What does a volume of distribution tell you about the medication?

Dan Carter Course: Pharmacokinetics and PharmacodynamicsCOLLAPSEName Dan CarterInstructor’s Name: Dr. Peele Course: Pharmacokinetics and PharmacodynamicsDate of Submission 6/1/2020The purpose of this discussion is to present a critical evaluation and assessment of how a patient’s pharmacokinetic and pharmacodynamic processes influence his or her reactions to a drug. The discussion focuses on presenting a patient case based on personal experiences and observations in recent years and explains how specific factors may have shaped the patient’s pharmacokinetic and pharmacodynamic processes in response to the administration of the drug. Accordingly, the discussion also presents a customized plan of care for the patient in the light of the identified considerations, specific factors and patient history.Description of Patient CaseMrs R is a 56-year-old widowed woman who lives alone in a cottage in the suburbs. Three weeks after a partial colectomy to eliminate carcinoid tumors she was taken to the Emergency Room with a case of diarrhea which led to dehydration and severe rectal pain. Mrs. R has a year-long history of diarrhea and was diagnosed with depression 6-months ago following the death of her husband from cancer about a year-and-a-half ago.Despite several consultations with a psychiatrist, Mrs R has not been taking her anti-depressants about a month into the diagnosis and prefers to engage in spiritual activities such as attending church and prayers. She is a devout Catholic and believes that the power of prayer is greater than the healing power of medicine. She has often proven to be uncooperative with medical staff during her previous visits to the hospital and has left the hospital against medical advice once. This happened when she experienced moderate diarrhea 3-months ago along with a fever of 102 F. Mrs R prefers to lead an isolated lifestyle and only checks into the hospital upon the advice of her sister who lives a 45-minute drive away.Influence of Pharmacokinetic and Pharmacodynamic FactorsPharmacokinetic factors are associated with the distribution and absorption of an administered drug along with other elements (Sandritter et al., 2017). In case of diarrhoeal disease, pharmacokinetic is influenced by the time of administration which is either during the acute phase of the disease, recuperation or once bowel movements have come back to normal. In the acute phase of diarrhea, extraintestinal movement of the drug is swift which contributes to a quicker absorption thus diminishing efficacy (Bergan et al., 1988).Massive diarrhea also requires therapeutic drug monitoring of patients that present critical symptoms as absorption rates are significantly elevated (Oami et al., 2017). In view of these considerations, Mrs. R’s pathophysiological and dietary changes are associated with the functioning of her pharmacokinetic and pharmacodynamic processes. Difficult patient behavior is an important factor in the efficacy of pharmacodynamic processes as a patient’s unwillingness to understand his or her condition and accepting the recommended treatment plan affects treatment success (Janosevic, 2019). Mrs. R has a history of going against medical advice which raises the possibility of her not completing prescribed treatments which significantly affects the implementation of successful treatment plans.Personalized Plan of CareMrs. R’s personalized plan of care is based on ensuring that dietary intake is monitored and controlled by ensuring that her protein consumption is increased (Brand, Craft, and Christensen, 2018). IV treatment will only be prescribed in case the patient is unable to consume a balanced diet which consists of a healthy combination of carbohydrates, minerals, and proteins. Mrs. R would also be advised to increase her water intake. As a part of the patient’s personalized care plan food intolerances will also be explored and alteration in eating schedule will be recommended to ensure that she is not eating too much. As Mrs. R lives alone, her food preparation practices will also be inquired about to understand whether any unhealthy practices are contributing to the concern. Mrs. R’s sister will be actively involved in the personalized care plan and advised to provide the patient with fresh food items, as required. The patient and caregiver will be educated about healthy dietary habits and the importance of appropriate fluid intake.ReferencesBergan, T., Lolekha, S. O. M. S. A. K., Cheong, M. K., Poh, C. L., & Patancharoen, S. (1988). Consequences of diarrhoeal disease on the pharmacokinetics of norfloxacin. Scandinavian journal of infectious diseases. Supplementum, 56, 11-13.Brand, C., Craft, J., & Christensen, M. (2018). Post-cholecystectomy dietary factors and implications for nursing practice. Gastrointestinal Nursing, 16(7), 44-50.Janosevic, D., Wang, A. X., & Wish, J. B. (2019). Difficult Patient Behavior in Dialysis Facilities. Blood purification, 47(1-3), 254-258.Oami, T., Hattori, N., Matsumura, Y., Watanabe, E., Abe, R., Oshima, T., … & Oda, S. (2017). The effects of fasting and massive diarrhea on the absorption of enteral vancomycin in critically ill patients: a retrospective observational study. Frontiers in medicine, 4, 70.Sandritter, T. L., Mclaughlin, M., Artman, M., & Lowry, J. (2017). The Interplay between Pharmacokinetics and Pharmacodynamics. Pediatrics in review, 38(5), 195-206.