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Discussion: Pharmacokinetics & Pharmacodynamics

Discussion: Pharmacokinetics & Pharmacodynamics

Discussion: Pharmacokinetics & Pharmacodynamics

Discussion: Pharmacokinetics & Pharmacodynamics

NOW FOR AN ORIGINAL PAPER ASSIGNMENT:Discussion: Pharmacokinetics & Pharmacodynamics

As a nurse working in a skilled nursing facility you will frequently see patients with dementia and Alzheimer’s disease with orders for Depakote also known as valproic acid, to manage their behaviors. I had a resident that was taking Depakote for the diagnosis of dementia with behavioral disturbance. She got into an altercation with her roommate and had to be moved which intensified her behaviors and agitation. The doctor increased her Depakote due to the increased behaviors. The resident’s behaviors improved. Later the resident began to have a decline in condition and we all believed that she was having transient ischemic attacks (TIA). The resident had a history of TIAs. We placed the resident on comfort care and discontinued all of her medications. A short time after discontinuing her medication the resident became more alert and was functioning at her prior level. Her physician believed that her decline was from the Depakote because she had no other new medications or medication changes.

Pharmacokinetics & Pharmacodynamics

Depakote is typically used to treat seizure disorders but can be used as a mood stabilizer. Many providers prefer to use Depakote for behaviors with geriatric population than antipsychotics because of their side effects. Depakote is easily absorbed when taken orally. It is rapidly distributed into plasma, extracellular water, and crosses the blood-brain barrier (Deglin, Vallerand, & Sanoski, 2009, p. 1263). Depakote binds easily to protein which results in low clearance of the medication (Ghodke-Puranik, et al., 2013).  Depakote is metabolized in the liver and excreted in the urine. Depakote increases the levels of GABA, an inhibitory neurotransmitter in the CNS which is involved in controlling cortical excitability (Pravat, Krity, & Aroma, 2017).  According to Puerta & Ramirez (2015), “Significant reductions in GABA levels have been described in severe cases of AD, which could be underlying the behavioral and psychological symptoms of AD.

Influencing Factor of Adverse Effect to Depakote

This patient may have been having an adverse reaction to Depakote due to impaired hepatic function. As we age the liver’s ability to metabolize many substances decreases (Siddoqui, 2017). The level of Depakote likely built up in this patient’s bloodstream related to impaired ability to metabolize the medication and the kidneys functions also decline as we age so execration may be impaired. What I have learned from this experience is that geriatric patients should have a hepatic function panel and comprehensive metabolic panel before starting to rule out impairment. A valproic acid level should be drawn during the course of treatment periodically to ensure that the medication is not at a toxic level.

References

Ghodke-Puranik, Y., Thorn, C. F., Lamba, J. K., Leeder, J. S., Song, W., Birnbaum, A. K., … Klein, T. E. (2013). Valproic acid pathway: pharmacokinetics and pharmacodynamics. Pharmacogenetics and genomics23(4), 236–241. doi:10.1097/FPC.0b013e32835ea0b2

Deglin, J. H., Vallerand, A. H., & Sanoski, C. A. (2009). Daviss drug guide for nurses. Philadelphia: F.A. Davis.

Puerta, M.S.,  & Ramirez, M.J.(2015). Treatment options in Alzheimer’s disease: the gaba story. Current Pharmaceutical Design. 21(34). 4960-71. doi: 10.2174/1381612821666150914121149

 


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RESPONSIVENESS TO DISCUSSION QUESTION

Discussion post minimum requirements:

*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.

8 (26.67%) – 8 (26.67%)

Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.

7 (23.33%) – 7 (23.33%)

Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.

6 (20%) – 6 (20%)

Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.

0 (0%) – 5 (16.67%)

Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.

CONTENT KNOWLEDGE 8 (26.67%) – 8 (26.67%)

Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.

7 (23.33%) – 7 (23.33%)

Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.

6 (20%) – 6 (20%)

Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course

0 (0%) – 5 (16.67%)

Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.

CONTRIBUTION TO THE DISCUSSION 8 (26.67%) – 8 (26.67%)

Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.

7 (23.33%) – 7 (23.33%)

Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature

6 (20%) – 6 (20%)

Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.

0 (0%) – 5 (16.67%)

Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas

QUALITY OF WRITING 6 (20%) – 6 (20%)

Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.

5 (16.67%) – 5 (16.67%)

Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.

4 (13.33%) – 4 (13.33%)

Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.

0 (0%) – 3 (10%)

Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.

Total Points: 30