Response on Beer Criteria
Travis,
Great post! I agree with you. Beer criteria list medications that should be used cautiously and those that need to be avoided when attending to older patients (Pauldurai et al., 2012). This criterion helps to minimize the negative health outcomes of patients. With less research, the safe method for calculating medicine in a pediatric patient is body surface area or weight-based dosing. Teratogenesis is common during the organogenesis stage of the embryonic period. During this period, one is sensitive to teratogens, which include medications. These teratogens have a probability of causing organ malformations such as cleft lips. For a patient who easily forgets to take their medication, then a drug with a long half-life will be beneficial to them. This will allow the medicine to cause the desired effect on the patient’s body. Our assignment writing help is at affordable prices to students of all academic levels and academic disciplines.
The type of patients with rapid metabolizers rarely do have the desired effect after receiving medication. This applies to increasing the doses of medication. The bodies of these patients have very active enzymes that readily absorb the medicines before they can cause the desired effect. During drug prescriptions for older adults, it is important to consider an aspect of food-drug interaction. I agree with you; grapefruit juice interacts with so many prescribed medications. It does this by inhibiting cytochrome P3A4 (Bailey, 2016). With this inhibition, drug metabolism is inhibited and cannot be absorbed into the tissues. Instead, the levels of non-metabolized drugs rise in the blood, causing drug toxicity. To prevent drug toxicity, it is important to avoid an oral route of drug administration. This is because the juice will inhibit the cytochrome found in the intestines. However, the intravenous way is more advisable in older people since the juice has minimal and reduced effects on the liver. For patients who take more grapefruit juices, their drug toxicity levels are elevated.
References
Bailey, D. G. (2016). Predicting clinical relevance of grapefruit-drug interactions: a complicated process. Journal of clinical pharmacy and therapeutics, 42(2), 125-127. https://europepmc.org/article/med/27709656
Pauldurai, M., Kannaaiyan, D., & Rao, R. (2015). Assessment of Potentially Inappropriate Medicines Used in Geriatric Patients According to 2012 AGS Beer’s Criteria in Tertiary Care Teaching Hospital. Asian Journal of Pharmaceutical and Health Sciences, 5(3). https://ajphs.com/article/2015/5/3/1273-1279
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Question 
What is the Beer Criteria, and what is its significance in prescribing?
Beers criteria is a list of medications that may be unsafe or harmful to older adults (Jacobs, 2019). There are five other lists of drugs, and they include drugs that are avoided by most older adults, avoided by older adults who have certain health conditions, avoided in combination treatments, used with caution due to possible harmful side effects, and medications that have different dosing for people with reduced renal function (Jacobs, 2019). This list was updated in 2019, and the new criteria have 30 medications or medication classes that should be avoided in older adults and 40 pills that should be used with caution or not when the person has specific conditions (Jacobs, 2019). The Beers Criteria is significant because it can help avoid potential negative outcomes in the older population that can be associated with certain drugs or drug classes.
Response on Beer Criteria
What is the safest method of calculating a medication dose for a pediatric patient?
The most common way of getting a pediatric dose of a medication is either weight-based or body surface area-based dosing (O’Hara, 2016). Since there are very limited studies of the pharmacokinetics in the pediatric population, it can be difficult to determine the correct dose for this population (O’Hara, 2016). Generally, the pediatric dose can be extrapolated from the adult dose of a drug using a formula that involves the adult dose and the child’s body surface area; however, this is only approximate, and the amount may still need adjusting to reach a therapeutic level (Rosenthal & Burchum, 2018).
At what period in pregnancy can medication potentially have the greatest risk of causing malformations?
Teratogenesis, which is usually thought of as a gross malformation like a cleft palate, most likely happens during the embryonic development period because this is when the organs are forming (Rosenthal & Burchum, 2018). The embryonic period is weeks 3-8 of pregnancy (Rosenthal & Burchum, 2018). Teratogens during the first few weeks of pregnancy are usually all or nothing in that there will either be death or complete recovery, and exposure after the embryonic period usually results in loss of function since the organs themselves have already taken shape (Rosenthal & Burchum, 2018).
If your patient sometimes forgets to take her medication, what type of medication half-life would be beneficial?
According to Rosenthal and Burchum (2018), drugs that have a long half-life and a longer period can go between doses without a loss of the benefit of that particular drug. This means that when a patient forgets to take their medications periodically, it would be better to have a drug with a long half-life so they do not miss out on the effects of their medication when they forget to take it.
Your patient is on the highest daily dose of his medication, and it is not giving him the desired effect. What type of metabolizer is he with this medication?
People have different rates of metabolism, and this can affect the rate at which medications are metabolized as well. People who quickly metabolize medications are known as rapid metabolizers (Rosenthal & Burchum, 2018). It can be difficult to achieve a therapeutic effect of medicines in fast metabolizers because their body renders the drug ineffective by metabolizing the drug so quickly (Rosenthal & Burchum, 2018).
What food item interacts with many medications and should be asked about ingestion, especially in the elderly?
Grapefruit juice can affect the metabolism of drugs. Compounds identified in the grapefruit juice inhibit CYP3A4, which inhibits the metabolism of drugs and causes an increased blood level of some drugs, making the drug toxic (Rosenthal & Burchum, 2018). Since CYP3A4 is found in the wall of the intestines and the liver and the grapefruit juice has a high effect on the intestinal CYP3A4 and a minimal effect on the liver CYP3A4, this effect is minimal or nonexistent on intravenous drugs since the intestinal metabolism is not involved with intravenous drugs (Rosenthal & Burchum, 2018). Lastly, CYP3A4 inhibition is directly related to the amount of grapefruit juice that a person drinks; the more juice a person drinks, the greater the inhibition and the greater the potential toxicity (Rosenthal & Burchum, 2018).
References
Jacobs, L. G. (2019). For Older Adults, Medications are Common: An Updated AGS Beers Criteria ® Aims to Ensure They Are Appropriate, Too. Journal of Gerontological Nursing, 45(5), 47–48. https://doi.org/10.3928/00989134-20190319-01
O’Hara, K. (2016). Pediatric pharmacokinetics and drug doses. Australian Prescriber, 39(6), 208–210. https://doi.org/10.18773/austprescr.2016.071
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.