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Advanced Pharmacology

Advanced Pharmacology

Sample Answer 

Advanced Pharmacology

Explain how Agee might influence the pharmacokinetic and pharmacodynamics processes in the patient.

Pharmacokinetics and pharmacodynamics of drugs are altered in patients that have diabetes. The pharmacokinetics of different drugs may be affected by diabetes in several ways, including absorption because of the changes in the gastric emptying, muscle blood flow, and subcutaneous adipose blood flow; distribution because of albumin non-enzymatic glycation distribution; biotransformation because of enzymes/transporters regulation involved in the biotransformation of the drug, and through excretion because of nephropathy.

Describe the effect of Age on PK/PD in general

Age-related changes in the functioning of the liver and kidney are the most critical physiological changes that need to be put into consideration when an appropriate regimen for diabetes for an elderly patient is being selected. The progressive renal function decline that occurs as a person ages may cause a slower removal of drugs from the system. The kidneys may completely or partially clear the drugs, and this includes metformin as well as other agents for diabetes. Additionally, some types of drugs are metabolized into active metabolites, which are then eliminated through the kidneys, such as nateglinide and sulfonylureas. These can build up within the body and result in addictive side effects and toxicity if the drug doses are not revised. When such drugs are used, a higher risk of hypoglycemia may result from high serum concentrations.

Describe how changes in the processes might impact the patient’s recommended drug therapy.

Aging is linked to a reduction in metabolism in the first pass. This could be because of blood flow and mass liver reduction. Consequently, because of age-related body composition changes, polar drugs that are mostly water-soluble often have smaller distribution volumes, which results in elevated serum levels in elderly people. The acidic compounds, such as salicylic acid, warfarin phenytoin, and diazepam, bind primarily to albumin, whereas the basic drugs, such as propranolol and lignocaine, bind primarily to the α1-acid glycoprotein. Although the binding of the plasma protein may theoretically contribute to the physiological effects of drug interactions that are bound highly to protein, there’s limited clinical relevance. The reduction in elderly people’s renal function and, more so, the glomerular filtration rate affects a number of drugs’ clearance. Although creatinine clearance in elderly people is reduced slightly compared to younger people, the excretion of triamterene, hydrochlorothiazide, and atenolol remains the same as one age. However, the synthesis of vitamin –K-dependent clotting factors’ inhibition is greatest at similar warfarin plasma concentrations in the elderly in comparison to younger individuals (Sera & Uritsky2016).

Describe the pharmacokinetics/pharmacodynamics of EACH drug in the patient’s list.

  • Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun for prevention and treatment of clots with atrial fibrillation or heart valve replacement.
  • Aspirin 81 mg daily is the most common dose used in preventing a heart attack or a stroke.
  • Metformin 1000 mg po bid is for controlling blood sugar. Treatment should be combined with exercises and diet
  • Glyburide 10 mg bid is a sulfonylurea and causes the pancreas to produce insulin.
  • Atenolol 100 mg po daily is used for the treatment of high blood pressure and arrhythmia
  • Motrin 200 mg is used 0 relieving minor aches and pains

Research the effect of the factor you selected on EACH drug in the drug list provided as part of the patient case.

Warfarin assists elderly patients in achieving enhanced anticoagulation control but increases their risk of major hemorrhaging in comparison to younger patients. The risk of cardiovascular disease increases in the elderly with the use of aspirin compared to the younger populace. Metformin has been shown to be effective for persons of all age categories. Glyburide has prolonged hypoglycemic side effects, which are mostly observed in elderly patients. This is due to the ability of the glyburide to stimulate insulin secretion continually in a state that is already hypoglycemic. Additionally, elderly patients are more sensitive to atenolol chronotropic effects compared to younger patients. Lastly, the use of NSAID therapy for elderly patients is known to cause cardiovascular, renal, and gastrointestinal side effects and hence should be administered for short periods in elderly patients for episodic flares.

Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

  • To lower the patient’s blood pressure, he will need to take brisk walks for 30-45 minutes or other moderately intensive physical activities (Dempsey et al., 2016).
  • The benefits of ACE inhibitors on diabetic patients’ multiple adverse outcomes, including both macrovascular and microvascular complications, and in those that have severe or mild hypertension, using ACE inhibitors as a first-line agent is effective. The patient will be prescribed captopril 25mg three times a day (Tan et al., 2015).

References

Dempsey, P. C., Sacre, J. W., Larsen, R. N., Straznicky, N. E., Sethi, P., Cohen, N. D., … & Dunstan, D. W. (2016). Interrupting prolonged sitting with brief bouts of light walking or simple resistance activities reduces resting blood pressure and plasma noradrenaline in type 2 diabetes. Journal of hypertension34(12), 2376-2382.

Sera, L., & Uritsky, T. (2016). Pharmacokinetic and pharmacodynamic changes in older adults and implications for palliative care. Progress in Palliative Care24(5), 255-261.

Tan, J. L., Eastment, J. G., Poudel, A., & Hubbard, R. E. (2015). Age-related changes in hepatic function: an update on implications for drug therapy. Drugs & aging32(12), 999-1008.

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Question 


Advanced Pharmacology

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease. Drugs currently prescribed include the following:

  • Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
  • Aspirin 81 mg daily
  • Metformin 1000 mg po bid
  • Glyburide 10 mg bid
  • Atenolol 100 mg PO daily
  • Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

    Advanced Pharmacology

    Advanced Pharmacology

By Day 7 of Week 2

Write a 2-page paper that addresses the following:

  • Select one of the following factors: genetics, gender, ethnicity, age, or behavior factors.
  • Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. Stick to ONE factor! Describe the effect of the factor on PK/PD in general
  • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. Describe the pharmacokinetics/pharmacodynamics of EACH drug in the patient’s list. Research the effect of the factor you selected on EACH drug in the drug list provided as part of the patient case. You can use primary research articles and a drug reference for information
  • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Use bullet points for your recommendations. Include one bullet point for each drug. Be specific. For example:  decrease atenolol to 50mg daily because of bioavailability…
    stop metformin. Start….at XXmg because of bioavailability…

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