Advanced Pharmacology Essay
Advanced Pharmacology Essay
JJ is a patient known to have had a stroke. The patient has been recently diagnosed with diabetes type 2, hypertension, and hyperlipidemia. The patient is taking Glipizide 10 mg PO daily, Metformin 500 mg PO daily, HCTZ 25 mg daily, Atenolol 25 mg PO daily, Hydralazine 25 mg QID, Simvastatin 80 mg daily, and Verapamil 180 mg CD daily. Advanced Pharmacology Essay
- Discuss the pharmacology of existing agents briefly, the molecular mechanism of action, therapeutic & adverse effects, & relevant kinetics, all as short paragraphs, readable.
Glipizide is a second-generation sulfonylurea that lowers the blood glucose level by stimulating the release of insulin from the pancreas. It also decreases the rate of hepatic glucose production. It is 100% bioavailable and has maximum effects within three hours.it is metabolized in the liver and excreted in the urine. It causes dermatologic reactions, GI symptoms, and hypoglycemia.
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Metformin is a biguanide antihyperglycemic that decreases hepatic glucose production, and GI glucose absorption, and increases target cell insulin sensitivity. It has 60% bioavailability and a 3-8hours plasma peak. It has a plasma half-life of 4-9hours and it is eliminated in the liver. Its adverse effects are diarrhea, nausea, vomiting, and dyspepsia.
Hydrochlorothiazide HCTZ is a thiazide used in treating hypertension. Its mechanism of action is at the distal convoluted tubule to prevent the reabsorption of water and sodium. This causes increased elimination of water through urination. It has 75% bioavailability with a peak plasma time of 2 hours, the peak effect of diuresis 6hours, protein-bound 40-60%, plasma half-life of 14hours, and excreted through urine. It has a wider therapeutic window because its dosage starts from 12.5mg o 100mg. HCTZ has adverse effects such as hyperglycemia, epigastric distress, anorexia, and anaphylaxis.
Atenolol is a beta-1 selective blocker for the treatment of hypertension and angina pectoris. It is a cardioselective beta blocker that blocks the response of adrenergic stimulation, reducing the heart rate, electrical conductivity, and contractility, therefore reducing the mismatch of oxygen demand and supply in events of coronary heart disease. It has a 60% bioavailability with a peak plasma time of 4hours and a plasma half-life of 4hours. Its adverse effects are bradycardia, hypotension, fatigue, and depression.
Hydralazine is an antihypertensive agent for managing severe to essential hypertension. It is a central vasodilator whereby it dilates the artery, reducing the systemic resistance, hence reducing the blood pressure. It is 87% protein bound, has a 50% bioavailability, maximum effect after 80minutes, and half-life of 8houurs. It is metabolized in the liver and excreted in the urine.
Simvastatin is a lipid-lowering drug for treating hyperlipidemia and prophylaxis for cardiovascular diseases. It competitively inhibits the enzyme HMG-CoA reductase that catalyzes the conversion of HMG-CoA to mevalonic acid resulting in the production of several compounds that metabolizes and transports lipids and cholesterol. It has less than 5%bioavailability, the onset of action within three days, and maximum effects after 4-6weeks. It is 95%protein bound and has a fast pass metabolism in the liver. Its adverse effects are constipation, upper respiratory tract infections, vertigo, and eczema.
Verapamil is a non-dihydropyridine calcium channel blocker for treating hypertension. It inhibits the transmembrane for the influx of extracellular calcium ions across the membranes of myocardial cells and smooth muscle contraction, thereby dilating the main coronary and systemic arteries. Its adverse effects are headache, constipation, hypotension, and edema.
- Talk About What Modifications Are Needed, What Drugs Are Not At The Best Interest.
These drug combinations are not appropriate for the patient because of the drug interaction and may worsen the stroke. Glipizide and metformin are recommendable in diabetes mellitus. However, this combination may result in hypoglycemia and increases the risk of stroke recurrence and cardiovascular diseases. Its severe adverse effect is lactic acidosis. Additionally, the antihypertensive treatment for the patient is not recommended for newly diagnosed hypertension.
- Follow A Guideline, Preferably JNC 8 And Its Current Modifications (Also ACC/AHA 2019 Guidelines).
The JNC 8 guidelines state that the first-line treatment for hypertension should either be a thiazide diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or an angiotensin receptor blocker. The first-line treatment is usually a single dose. Second-line treatment is a dose combination of angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers with a thiazide diuretic, calcium channel blocker, or both. Beta-blockers and direct vasodilators are later-line treatments for malignant hypertension (Flack, et al, 2018). Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are recommended in patients with kidney injury.
- Talk About The Drugs You Have Substituted Or Added, & Their Key Pharmacology.
- Sitagliptin 50mg PO daily for diabetes
- Aspirin 81mg PO daily for prophylaxis
- Amlodipine 10mg PO once daily for hypertension
- Losartan 50mg PO once daily for hypertension
- HCTZ 25mg PO once daily for hypertension
- Atorvastatin 80mg PO daily for hyperlipidemia
- Does This Patient Need Both Verapamil & Atenolol At The Same Time, Since Both Have Similar Actions?
This drug combination is contraindicated because the mechanism of action is in the myocardial, hence, it would have a profound effect on the atrioventricular nodal conduction, heart rate, and cardiac contractility. The adverse effects are heart block and hypotension.
- Recent guidelines do not recommend beta-blockers for hypertension. But it was possibly added for the best therapeutic outcome? Why beta-blockers? (example, he had strokes?).
Beta-blockers increases lipid solubility, intrinsic sympathomimetics activity, membrane stabilization, and decreases microvascular events (Balla, et al, 2021). Therefore, it decreases the risk of heart attack and recurring stroke.
Is There A Drug To Be Added For Stroke Prevention?
There is no specific drug that prevents stroke. However, patients with a risk of stroke should control their blood pressure, blood glucose level, and cholesterol. Aspirin is an anticoagulant for stroke prophylaxis (Flach, et al, 2020). A healthy diet, physical exercise, and cessation of smoking prevent stroke.
- Why can’t this patient be a candidate for metformin, the best-used diabetes drug, efficacious, no hypoglycemic attacks, etc.?
Metformin is a biguanide that helps in glycemic control for type two diabetes mellitus. According to Flory, J., & Lipska, K. (2019), it is not the best for this patient because of hyperlipidemia and obesity. Hyperlipidemia is a risk factor for lactic acidosis, posing a risk for cardiovascular diseases, stroke, and acute kidney injury.
Week 2 Case Study
Posted on: Monday, June 6, 2022 9:53:40 AM EDT
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Here is the week 2 Case for your Study!
Please read the whole message.
Patient JJ has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Advanced Pharmacology Essay
Drugs currently prescribed include the following:
Glipizide 10 mg po daily
Metformin 500 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily
INFORMATION AS SHORT PARAGRAPHS, READABLE. All information & presentation have to be at advanced clinician level.
1. Discuss pharmacology of existing agents briefly, molecular mechanism of action, therapeutic & adverse effects, & relevant kinetics, all as short paragraphs, readable.
2. Talk about what modifications are needed, what drugs are not at the best interest.
3. Follow a guideline, preferably JNC 8 and its current modifications (also ACC/AHA 2019 guidelines).
4. Talk about the drugs you have substituted or added, & their key pharmacology.
5. Address any specific questions that you are asked for in this case.
Example, here are some questions you may want to address in your assignment:
Does this patient need both verapamil & atenolol at the same time, since both have similar actions?
Recent guidelines do not recommend beta blockers for hypertension. But it was possibly added for the best therapeutic outcome? Why beta blockers? (example, he had strokes?).
Is there a drug to be added for stroke prevention?
What are the major adverse effects of Statins (muscle related), Hydralazine (many, lupus like syndrome), glipizide (hypoglycemia) HCTZ (hypokalemia) etc. Advanced Pharmacology Essay
Why can’t this patient be a candidate for metformin, the best used diabetes drug, efficacious, no hypoglycemic attacks etc.?