Understanding Balance Issues and First-Pass Metabolism in a 70-Year-Old Patient Taking Diazepam

Understanding Balance Issues and First-Pass Metabolism in a 70-Year-Old Patient Taking Diazepam

Question One: The Cause of the Patient’s Difficulty in Maintaining Her Balance

As with other benzodiazepines, diazepam (valium) works on the central nervous system (CNS). It affects how brain neurotransmitters work and how related chemicals are released. Thus, Valium aids nerves in communicating with other nerves. Prolonged use can impair the aging nervous system, causing the 70-year-old woman to have a dizzy feeling and things around her turn around. Our assignment writing services will allow you to attend to more important tasks as our experts handle your task.

Question Two: First-Pass Effect

The first pass effect occurs when a drug gets metabolized at a certain location in the body, leading outside of the target site, reducing the concentration and action of the active ingredient on the site of action (Zaidat et al., 2018). The first-pass effect in orally administered diazepam is affected by gastrointestinal, gut wall, bacterial, and hepatic enzymes. To circumvent this, a change of the mode of administration is required. The use of intranasal delivery reduces the chances of enzyme action on the active ingredients and also creates a larger surface area for absorption.

Question Three: Causes of The Signs of Confusion

Acetaminophen action in the body of the 75-year-old woman is the cause of the confusion. Acetaminophen poisoning in older adults leads to liver toxicity and acute liver failure, leading to functional impairment (Ramachandran & Jaeschke, 2018). The impaired liver functions allow the accumulation of toxins within the circulatory system, affecting the lady’s psychomotor and cognitive function, which explains her episodes of confusion.

Question Four: Warfarin Metabolism

Warfarin has a half-life of 20 to 60. It is metabolized in the liver by the CYP-2CP microsomal liver enzymes (Grayson et al., 2018). If taken during pregnancy, warfarin may cause fetal plasma levels to equal the mother’s values as the drug can cross the placental barrier.

Question Five: The Hepatic Drug Metabolism of Children 1 Year and Older

Hepatic metabolism in children is controlled by the activities and expression of drug-metabolizing enzymes based on maturity. In addition, hepatic blood flow, active transport processes, and related plasma protein binding also affect the metabolism’s efficiency (Krekels et al., 2017). Hepatic drug metabolism in children and adults differs due to body age, body weight, and functions. The liver weight and hepatic blood flow rate per unit liver weight in children is higher than in adults, thus affecting drug pharmacokinetics.

Question Six: Protein Binding in Neonates

Protein binding is how drugs attach to protein in the blood. Drug-binding proteins in neonates determine the disposition and action of drugs as they control drug distribution throughout the body. If a high competition for binding proteins between neonates and other substrates exists, then a decreased protein binding in neonates may be experienced.

References

Grayson, L., Vines, B., Nichol, K., & Szaflarski, J. P. (2018). An interaction between warfarin and cannabidiol, a case report. Epilepsy and Behavior Case Reports, 9, 10–11. https://doi.org/10.1016/j.ebcr.2017.10.001

Krekels, E. H. J., Rower, J. E., Constance, J. E., Knibbe, C. A. J., & Sherwin, C. M. T. (2017). Hepatic Drug Metabolism in Pediatric Patients. Drug Metabolism in Diseases, 181–206. https://doi.org/10.1016/B978-0-12-802949-7.00008-0

Ramachandran, A., & Jaeschke, H. (2018). Acetaminophen toxicity: Novel insights into mechanisms and future perspectives. Gene Expression, 18(1), 19–30. https://doi.org/10.3727/105221617X15084371374138

Zaidat, O. O., Castonguay, A. C., Linfante, I., Gupta, R., Martin, C. O., Holloway, W. E., Mueller-Kronast, N., English, J. D., Dabus, G., Malisch, T. W., Marden, F. A., Bozorgchami, H., Xavier, A., Rai, A. T., Froehler, M. T., Badruddin, A., Nguyen, T. N., Asif Taqi, M., Abraham, M. G., … Nogueira, R. G. (2018). First pass effect: A new measure for stroke thrombectomy devices. Stroke, 49(3), 660–666. https://doi.org/10.1161/

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Post your answers to the 6 questions corresponding to this week’s primary care medication management content. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)

Understanding Balance Issues and First-Pass Metabolism in a 70-Year-Old Patient Taking Diazepam

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.
Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?

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 it, she becomes very confused and disoriented.

Q3. What is likely causing the signs of confusion?

A 26-year-old woman who has never been pregnant is seeking preconception care as she is planning to pursue pregnancy in a couple of months. Currently, she has no symptoms to report, and on review of body systems, there were no concerns. Her past medical history is significant for a history of rheumatic fever as a child. She subsequently underwent valve replacement with a mechanical heart valve. She is followed by a cardiologist who has already evaluated her cardiac function, and she has received clearance from her cardiologist to pursue pregnancy. Records from her cardiologist include a recent cardiac echocardiography report that reveals a normal ejection fraction, indicating normal cardiac function.

She has no alterations in her daily activities related to her heart. She has no other significant medical or surgical history. She is a non-smoker, drinks occasionally but has stopped as she is attempting to conceive, and does not use any non-prescription drugs.

Current Medications: Her current medications include only prenatal vitamins, which she has begun in anticipation of pregnancy, and warfarin. She has no known drug allergies.

Vital Signs: On examination, her pulse is 80 beats per minute, her blood pressure is 115/70 mm Hg, her respiratory rate is 18 breaths per minute, and she is afebrile.

Measurements: Weight = 152 pounds, Height = 5′5 ″, BMI= 25.29

Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?

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?

Q6. Explain protein binding in the neonate.
A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years