extent to which the patient’s physiology has been affected, and the principles governing dosing regimens. According to Lea-Henry et al. (2018), there are currently guidelines available to inform decisions regarding dosing in CKD. However, many of these guidelines rely on limited data, necessitating a deeper comprehension of the underlying pharmacokinetic principles. CKD, marked by a decreased glomerular filtration rate (GFR), profoundly influences drug pharmacodynamics and pharmacokinetics. Ultimately, this diminishes renal clearance and subsequent drug excretion (Lea-Henry et al., 2018). Hence, without appropriate dose adjustments, patients face an elevated risk of experiencing toxicity.

Qualitative and Quantitative Research Design Summary

CKD induces alterations in drug absorption, distribution, metabolism, and excretion processes. In the case of this patient, age emerged as a pivotal factor affecting the pharmacokinetics and pharmacodynamics of the prescribed drug. Advanced age correlates with reduced GFR and creatinine clearance, and vice versa. However, the serum creatinine levels remained within normal limits in this instance of Chronic Kidney Disease (CKD) Pharmacokinetics and Pharmacodynamics Essay. Sabatino et al. (2017) highlight how clinicians often evaluate patients based on serum creatinine levels. In patients like this one, where the values fall within the normal range, these findings can be deceptive. Consequently, due to the patient’s advanced age and underlying CKD diagnosis, a precise dosage adjustment was essential to mitigate the risk of drug toxicity.

Personalized Care Plan

Non-pharmacological interventions for managing chronic diseases, such as lifestyle modifications, play a pivotal role in preventing CKD progression. Lifestyle adjustments can be effectively implemented through behavior change interventions encompassing dietary modifications and physical activity (Evangelidis et al., 2019). In dietary therapy, patients must adhere to a stringent regimen characterized by restricted sodium intake and increased consumption of essential vitamins, including folic acid, vitamin B, erythropoietin, and iron. To navigate these lifestyle changes successfully, the patient requires collaborative support from a dietitian, nurse practitioner (NP), physician, and family members. Regarding the dosing regimen, the typical gabapentin dosage for adults and older adults ranges from 300mg to a maximum of 2400mg daily in the context of Chronic Kidney Disease (CKD) Pharmacokinetics and Pharmacodynamics Essay. Following the recommendations outlined by Raouf et al. (2017), this patient’s dosage should be adjusted to an initial dose of 125mg, with a maximum of 300mg daily.

Conclusion

Factors such as advanced age and underlying chronic diseases like chronic kidney disease significantly impact the pharmacokinetics and pharmacodynamics of medications by reducing creatinine clearance and GFR. Consequently, this diminishes the renal mechanism responsible for drug excretion. Therefore, prescribers must possess in-depth knowledge of the renal physiological changes associated with age and CKD to make informed decisions regarding the most suitable drug modification strategies for preventing adverse events in the context of Chronic Kidney Disease (CKD) Pharmacokinetics and Pharmacodynamics Essay.

References

Evangelidis, N., Craig, J., Bauman, A., Manera, K., Saglimbene, V., & Tong, A. (2019). Lifestyle behavior change for preventing the progression of chronic kidney disease: a systematic review. BMJ open, 9(10), e031625. https://doi.org/10.1136/bmjopen-2019-031625 Chronic Kidney Disease (CKD) Pharmacokinetics and Pharmacodynamics Essay

Lea-Henry, T. N., Carland, J. E., Stocker, S. L., Sevastos, J. Roberts, D. M. (2018). Clinical Journal of American Society of Nephrology. Clinical Pharmacokinetics in Kidney Disease. 13(7) 1085-1095; DOI: 10.2215/CJN.00340118

Raouf, M., Atkinson, T. J., Crumb, M. W., & Fudin, J. (2017). Rational dosing of gabapentin and pregabalin in chronic kidney disease. Journal of pain research, 10, 275.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of nurse practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446 Chronic Kidney Disease (CKD) Pharmacokinetics and Pharmacodynamics Essay