Pharmacology and Pathophysiology for Nurses

Q1. Pharmacodynamics and pharmacokinetics are the processes that are undergone by the drug such that it can interact with the body and the effect which is required can be seen. There are two main aspects of pharmacokinetics are absorption, distribution and metabolism, excretion. After administration of the drug, the process by which the drug actually enters the bloodstream to reach the target site or organ is called absorption (Loisios‐Konstantinidis et al., 2019). This is vital because other than intravenous administration of the drug, a drug needs to cross multiple barriers like dermis, epidermis, mucosa, muscles, and capillary walls to reach the blood. Distribution of the drug is the way in which the drug moves in the body after entering the blood to reach the tissues and cells. Metabolism of the drug is related to the process by which the drug is altered chemically such that its effectiveness can be increased and it can be easily excreted from the body by increasing its solubility. This process occurs at various sites depending on the drug like locally at the tissues, in the blood or in the gut, liver, kidneys and even skin. Lastly, excretion is the process by which the drug in unchanged or its byproduct after metabolism can be excreted from the body (Loisios‐Konstantinidis et al., 2019).

Q2. Asthma is a chronic disease which affects the respiratory system such that the patient is not able to breathe properly and there is a characteristic wheeze. The pathophysiology of the disease is that there is inflammation of the respiratory mucosa which causes a restriction to the flow of the air to the lungs (Carpaij et al., 2019). This inflammation can be due to the presence of allergens, smoke, or infection which causes adverse inflammation of the mucosa present in the respiratory system (Carpaij et al., 2019). Salbutamol is the first drug of choice that is administered to the patient with asthma and another drug that can be administered to the patient is hydrocortisone. Salbutamol is a beta-adrenergic agonist which acts on the beta-adrenergic receptors present in the smooth muscles of the respiratory system (Bjermer et al., 2019). Upon activation, it causes relaxation of smooth muscles and reduces the constriction of the airway that has occurred and causes the easy passage of air (Bjermer et al., 2019). Hydrocortisone is a steroid which can be administered either inhalation or even intravenous which in lower doses causes anti-inflammatory action on the respiratory mucosa (Barnes, 2019). It helps in the reduction of swelling and inflammation which helps in better flow of air to the lungs. In higher doses, hydrocortisone can cause immunosuppression (Barnes, 2019).

Q3. Graves' disease is an autoimmune disorder which causes hyperthyroidism. In this disease, the immune system attacks the cells of the thyroid gland and makes the thyroid gland secrete more thyroid hormone and affect the body (Smith & Hegedüs, 2016). The thyroid-stimulating hormone is generally seen to be low so that the feedback mechanism is such that there is excess in thyroid hormone can be reduced in blood. So in a patient with Graves’ disease, the serum thyroid-stimulating hormone is reduced and serum thyroxine is reduced (Smith & Hegedüs, 2016). From the table, it is seen that patient B as the serum thyroid-stimulating hormone is the least 0.75 uIU/mL and in the same patient the serum thyroxine 16 ug/100mL.

Q4. Blood pressure is the pressure that is exerted by the flow of blood within the arteries on the walls of the arteries. The primary cause of blood pressure is the pumping action of the heart and it is measured by the systolic and diastolic former is the one which is the highest contraction and second is after the lowest contraction (Rocco et al., 2016). There can be disorders of blood pressure which is caused by the dysregulation and can be either hypertension or hypotension. Chronic hypertension is caused by an increase in systemic vascular resistance. There are baroreceptors which are present in the brain and kidneys which are sensitive to change in the pressure and the compensatory mechanism is activated for the regulation of blood pressure (Garfinkle, 2017). When this regulation is overpowered the regulation of blood pressure is reduced or impaired resulting in primary and chronic hypertension.

The compensatory mechanism that exists in the body is the renin-angiotensin system. Renin helps in breaking of angiotensin and the byproducts formed is angiotensin I which is converted to angiotensin II. In case of hypertension, this mechanism due to positive feedback the system is stimulated and there is reduced reabsorption of sodium and increased water retention and blood pressure is regulated (Kaschina et al., 2018). One the class of drugs that are prescribed for the control of hypertension is beta-blockers for example atenolol. The mechanism of action of atenolol is by selectively acting on beta receptors and it acts by blocking them. It selectively binds to beta-1 adrenergic receptors which are present in the cardiac smooth muscles which reduce the contractibility of the muscles to and the blood pressure is eventually reduced (Rehman et al., 2020).

References for Pharmacology and Pathophysiology for Nurses

Barnes, P. J. (2019). Pharmacology of asthma and COPD. ERS Handbook of Respiratory Medicine, 344.

Bjermer, L., Abbott-Banner, K., & Newman, K. (2019). Efficacy and safety of a first-in-class inhaled PDE3/4 inhibitor (ensifentrine) vs salbutamol in asthma. Pulmonary Pharmacology & Therapeutics, 58, 101814. https://doi.org/10.1016/j.pupt.2019.101814.

Carpaij, O. A., Burgess, J. K., Kerstjens, H. A., Nawijn, M. C., & van den Berge, M. (2019). A review on the pathophysiology of asthma remission. Pharmacology & Therapeutics, 201, 8-24. https://doi.org/10.1016/j.pharmthera.2019.05.002.

Garfinkle, M. A. (2017). Salt and essential hypertension: Pathophysiology and implications for treatment. Journal of the American Society of Hypertension, 11(6), 385-391. https://doi.org/10.1016/j.jash.2017.04.006.

Kaschina, E., Steckelings, U. M., & Unger, T. (2018). Hypertension and the renin-angiotensin-aldosterone system. In Encyclopedia of Endocrine Diseases (pp. 505-510). Elsevier Editora. https://doi.org/10.1016/B978-0-12-801238-3.03969-6.

Loisios‐Konstantinidis, I., Paraiso, R. L., Fotaki, N., McAllister, M., Cristofoletti, R., & Dressman, J. (2019). Application of the relationship between pharmacokinetics and pharmacodynamics in drug development and therapeutic equivalence: A PEARRL review. Journal of Pharmacy and Pharmacology, 71(4), 699-723. https://doi.org/10.1111/jphp.13070.

Rehman, B., Sanchez, D. P., & Shah, S. (2020). Atenolol. In StatPearls [Internet]. StatPearls Publishing.

Rocco, M. V., Chapman, A., Chertow, G. M., Cohen, D., Chen, J., Cutler, J. A., ... & Killeen, A. A. (2016). Chronic kidney disease classification in systolic blood pressure intervention trial: comparison using modification of diet in renal disease and CKD-epidemiology collaboration definitions. American Journal of Nephrology, 44(2), 130-140. https://doi.org/10.1159/000448722.

Smith, T. J., & Hegedüs, L. (2016). Graves’ disease. New England Journal of Medicine, 375(16), 1552-1565. https://doi.org/10.1056/NEJMra1510030.

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