Pharmacokinetic and Pharmacodynamic Processes in a Patient with Strokes

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Patient CB is suffering from strokes and exhibits many common comorbidities. Related conditions such as type 2 diabetes, hypertension, and hyperlipidemia that the patient is diagnosed with may lead to insulin resistance putting the patient at higher risk of developing Coronary heart disease (CHD).

Type 2 diabetes is a condition, in which the body resists insulin or is unable to produce enough insulin. This affects the metabolism of sugar in the cells leading to unusual glucose levels in the body (Jelinek et al., 2017). Hyperlipidemia means a high level of cholesterol or lipids in the blood, leading to blockages in the arteries. Due to these obstructions caused by deposits of lipids, the artery may develop high blood pressure. These comorbidities are majorly associated with obesity brought about by the lack of exercise and unhealthy lifestyles.

How Behavior Factor Influences the Pharmacokinetic and Pharmacodynamics Processes

Owing to the health condition of Patient CB, the behavior factor would affect drug pharmacodynamics and pharmacokinetics the most. Pharmacodynamics is when there is a set of processes in place, in which drugs produce physiological changes in the body. It is what a drug does to the body, and it involves receptor effects and chemical interactions.

Pharmacokinetics consists of a process, in which drug absorption and elimination occur in the blood. The rate of drug accumulation and removal from the body depends on the following functions: absorption, distribution, metabolism, and excretion (Patilea‐Vrana & Unadkat, 2016). Since the patient has a history of strokes, his or her behaviors can significantly influence the therapeutic procedure recommended. For instance, consumption of alcohol and smoking can affect drug metabolism in the body forcing the patient to take multiple drugs to manage the conditions.

How Behavioral Factors May Affect Drug Therapy

When alcohol interacts with drugs in the body, it reacts against them, altering their metabolism processes or effects. It affects pharmacokinetics through alteration of gastric emptying or liver metabolism. The liver is the primary site where breakdown and absorptions of drugs occur once patients take them, and it has enzymes that aid the whole process.

However, in case there is a presence of alcohol in the bloodstream, aldehyde dehydrogenase (ADH) and cytochrome P450 enzymes would react with its chemical components through the oxidation process producing acetaldehyde (Durant et al., 2018). The later chemical compositions are harmful and toxic to the body and can affect the pharmacokinetics and pharmacodynamics processes. The adverse drug reactions caused by medicines and ADH interactions can further result in some side effects such as nausea, vomiting, headaches, and fainting. Other severe reactions such as internal bleeding may be experienced, causing ulcers or gastritis.

Behavioral factors such as smoking can also affect the metabolic process by slowing down enzymes’ actions, such as hepatic cytochrome P-450 (CYP). Many drugs are substrates to hepatic enzymes, meaning it aids in the body’s metabolism. However, the presence of nicotine may counter or decrease the pharmacologic actions of some of them. The presence of nicotine can also increase the rate of heparin clearance leading to heparin binds with a high affinity and consequently affecting pharmacokinetics and dosage (Stiles et al., 2017).

Nicotine may also lead to Cutaneous vasoconstriction, decreasing the rate of insulin absorptions, hence undermining pharmacodynamics. When a patient with hypertension, such as patient CB, takes beta-blockers, cigarette smoking may reduce the drug’s effects, resulting in increased blood pressure and heart rate.

Recommended Improvements

To improve patient CB’s drug therapy, the current drug treatment plan should be altered. The patient’s lifestyle should also change to reduce adverse health conditions and limit multiple drugs. Aspirin should be added to the drug list to prevent blood clots and future heart attacks from occurring (Patrono & Baigent, 2019).

In adults experiencing severe pain and fever, the dose recommended is 325-650 mg of aspirin every 4-6 hours. However, it has some side effects such as nausea, abdominal burning, pain, cramping, and ringing in the ears. Both simvastatin and verapamil should be removed from the patient’s drug list and replaced with atorvastatin and amlodipine. This is because atorvastatin and amlodipine can reduce and prevent cardiovascular diseases and events. Statins should be added in the list since they have a higher capability of lowering cholesterol levels in the blood.

Moreover, the patient should take atorvastatin (Rx) at 10-80 mg PO qDay. Atenolol may sometimes cause hyperglycemia; therefore, patient CB should replace it with Coreg that has been proven to improve blood pressure and lower glucose levels in the blood (Bharati & Singh, 2016). Although Coreg may cause chest pain, dry cough, wheezing, and dry mouth, it can be administered at 80 mg PO qDay.

Glipizide doses should be maintained, and alternatively, the patient should start regular physical exercises and keeping healthier diets. Consequently, blood pressure would improve, leading to the stoppage of HCTZ, hydralazine, atenolol, and glipizide. The patient would have to take minimal dosage saving on cost.

Conclusion

In conclusion, patient CB is suffering from stokes and exhibits type 2 diabetes, hypertension, and hyperlipidemia conditions related to higher blood sugar. Weight gain due to lack of regular exercise may be the leading cause of these conditions; therefore, there is a need for a lifestyle change. If conditions persist, the medications prescribed would be ineffective since unhealthy behaviors such as alcoholism and smoking may affect their pharmacodynamics and pharmacokinetics processes in the body cells.

Patient CB should adjust the medicine list by introducing aspirin, replacing simvastatin and verapamil with atorvastatin and amlodipine, and Atenolol with Coreg. Alternatively, the patient should start regular physical exercises and keep healthier diets to improve blood pressure and stop using multiple drugs simultaneously.

References

Bharati, S. M., & Singh, N. (2016). Effect of losartan and atenolol on insulin sensitivity in nondiabetic hypertensive patients. Journal of Pharmacology & Pharmacotherapeutics, 7(2), 80. Web.

Durant, C. F., Paterson, L. M., Turton, S., Wilson, S. J., Myers, J. F., Muthukumaraswamy, S., Venkataraman, A., Mick, I., Paterson, S., Jones, T. & Nahar, L. K. (2018). Using baclofen to explore GABA-B receptor function in alcohol dependence: Insights from pharmacokinetic and pharmacodynamic measures. Frontiers in Psychiatry, 9, 664. Web.

Jelinek, H. F., Osman, W. M., Khandoker, A. H., Khalaf, K., Lee, S., Almahmeed, W., & Alsafar, H. S. (2017). Clinical profiles, comorbidities and complications of type 2 diabetes mellitus in patients from United Arab Emirates. BMJ Open Diabetes Research and Care, 5(1). Web.

Patilea‐Vrana, G., & Unadkat, J. D. (2016). Transport vs. metabolism: What determines the pharmacokinetics and pharmacodynamics of drugs? Insights from the extended clearance model. Clinical Pharmacology & Therapeutics, 100(5), 413-418. Web.

Patrono, C., & Baigent, C. (2019). Role of aspirin in primary prevention of cardiovascular disease. Nature Reviews Cardiology, 16(11), 675-686. Web.

Stiles, M. F., Campbell, L. R., Graff, D. W., Jones, B. A., Fant, R. V., & Henningfield, J. E. (2017). Pharmacodynamic and pharmacokinetic assessment of electronic cigarettes, combustible cigarettes, and nicotine gum: implications for abuse liability. Psychopharmacology, 234(17), 2643-2655. Web.

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Pharmacokinetic and Pharmacodynamic Processes in a Patient with Strokes

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