Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts Case Scenario 

 NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts

Over the years working as a nurse I have encountered many patients who state that sleep aids do not work for them.  They often complain that the treatment for insomnia has the opposite effect for them.  People who use these medications and fall fast asleep without difficulty would probably question how is this possible.  The first time I had someone tell me that sleep aids did not work for them I to in the back of my mind questioned why.  For the sake of privacy, I will call the patient that I am referring to Sam.

Sam was a male Caucasian patient in his mid-60’s who was brought into the ED by his wife for new onset of confusion.  Sam’s wife stated that he had been very forgetful lately doing things like driving to the store and not remembering the trip there, or where he parked, he seemed to have an increase in anxiety, and he was not sleeping many hours at all.  Being that this behavior was out of the patient’s norm and recently started, she was concerned enough to convince him to come to the Emergency room.

A neurologic workup was completed on Sam.  He had a minor health history, and he was a social drinker.  A week before the ED visit he functioned normal going to work, shopping, and driving without any issues.  Although a medication list was collected at the beginning of the visit new information came to light.  The patient told his wife that he was had been taking his Ambien in the morning with his other medications.  The patient was unaware that the Ambien was intended for sleep.  The ED physician contributed the patient’s new confusion to the Ambien that he just started taking before the confusion started.

Pharmacokinetics and Pharmacodynamics

When prescribing medication, I understand that it is important to know how the drug works in the body and what effect it achieves.  Pharmacokinetics is defined as “how the drug is absorbed, distributed and eliminated from the body” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p.17).  Ambien is rapidly absorbed through the GI tract which means that taking the medication with food or while the stomach is full can slow down the onset of the medication.  The medication is distributed throughout the body by binding to protein carriers at 92% (Kizior, 2018).  Different medications are metabolized in different ways.  When it comes to how the Ambien is broken down, it is metabolized by the liver and eliminated through urination (Kizior, 2018).  The effectiveness of how the body receives the Ambien will determine how well it works for the Sam.  Also, the overall health, gender, and age of the patient can play a role in how well the medication is excreted by the body.  Sam is in his late 60’s, “older adults undergo physiologic changes that affect the absorption, distribution, and elimination of many agents” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p.30).

Pharmacodynamics is defined as “the set of processes by which drugs produce specific biochemical or physiologic changes in the body” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p. 27).  Many factors can play a factor in how a drug will affect a person such as age, race, gender, and genetics.  Due to Sam’s age and the fact that he is a drinker it is possible that the effect of the medication was intensified causing his confusion.

Personalized Plan

When prescribing for Sam, I would take his not only his health history and social history into account but also his age.  From the beginning, it is clear to see that Sam did not understand why he was taking Ambien because he was taking it at the wrong time of day.  Thorough patient teaching would be performed so that Sam would understand to take the medication at night for his insomnia and not to drink while taking the medication.  Also, I would have him take it on an empty stomach.  I would decrease Sam’s dose if possible and include his wife in the education because he would need to be monitored while taking a hypnotic such as Ambien, “consistent monitoring of the elderly is needed when taking a long-acting hypnotic due to accumulation in the renal or hepatic system” (Arcangelo, Peterson, Wilbur, Reinhold, 2017, p.732).  I would suggest other options for relaxation prior to medication.  As a prescriber, I would take into consideration Sam’s age even if he seems healthy the body changes as it ages, “when prescribing you must be focused and attentive because every patient is different” (Laureate Education, 2012).

Reference:

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).

Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.