Personalized Treatment Based On Pharmacokinetics And Pharmacodynamics Discussion

Personalized Treatment Based On Pharmacokinetics And Pharmacodynamics Discussion

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Paige Gunter
Personalized Treatment based on Pharmacokinetics and Pharmacodynamics
COLLAPSE
Pharmacokinetics and pharmacodynamics play a vital role in the medication management of every patient seen by practitioners. Some are more affected by these factors than others, and each patient must be considered individually when making clinical decisions. I recall a frequent patient I cared for at my previous hospital setting, who I will refer to as “Mrs. Doe.” She was a female in her thirties admitted for a hip fracture with an underlying diagnosis of multiple myeloma with a vertebral compression fracture. While awaiting surgery, the primary concern was pain control, because as Davies et al. (2019) explain, patients with this diagnosis experience severe bone pain that limits mobility and lowers their quality of life. As Bird & Boyd (2019) explain, renal impairment occurs frequently alongside multiple myeloma, which must be taken into consideration when determining medication for pain management. Personalized Treatment Based On Pharmacokinetics And Pharmacodynamics Discussion

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Mrs. Doe had been prescribed morphine at home and developed opioid tolerance as a result. Pharmacodynamic tolerance results from a decreased intrinsic response in the nervous system due in part to the increased selectivity of the blood-brain barrier (Dumas & Pollock, 2008). Initially, the patient was only ordered intravenous morphine at a higher dosage than the home prescription to treat her pain. Although this dose was higher, the patient was unable to achieve adequate pain control as expected. The dosage was increased again, but the acute pain persisted due to the pharmacological tolerance.

The pharmacodynamic factor of tolerance impacted the plan of care regarding pain management as the “gold standard” in our facility was not an appropriate choice for this particular patient. We needed to find a more effective substitute and began looking at alternate opioids. Rosenthal & Burchum (2017) explain the pharmacokinetic factor of the selectivity of the blood-brain barrier requiring lipid solubility to cross. Contrary to morphine, fentanyl is a highly lipophilic medication. This characteristic contributes to a higher potency associated with fentanyl. In addition, morphine can pose a risk of toxicity in patients with renal impairment, while fentanyl is only a risk when hepatic impairment is present (Young & Jong, 2021). With this in mind, the treatment was personalized to consider the effects of opioid tolerance, and morphine was switched to fentanyl. This change yielded a positive response from the patient and was a great example of tailoring treatment to fit the individual pharmacodynamic and pharmacokinetic factors exhibited by this patient. Personalized Treatment Based On Pharmacokinetics And Pharmacodynamics Discussion

References:

Boys, S. A., & Boyd, K. (2019). Multiple myeloma: an overview of management. Palliative Care & Social Practice, 13, 1–13. https://doi.org/10.1177/ 1178224219868235

Davies, M. P., Fingas, S., & Chantry, A. (2019). Mechanisms and treatment of bone pain in multiple myeloma. Current Opinion in Supportive & Palliative Care, 13(4), 408–416. https://doi.org/10.1097/spc.0000000000000467

Dumas, E. O., & Pollack, G. M. (2008). Opioid tolerance development: a pharmacokinetic/pharmacodynamic perspective. The AAPS journal, 10(4), 537–551. https://doi.org/10.1208/s12248-008-9056-1

Rosenthal, L. D., & Burchum, J. R. (2018). Lehneâ€s pharmacotherapeutics for advanced

practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Young, P. J., & De Jong, A. (2021). New insights into the comparative effectiveness of fentanyl and morphine infusions in ICU patients. American Journal of Respiratory and Critical Care Medicine, 204(11), 1243–1245. https://doi.org/10.1164/rccm.202109-2112ed Personalized Treatment Based On Pharmacokinetics And Pharmacodynamics Discussion