N6521 Pharmacology Discussion Board 1

Discussion board 1 A personal experience from my clinical experience that really stood out to me was a male patient that was a regular patient of ours or as we call them a frequent flyer. This patient constantly presented with same symptoms of self-harm behavior and constant thoughts of self- harm. This patient had an extensive history of schizophrenia since he was an adolescent, and at the moment he was in his mid 40’s. The patient had been placed on Clozapine, since it was the only medication that seemed to help him. For over five months the doctor kept changing the dosages, since the patient kept being re-admitted, but while hospitalized seemed to be working. At that moment the doctor was trying to figure out what would be the best therapeutic dose for him. While being in our facility, and on my shift patient and a few days prior patient kept complaining of chest discomfort. The EKG was performed on my shift as directed by the doctor. Pharmacodynamics of Clozapine The exact pharmacological mechanism of action of the Clozapine is not fully understood, but it is known to have significant binding affinity for Dopamine D4 receptor, but can also bind to D1, D3, and D5 receptors (McEvoy, 2018). It is also evident that it loosely and transiently can bind to the D2 receptors, but the implications of the D2 receptors binding are unclear at the moment and still continues to be studied. Pharmacokinetics of Clozapine Clozapine undergoes extensive hepatic metabolism and quickly absorbed. It is know that after the first pass of metabolism process, the bioavailability of clozapine is reduced to 60 to 70 percent, with food having very little effect on the reduction. It is stated in McEvoy (2018) that Clozapine has different effect on each individual depending on their metabolism and underlying conditions, but usually elimination half-life of Clozapine it is approximately 14 hours. Care Plan Clozapine is known to have increased incidence of clozapine-induced myocarditis and cardiomyopathy. For the care plan of this patient it will be really important to have the patient connected to a cardiologist in order to be monitored closely for the effect of the Clozapine. It is important to have standardized protocols and care plans for Clozapine to do an EKG, troponin levels and echocardiograms at each facility while the patient is hospitalized (Knoph, 2018). Another care plan would be good to place is for airway clearance due to the side effect of Clozapine of excessive salivation and neutropenia (Patuszynski & Applegate, 2017). References: McEvoy, J, (2018). Guidelines for prescribing clozapine in schizophrenia Retrieved from Knoph, K, Morgan, R, Palmer B, Schak K, Leloux M, Patel, M, Leung, J, Schizophrenia research, ISSN: , Vol: 199, Page: Patuszynski, D., & Applegate, P. M. (2017). Suspected Clozapine-Induced Cardiomyopathy and Heart Failure With Reduced Ejection Fraction. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 34(4), 20–22. Response 1: Hello Biftu, This is a really great post you have posted. In healthcare nurse and any healthcare providers have to face situations where legality and ethics has to be implied. You had made a great point when you stated, “If the patient or the family members would not want the patient to live they would have not brought him to the hospital.” In the scenario of the patient, it appears as you stated that the nurse and doctor had to make the medical decision in more logical way. There is a Mental Capacity Act 2005 that is intended to protect people that lack capacity on making decisions on their own or lack mental capacity as the patient in the scenario (Alonzi & Pringle, 2007). The APRS’s are obliged to follow the principles and limits of the nursing code of ethics to do no harm, prevent evil, remove harm and promote good regardless of the scenario placed in. Nurse practitioners must use evidence based research such as patients history, prior experiences and recent studies as a basis to provide safe patient care (American Association of Nurse Practitioners, 2015). Therefore, with these facts I believe that the healthcare professional should either provide a better understanding of the treatment to patients family, or defer family’s decision and follow the ethical and moral principles. References: Alonzi, A., & Pringle, M. (2007). Mental Capacity Act 2005. BMJ (Clinical research ed.), 335(7626), 898. American Association of Nurse Practitioners. (2015). Standards of practice for nurse practitioners. Retrieved from standards-of-practice-for-nurse-practitioners Response 2 Hello Erin Very interesting post. It is quite attention-grabbing when I was reading the post to see what actually happened to the patients from such a high dose of medications of both routes intramuscular and by mouth. It is very important to keep in mind for any healthcare professional the pharmacokinetics and pharmacodynamics of the medication prescribed and given. As it is described by Rosenthal and Burchun (2021) that pharmacokinetics is the movement of the medication across the body’s system through mechanism of absorption, distribution, metabolism and absorption. As you stated in the post that patient has been consistently coming to the emergency department and the mental health facilities and has always been medicated with such high doses. This should be taken into consideration and also including patients age, weight and gender. It is evident that age plays a major factor on the absorption and the excretion of the medication due to the change in the body changes especially the kidneys and the heart (Mathur & Sutton, (2017). Including that the body adapts to the dosages and requires higher dosages. Therefore, especially in the scenario presented by you pharmacokinetics and pharmacodynamics understanding was imperative. It appears to me that everyone performed and did best at their ability to keep patient and everyone around safe. References: Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. Mathur, S., & Sutton, J. (2017). Personalized medicine could transform healthcare. Biomedical Reports, 7(1), 3-5.