Essay On Integrated Pharmacology

This Paper Will Discuss The Case Study Of Marta Who Is An 82-Year-Old Woman. She Is Visiting The Clinic About Her Osteoarthritis, Osteoporosis, And Atrial Fibrillation (AF). This report will be divided into two sections: Part A and Part B. Part A will discuss osteoarthritis and its pharmacological aspects of it. Part B will discuss the use of strains in hypercholesterolemia. The medicines that have been changed in her care plan will be discussed. Altered pharmacokinetics in older patients like Martha will also be discussed. 

 

The most prevalent type of arthritis, osteoarthritis, affects millions of individuals all around the world (Sen & Hurley, 2021). When the protective cartilage that acts as a cushion between the ends of the bones gradually deteriorates, it happens. Even though osteoarthritis can harm any joint present in the body, it usually frequently damages the joints present in the hands, knees, hips, and spine (Mora, Przkora & Cruz-Almeida, 2018). The clinical manifestations of this disease involve pain and stiffness of the affected joints. The joint might feel very tender and it might become very difficult to move the joint in the full range of motion. There can be inflammation of the soft tissues present around the joint (Doherty, Abhishek & Hunter, 2017). The risk factors in the case of Marta for this disease are her old age, female gender, obesity, and hyperlipidaemia (O'Neill, McCabe & McBeth, 2018). 

 

 

A mixture of pharmaceutical and non-pharmacologic methods is used to address pain in Osteoarthritis, with paracetamol frequently being suggested initially in the therapy process for analgesia (Conaghan, et al., 2019). Through blocking the production of prostaglandin (PG) by suppressing COX-1 and COX-2, two isoforms of cyclooxygenase, paracetamol raises the threshold of pain. Pain feelings are brought on by prostaglandins (Mallet, Eschalier & Daulhac, 2017). The use of paracetamol can lead to serious allergic reactions such as hives, rashes, breathing difficulties, and swelling of the face and lips. It can also cause nausea, pain in the stomach, and loss of appetite (McCrae, et al., 2018). Panadol consists of 500 mg of paracetamol which is used as an analgesic and has no anti-inflammatory substances. The typical adult dosage is 1000 mg, or 2 pills every 4 hours. The gastrointestinal tract absorbs the active component paracetamol, with the peak amount reaching 30 to 60 minutes after intake whereas Panadol Osteo is a special bi-layer tablet that combines an instant release and a prolonged release dosage of paracetamol. It includes 665 mg of paracetamol. The paracetamol in Panadol Osteo is given in two stages: 31% of the paracetamol is released right away for instant commencement of the action and 69% of the paracetamol is administered gradually throughout the day or night for more lasting relieving pain (Paracetamol, 2022). Marta should use Panadol Osteo for her OA pain.

 

The active components in each Nurofen plus pill are 200 mg of ibuprofen and 12.8 mg of codeine phosphate hemihydrate. Ibuprofen is an example of a non-steroidal anti-inflammatory drug (NSAIDs) that can be helpful for persons experiencing pain and distress throughout a flare. The main active element of Nurofen, ibuprofen, has both analgesic and anti-inflammatory effects. Ibuprofen 200mg in Nurofen Tablets can help lessen swelling and provide pain relief from osteoarthritis flare-ups for up to 8 hours (Bell, 2017). After considering the aspects of Marta’s history, Nurofen plus should not be recommended to her as she has asthma. It can exacerbate symptoms of asthma by inducing bronchospasm, which narrows the respiratory airways (Carter, 2017). To manage her conditions along with the medications she should eat a balanced and healthy diet to manage her weight and should sleep well. She should try to stay active. If she notices any sign of adverse reactions because of the medications she should immediately seek help and contact her doctor.

 

Considering that NSAIDs are available over-the-counter (OTC), patients must be informed of the basic safety procedures that include the fact that using OTC NSAIDs in accordance with the authorised doses for brief periods of time as directed on the label is safe. However, using these medications improperly or excessively might be dangerous to your health. Administration of NSAIDs may make unfavourable cardiovascular events more likely (Mullan, et al., 2017).

 

By avoiding items that are extremely salted and table salt, it is healthy to minimise her dietary salt intake. As she has a history of asthma, the administration of medications that can trigger her asthma should also be checked. The signs of adverse reactions should be checked in case of flare ups. If her joint pain and other problems are not under control, she would be referred to her general physician. 

 

Low-density lipoprotein (LDL) cholesterol can be decreased by statins. This kind of cholesterol is often referred to as "bad" cholesterol. High-density lipoprotein (HDL), or "good" cholesterol, can be increased with statins. Additionally, statins can reduce the level of triglycerides, a kind of fat, in the blood (Horodinschi, et al., 2019). The enzyme HMG-CoA reductase, which is involved in the pathway of production of cholesterol conversion of HMG-CoA to mevalonate, is selectively and aggressively inhibited by statins. LDL-receptors are upregulated and there is a greater hepatic absorption of LDL-cholesterol from the circulation as a result of decreased hepatic cholesterol production (Carmena & Betteridge, 2019). One can take statin drugs along with or without food. To reduce interactions of CYP3A4 that could lead to higher blood concentrations, grapefruit juice must refrain when taking some statins. Hepatic cholesterol synthesis varies throughout the day, peaking in the early morning hours. The suggested dosing strategy for several statins is an evening dose (e.g., fluvastatin, lovastatin, pravastatin, and simvastatin). The administration of atorvastatin, pitavastatin, and rosuvastatin should occur at the same time of day, regardless of whether it is morning or evening (Sizar, et al., 2022).

 

For patients with high cholesterol, physicians recommend statins to reduce their total cholesterol and lessen their likelihood of a heart attack or stroke. Although statins are quite safe and efficacious for the majority of people, they have occasionally been related to damage to the liver, muscle discomfort, digestive issues, and mental vagueness in those who consume them. Muscle discomfort is among the most prevalent side effects of statin users. The muscles may seem sore, worn out, or weak as a result of this ache. The soreness may be slight or it may be strong enough to make going about the usual business challenging. Statins can very occasionally result in rhabdomyolysis, a kind of injury to the muscles that can be fatal. Rhabdomyolysis can result in mortality, damage to the liver, kidney failure, and excruciating pain in the muscles. It is estimated that just a few instances of really significant adverse effects occur in a million people on statins, which is a very small probability. If patients take a high dose of statins or combine them with other medications, rhabdomyolysis may develop. Sometimes, using a statin may result in a rise in the enzymes that indicate inflammation of the liver. If the rise is only slight, one can keep taking the medication. Rarely, patients may have to consider an alternative statin if the increase is significant (Pinal-Fernandez, Casal-Dominguez & Mammen, 2018). When people consume a statin, it is conceivable that their blood sugar (blood glucose) level could rise, which could cause type 2 diabetes to occur. The Food and Drug Administration (FDA) has warned statin labels concerning blood glucose levels and diabetes due to the tiny but significant risk. On the labels of statins, the FDA issues a warning stating that some users may experience disorientation or loss of memory. Once patients stop taking the drug, these negative effects go away. Although there is little evidence to support a cause-and-effect connection, if one feels disorientation or loss of memory while taking statins, consult the doctor. Statins may also aid in brain activity, for instance in dementia patients, according to some data (Sultan, et al., 2019).

 

Marta has altered a lot of her medications since I last saw her, including ones that can affect myalgia and the density of the bone. Adults who have osteoporosis can use the prescription drug Fosamax to both avoid and cure specific types of osteoporosis or loss of bone. A selective suppressor of osteoclast-mediated resorption of bone, Fosamax is a bisphosphonate. Synthetic pyrophosphate analogues known as bisphosphonates connect to the hydroxyapatite present in bone. NSAIDS should be administered along with this drug with caution as it can cause irritation of the Gastrointestinal tract. There may be stomach discomfort, nausea, diarrhoea, gas, or constipation. Periodically, this medicine may result in severe oesophageal irritation and ulcers. Rarely will this medication cause a very severe allergic reaction. However, Marta should seek medical attention right away if she experiences any severe allergic response indications, such as a rash, itching or swelling (particularly of the face, tongue, or neck), dizziness, or difficulty in breathing (Parker & Preuss, 2021).

 

Prednisone acts quickly because its half-life is about 2-3 hours. The therapeutic window for corticosteroids is very broad since patients often need doses that are higher than what the body would normally manufacture. Prednisone oral pill may interfere with vitamins, herbs, or other drugs Marta may be consuming. To avoid such interactions the medications that she is consuming must be managed. The adverse effects of this medication include confusion, headache, nausea, and difficulty in sleeping (Puckett, Gabbar & Bokhari, 2018).

 

Lasix functions by preventing the kidney tubules' ability to absorb salt, chloride, and water, which significantly increases the amount of urine produced (diuresis). After oral administration, the drug starts to work within an hour, and the diuresis lasts for 6 to 8 hours. This medicine can cause severe allergic reactions such as hives, difficulty in breathing, rashes, swelling of the face and tongue, burning of eyes, ringing of ears, dizziness, fever and difficulty in urination (Khan, Patel & Siddiqui, 2018). A decline in first-pass metabolism is linked to ageing. This is most likely brought on by a decrease in the mass of the liver and the flow of blood. Body fat tends to rise with age whereas total body water tends to fall. Increased fat lengthens highly lipophilic medicines' elimination half-lives and raises the volume of distribution of those medications (Marzolini & Livio, 2019). Physiologic effects of drugs and pharmacokinetics such as absorption, distribution, metabolism and excretion should be considered.

 

Subedi, et al. (2019), concluded that Tramadol, a racemic combination of (+)- and ()-tramadol enantiomers, is a centrally functioning weak-opioid receptor analgesic. In their investigation, they detailed the most recent status of tramadol, as well as its chemistry, production, pharmacology, medical applications, side effects, and market-available combination products.

 

April, et al. (2019), determined the advantages and disadvantages of oral tramadol or tramadol coupled with acetaminophen or NSAIDs in individuals with osteoarthritis. They discovered that there is moderate quality data suggesting that tramadol alone or in conjunction with acetaminophen certainly provides no significant benefits on mean pain or function in individuals with osteoarthritis compared to placebo.

 

In conclusion, it can be said that with proper management of her medications and a healthy lifestyle, Marta can manage her health conditions. She should take the medicines as directed by her physicians and should not stop any medicines without consulting her physicians. As she is old the medicines can interact and cause some serious issues. She should pay attention to them. 

 

 

April, K. T., Bisaillon, J., Welch, V., Maxwell, L. J., Jüni, P., Rutjes, A. W., ... & Tugwell, P. (2019). Tramadol for osteoarthritis. Cochrane database of systematic reviews, (5).

 

 

Bell, J. (2017). Over the counter: Pain management: From Bex to ibuprofen. PS Post Script, (Jun 2017), 41.

 

 

Carmena, R., & Betteridge, D. J. (2019). Diabetogenic action of statins: mechanisms. Current atherosclerosis reports, 21(6), 1-9.

 

 

Carter, A. (2017). Asthma and ibuprofen: What are the effects? https://www.medicalnewstoday.com/articles/319354#what-effects-do-ibuprofen-and-other-painkillers-have-on-asthma

 

 

Conaghan, P. G., Arden, N., Avouac, B., Migliore, A., & Rizzoli, R. (2019). Safety of paracetamol in osteoarthritis: what does the literature say?. Drugs & aging, 36(1), 7-14.

 

 

Doherty, M., Abhishek, A., & Hunter, D. (2017). Clinical manifestations and diagnosis of osteoarthritis. UpToDate [Internet], 1-30.

 

 

Horodinschi, R. N., Stanescu, A. M. A., Bratu, O. G., Pantea Stoian, A., Radavoi, D. G., & Diaconu, C. C. (2019). Treatment with statins in elderly patients. Medicina, 55(11), 721.

 

 

Khan, T. M., Patel, R., & Siddiqui, A. H. (2018). Furosemide. https://www.ncbi.nlm.nih.gov/books/NBK499921/

 

 

Mallet, C., Eschalier, A., & Daulhac, L. (2017). Paracetamol: update on its analgesic mechanism of action. Pain relief–From analgesics to alternative therapies.

 

 

Marzolini, C., & Livio, F. (2019). Prescribing issues in elderly individuals living with HIV. Expert review of clinical pharmacology, 12(7), 643-659.

 

 

McCrae, J. C., Morrison, E. E., MacIntyre, I. M., Dear, J. W., & Webb, D. J. (2018). Long‐term adverse effects of paracetamol–a review. British journal of clinical pharmacology, 84(10), 2218-2230.

 

 

Mora, J. C., Przkora, R., & Cruz-Almeida, Y. (2018). Knee osteoarthritis: pathophysiology and current treatment modalities. Journal of pain research, 11, 2189.

 

 

Mullan, J., Weston, K. M., Bonney, A., Burns, P., Mullan, J., & Rudd, R. (2017). Consumer knowledge about over‐the‐counter NSAIDs: they don't know what they don't know. Australian and New Zealand journal of public health, 41(2), 210-214.

 

 

O'Neill, T. W., McCabe, P. S., & McBeth, J. (2018). Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best practice & research Clinical rheumatology, 32(2), 312-326.

 

 

Paracetamol, N. (2022). 3.61 PARACeTAMOL: MODIFIeD-ReLeAse FORMULATIONs. Toxicology Handbook.

 

 

Parker, L. R. W., & Preuss, C. V. (2021). Alendronate. In StatPearls [Internet]. StatPearls Publishing.

 

 

Pinal-Fernandez, I., Casal-Dominguez, M., & Mammen, A. L. (2018). Statins: pros and cons. Medicina Clínica (English Edition), 150(10), 398-402.

 

 

Puckett, Y., Gabbar, A., & Bokhari, A. A. (2018). Prednisone. https://www.ncbi.nlm.nih.gov/books/NBK534809/

 

 

Sen, R., & Hurley, J. A. (2021). Osteoarthritis. In StatPearls [Internet]. StatPearls Publishing.

 

 

Sizar, O., Khare, S., Jamil, R. T., & Talati, R. (2022). Statin medications. In StatPearls [Internet]. StatPearls Publishing.

 

 

Subedi, M., Bajaj, S., Kumar, M. S., & Mayur, Y. C. (2019). An overview of tramadol and its usage in pain management and future perspective. Biomedicine & Pharmacotherapy, 111, 443-451.

 

 

Sultan, S., D'Souza, A., Zabetakis, I., Lordan, R., Tsoupras, A., Kavanagh, E. P., & Hynes, N. (2019). Statins: rationale, mode of action, and side effects. In The Impact of Nutrition and Statins on Cardiovascular Diseases (pp. 171-200). Academic Press.