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

By
Responsive Centered Red Button

Need Help with this Question or something similar to this? We got you! Just fill out the order form (follow the link below), and your paper will be assigned to an expert to help you ASAP.

Order Form

Respond to the 2 following discussion posts separately and with separate references lists.
References to be no older than 5 years.
1. 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?
Diazepam is a benzodiazepine that causes sedative effect. The patient is 70 years old, and I need to ask questions about how many times in a day does she takes valium. Also, questions regarding forgetfulness or completing a dementia screening. A rationale for trouble maintaining her balance may be the decreased renal function capacity to clear out in the system can cause an overdose of diazepam. It is recommended to reduce her dose at a therapeutic level with her age (Dhaliwal et al., 2021).
Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?
“The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. When drugs are absorbed from the gastrointestinal tract, they are carried directly to the liver through the hepatic portal vein before entering the systemic circulation” (Rosenthal & Burchum, 2021, p. 18). This can be circumvented by administering it via the parenteral route to prevent it from passing in the gastrointestinal tract. (Rosenthal & Burchum, 2021, p. 18).
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?
Age is a factor in decreased kidney function, and kidney nephrons excrete the medication. There can also be a competition between two drugs when administered simultaneously and the same metabolic pathway, which can decrease the metabolic rate (Rosenthal & Burchum, 2021, p. 18).
This can cause the accumulation of drugs in the system causing the 75-year-old woman to have confusion and disorientation. These medications can also cause impaired motor coordination. (National Institute of Diabetes and Digestive and Kidney Diseases, 2017).
Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?
Hepatic microsomal enzymes metabolize warfarin, and the urine secretes it. Warfarin may cause to cross the placental barrier due to its low molecular weight (Yurdakök, 2012). Warfarin may cause teratogenic effects, but her history of valve replacement with a mechanical heart valve taking coumadin will outweigh the benefits than the risk to the mother. (Rosenthal & Burchum, 2021)
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?
At the age, there is a complete maturation of the liver, and pharmacokinetics is the same with adults. However, the children metabolize the drug faster, whereas in neonates, the liver is not mature and drug-metabolizing capacity is low. (Rosenthal & Burchum, 2021, p. 59)
Q6. Explain protein binding in the neonate.
Protein binding in the neonate is limited in the infant because “(1) the amount of serum albumin is relatively low, and (2) endogenous compounds (e.g., fatty acids, bilirubin) compete with drugs for available binding sites” (Rosenthal & Burchum, 2021, p. 59)
References
Dhaliwal JS, Rosani A, Saadabadi A. (2021). Diazepam. In: StatPearls [Internet]. Treasure Island (FL). Retrieved on March 3, 2022. DOI: https://www.ncbi.nlm.nih.gov/books/NBK537022/
National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Phenyltoloxamine. Retrieved on March 3, 2022. DOI: https://www.ncbi.nlm.nih.gov/books/NBK548789/?report=reader
Rosenthal, L. D. & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants.
Yurdakök M. (2012). Fetal and neonatal effects of anticoagulants used in pregnancy: a review. The Turkish journal of pediatrics, 54(3), 207–215.
2. This paragraph will explore the medication Diazepam or better known by it’s brand name Valium. Valium is a benzodiazepine that works on the neurotransmitters in the brain leading to decrease in anxiety and can also help control seizure activity. This medication is habit forming and should not be started or stopped without the oversight of a provider. The first question in the series is regarding a 70-year-old female with a history of taking valium for 15 years as needed for sleep or anxiety. She has difficulty maintaining her balance after taking her medication which could be due to several factors. Most likely she is experiencing a side effect of the medication which occurs with all medications, and a common one for Valium is hypotension (Khalid et al., 2021). This could be compounded if she takes medications for blood pressure control and the side effect of valium is becoming more pronounced. This medication also has a high first pass effect which can occur as quickly as within five minutes of administration (Khalid et al., 2021). First pass occurs when the liver, lungs, vasculature, or other metabolic sites within the body metabolizes the drug and reduces its concentration before reaching the target site (Nahler, 2021).
Over the counter medications are sold and considered safe for use by the general public. However, depending on the person taking the medication, their health conditions and the severity of their illness over the counter medications may not be a wise choice. In this paragraph we will determine possible causes of confusion and disorientation after its use. This patient is 75 years of age and took the recommended dose of OTC cold medication which contained several potent anticholinergic medications. These medications are known to “dry up” secretions and cause vasoconstriction. In an article by Springer they mention that older persons are at high risk of this side effect due to poly-pharmacy as well as central nervous systems toxicity due to dosage and the level of interference with neurotransmitter function (Moore & O’Keeffe, 1999).
In the next question we find a 26-year-old woman seeking preconception care and has a history of heart valve replacement that is currently followed by a cardiologist who has provided a clearance for pregnancy. She is currently taking prescribed warfarin, has no morbidities, is of normal body weight, and taking a prenatal vitamin. Warfarin is metabolized in the P 450 pathway and can be affected by other things metabolized in the same pathway for example grapefruit juice (Kaminsky & Zhang, 2022). Warfarin easily passes the placental barrier, because this patient cannot safely stop anticoagulant therapy changing her to low molecular weight heparin known by brand as Enoxaparin (Kaminsky & Zhang, 2022).
Metabolism of drugs and the way in which our bodies process medications can have significant impact on health and well-being. In vulnerable populations especially. Children who are age one have livers and kidneys that are immature. The liver in children at age one is more efficient than that of an infant, and this is in part due to relative size of the liver to the body size of a one-year-old. The kidneys have been found to execrate medications more readily after the age of one and is the primary site of elimination (Batchelor & Marriott, 2015). It has been seen that while hepatic metabolism in children is better than infants it does occur similar (dose dependent) to that of an adult (Batchelor & Marriott, 2015). It is also important to note that protein biding in neonates in plasma levels is decreased and gradually increases with age (Batchelor & Marriot, 2015).
References
Batchelor, H., & Marriott, J. (2015). Paediatric pharmacokinetics: Key considerations. British Journal of Clinical Pharmacology, 79(3), 395–404. Retrieved March 3, 2022, from https://doi.org/10.1111/bcp.12267
Kaminsky, L., & Zhang, Z.-Y. (2022). Human p450 metabolism of warfarin. PubMed.Gov. Retrieved March 3, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S0163725896001404?via%3Dihub
Khalid, S., Rasool, M., Imran, I., Majeed, A., Saeed, H., Rehman, A., Ashraf, W., Ahmad, T., Bin Jardan, Y. A., & Alqahtani, F. (2021). A physiologically based pharmacokinetic model for predicting diazepam pharmacokinetics after intravenous, oral, intranasal, and rectal applications. Pharmaceutics, 13(9), 1480. Retrieved March 3, 2022, from https://doi.org/10.3390/pharmaceutics13091480
Moore, A. R., & O??Keeffe, S. T. (1999). Drug-induced cognitive impairment in the elderly. Drugs & Aging, 15(1), 15–28. Retrieved March 3, 2022, from https://doi.org/10.2165/00002512-199915010-00002
Nahler, G. (2021). First pass effect. Dictionary of Pharmaceutical Medicine, 75–75. Retrieved March 3, 2022, from https://doi.org/10.1007/978-3-211-89836-9_566

How to create Testimonial Carousel using Bootstrap5

Clients' Reviews about Our Services