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How the Factor Selected Might Influence the Pharmacokinetic and Pharmacodynamic Processes in the Patient from the Case Study
Diabetes is currently the 7th leading cause of death in the United States and is associated with various comorbidities such as dyslipidemia, kidney disease, stroke, renal disease, and kidney disease (Layton, et al., 2018). Hypertension is common among patients with diabetes increases the risk of stroke, heart disease, and death. There are various factors that are impact hypertension and diabetes, including genetics, age, ethnicity, gender, and behavioral factors.
The selected factor is ethnicity, with the focus being on African Americans. Among African Americans, high salt intake, high water, and salt retention and overload impact hypertension. This is linked to excess secretion of aldosterone or excess sensitivity. The ethnic group has salt sensitivity; for example, after consumption of an energy drink, salt is excreted first within 12 hours. Excretion of sodium and potassium is usually low due to impaired natriuretic response resulting from the inability to produce natriuretic substances such as prostaglandin and dopamine and atrial natriuretic factor. Among African Americans, insulin resistance may also affect the pharmacokinetics and pharmacodynamic process. Insulin resistance occurs when cells in the muscles, liver, and body fat fail to pick signals from the insulin hormone. Among African Americans, insulin sensitivity is usually low (Layton et al., 2018). Syndrome X, which is associated with elevated levels of visceral adipose tissue that is susceptible to lipolysis, is a major aspect as it results in the raised concentration of fatty acids. Excess fatty acids result in reduced glucose utilization and the increased output of glucose from the liver.
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How Changes in The Processes Might Impact the Patient’s Recommended Drug Therapy. Be Specific and Provide Examples.
The patient in the case study is prescribed various drugs, and the changes in the processes impact absorption of the drug, distribution, metabolism, and removal from the body. Diabetic patient experiences a significant reduction in gastric mucosal blood flow, which may result to a delay in emptying the gastric. The impact of the changes in the digestive process becomes evident in changes in absorption of the orally-administered medication. With low sensitivity to insulin, prescription of Glipizide would be effective by stimulating the pancreas to produce insulin to reduce blood glucose and increasing cell sensitivity to facilitate intake of glucose. The drug would be effective in enabling the patient to achieve normal levels of blood sugar given the risk of insulin resistance.
When the kidney detects that the level of sodium ions reaching the sodium sensor in the nephron has been raised, secretion of renin is suppressed. For people from the ethnic group, angiotensin-converting enzyme inhibitors, calcium, and angiotensin blockers are less effective (Alrasheed & Dzimiri, 2016). For effective treatment, patients from the ethnic group should be prescribed diuretics and calcium blockers. As an African American, the patient has a higher risk of obesity, increased risk of developing coronary artery disease, and chronic cardiovascular disease (Nowakowska et al.,2019). The Simvastatin prescribed to the patient will be effective in facilitating a reduction in blood cholesterol. Due to the risk of complications related to diabetes, prescriptions should be monitored to identify the risk of a drug interaction that increases the risk of renal failure.
How to improve the Patient’s Drug Therapy Plan and Explain Reasons for these Recommended Improvements
The patient has been prescribed Atenolol 25my PO daily, HCTZ25mg daily, Verapamil 180 mg CD daily, Hydralazine 25 mg four times a day, Glipizide 10mg PO daily, and Simvastatin 80 mg daily. The patient has been prescribed HCTZ, Hydralazine, Atenolol, and Verapamil to lower the blood pressure. Simvastatin was prescribed to reduce levels of cholesterol in the blood. An increased amount of cholesterol and fat increases the risk of coronary heart disease and other cardiovascular diseases. Assuming the patient is an African American, I would discontinue Atenolol due to its interaction with verapamil, a calcium channel blocker, and also adjust Glipizide, an anti-diabetic medication. The dose for Simvastatin will be reduced from 80 mg to 10 mg due to the impact of calcium channel blockers. HCTZ would be maintained to facilitate control of blood pressure and prevention of renal failure. The plan would also entail monitoring the liver functions of the patient, lipid panel, and renal panels periodically. The ability of HCTZ to function effectively is based on how well the kidney of the patient is functioning (Rosenthal & Burchum, 2021). Due to the risk of suffering from diabetes complications such as renal failure, drug adjustment can be made accordingly. Diet modification, physical exercise, and education on a healthy lifestyle will be provided. High salt intake among the individuals in the group can cause water retainment increasing blood pressure. Inadequate potassium in the body can also lead to high levels of sodium in the blood. I would encourage the patient to incorporate non-pharmacologic interventions to manage their health condition since the prescriptions may not work effectively if healthy behavior and lifestyle are not maintained.
References
Alrasheed, M. M., & Dzimiri, N. (2016). Ethnicity and Response to Drug Therapy. Cholesterol-Lowering Therapies and Drugs, 131.
Layton, J., Li, X., Shen, C., de Groot, M., Lange, L., Correa, A., & Wessel, J. (2018). Type 2 Diabetes Genetic Risk Scores Are Associated with Increased Type 2 Diabetes Risk Among African Americans by Cardiometabolic Status. Clinical Medicine Insights: Endocrinology and Diabetes, 11, 1179551417748942.
Nowakowska, M., Zghebi, S. S., Ashcroft, D. M., Buchan, I., Chew-Graham, C., Holt, T., … & Kontopantelis, E. (2019). The Comorbidity Burden of Type 2 Diabetes Mellitus: Patterns, Clusters, and Predictions from a Large English Primary Care Cohort. BMC Medicine, 17(1), 1-10.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd Ed.) St. Louis, MO: Elsevier.
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Question
• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.