Please Reply To The Following 2 Discussion Posts:

Please Reply to the following 2 Discussion posts:

 

Requirements

 

APA format with intext citation

Word count minimum of 150 words per post

References at least one high-level scholarly reference per post within the last 5 years in APA format.

Plagiarism free.

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DISCUSSION POST # 1 Talia

 

Q1. A 70-year-old woman presenting with difficulty maintaining her balance after taking diazepam for anxiety and difficulty sleeping should understand the adverse effects of the medication and how this medication may affect her differently as she ages. With a 16-year history of taking diazepam she may be unaware that the drug is metabolized slower in older patients. Research shows that concentrations of diazepam and its active metabolite, desmethyldiazepam, were 30% to 35% higher in older people compared to a younger group (Greenblatt et al., 2021). Side effects include dizziness, drowsiness, difficulty breathing, confusion, and fatigue (Drugs.com, 2022).

 

Q2. The first pass effect describes how a drug gets metabolized by the body, most often the liver, causing it to have a reduced concentration of the active drug. Other sites for drug metabolism include the lungs, vasculature, gastrointestinal tract, and other metabolically active tissues in the body (Herman & Santos, 2022). Using an alternate administration route can bypass the first pass effect (Herman & Santos, 2022).

 

Q3. The likely cause of confusion in a 75-year-olde woman is adverse effects of the over-the-counter medication containing diphenhydramine and phenylephrine. Side effects include, altered level of consciousness, sleepiness, dizziness, disturbed coordination and more (Drugs.com, 2022). There is a greater risk for these side effects due to her advanced age.

 

Q4. Warfarin is metabolized primarily by the liver via several isoenzymes (Drugs.com, 2022). It does cross the placenta, but it is unclear if it enters breastmilk. There are risks of teratogenic effects in early stages of pregnancy and can cause serious bleeding at the time of delivery (Drugs.com, 2022).

 

Q5. Drug metabolism varies depending on age, genetics, and multiple other factors. Most drugs have half-lives 2 to 3 times longer in neonates than in adults (Tesini, 2022). Oxidation, reduction, and hydrolysis is reduced in neonates and progressively increases during the first six months of life (Tesini, 2022). Drug metabolism is affected by several factors, all of which may be altered in the first two years of life (Tesini, 2022).

 

Q6. Many drugs are protein bound and protein binding is less in neonates than in adults and older children due to the lower concentration of total protein (Tesini, 2022). This results in more free medication and a great effect. Extracellular fluid accounts for up to 45% of a neonate’s body weight resulting in the need for higher doses of certain medications compared to adults due to lower concentrations of serum albumin (Tesini, 2022).

 

DISCUSSION POST # 2 Ella

A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking diazepam (valium). She occasionally takes diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking diazepam.

Q1. Explain the cause of this patient’s difficulty in maintaining her balance?

Patient’s age makes her more sensitive to medications. The question is how much diazepam is she taking? Diazepam is a benzodiazepine medication that not only influences the CNS but also affects the neuromuscular processing, which also controls balance. According to (Dou et al., 2018), benzodiazepines (BZD) are generally indicated for the short-term treatment of anxiety and sleep disorders, they also mentioned that problems arising from continual use of BZD include dependence, tolerance, cognitive impairment, and psychomotor impairment leading to increased risks of falls in the frail elderly (Dou et al., 2018).

 

Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?

The first – pass effect is the biotransformation that the medication undergoes when it is digested in the liver and /or intestinal mucosa, which results in a decrease in its effect. First-pass metabolism can be circumvented by administering the medication via subcutaneously, intramuscular, or intravenous.

 

A 75-year-old woman develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The medication contains diphenhydramine, acetaminophen, and phenylephrine. She takes the recommended adult dose but soon after taking the medication she becomes very confused and disoriented.

 

Q3. What is likely causing the signs of confusion?

The cold medication contains diphenhydramine, which is a first generation antihistamine and some of the most common side effect of this medication is sedation. According to (Rosenthal & Burchum, 2021), the degree of impairment seen with antihistamines equals that seen when blood levels of alcohol exceed the legal limit. This side effect most likely is what causing the confusion.

 

A 26-year-old woman who has never been pregnant is seeking preconception care as she is planning to pursue pregnancy in a couple of months. Currently, she has no symptoms to report and on review of body systems, there were no concerns. Her past medical history is significant for a history of rheumatic fever as a child. She subsequently underwent valve replacement with a mechanical heart valve. She is followed by a cardiologist who has already evaluated her cardiac function, and she has received clearance from her cardiologist to pursue pregnancy. Records from her cardiologist include a recent cardiac echocardiography report that reveals a normal ejection fraction indicating normal cardiac function.

She has no alterations in her daily activities related to her heart. She has no other significant medical or surgical history. She is a non-smoker, drinks occasionally but has stopped as she is attempting to conceive, and does not use any non-prescription drugs.

Current Medications: Her current medications include only prenatal vitamins, which she has begun in anticipation of pregnancy, and warfarin. She has no known drug allergies.

Vital Signs: On examination, her pulse is 80 beats per minute, blood pressure is 115/70 mm Hg, respiratory rate is 18 breaths per minute, and she is afebrile.

Measurements: Weight = 152 pounds, Height = 5′5 ″, BMI= 25.29

 

Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?

Warfarin is part of the drugs that are proven to be teratogens, and they should avoid taken them during pregnancy. Warfarin is metabolized in the liver and is eliminated through hepatic metabolism. CYP2C9 is the enzyme that catalyzed warfarin. Warfarin is low molecular weight, and it does cross the placenta.

 

Q5. Explain the hepatic drug metabolism of children 1 year and older. How do they compare with the hepatic drug metabolism of infants and adults?

Children 1 year and older have a similar hepatic drug metabolism to those of adults. The capacity of the liver reaches complete maturation by age 1, and they can metabolize the medication faster than infants do. The liver capacity in infants has not reached maturity therefore, the drug metabolism is low, and the medication dose needs to be adjusted and reduced accordingly to avoid complications with like drug toxicity.

 

Q6. Explain protein binding in the neonate.

In neonate the protein binding is lower due to low levels of albumin and proteins like plasma.  According to (van den Anker et al., 2018) the newborn there is a simultaneous lower concentration of different plasma proteins in combination with increased bilirubin concentrations and/or increased levels of free fatty acids.