NRNP 6566: Advanced Care of Adults in Acute Settings Essay

NRNP 6566: Advanced Care of Adults in Acute Settings Essay

NRNP 6566: Advanced Care of Adults in Acute Settings Essay

Advanced Care of Adults In Acute Settings

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Advanced Care of Adults in Acute Settings
Medications have formed a key part of the treatment and management of diseases for a long time, implying that those who administer the medications should have adequate knowledge regarding these medications, their administration, potential side effects, adverse effects, metabolism, and mechanism of reaction and drug interactions, among others. It is important to have such knowledge to protect patients from potential harm and ensure effective treatment (Lilley et al., 2022). Therefore, the purpose of this assignment is to explore various aspects of medications, such as the impact of grapefruit juice on the metabolism of Zocor, and an exploration of another combination of medications that would affect the metabolism of medications in the Cytochrome P450 system.

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The Effect of Grapefruit Juice on Zocor Metabolism and Pathways Involved
Grapefruit juice is today widely used as a way of protecting individuals against cancers and cardiovascular diseases. However, past and recent research shows that it impacts the metabolism of certain medications containing statins which are metabolized by CYP3A, an enzyme that is a member of the P-450 system. It is known to be responsible for the first-pass metabolism of many drugs. Grapefruit juice is known to inhibit the P-glycoprotein pump, which is found in the brush border of the intestinal wall and transports the majority of the cytochrome P-450 3A4 substrates (Tornio et al., 2019). Therefore, grapefruit juice changes the pharmacokinetics leading to an elevation of serum concentrations. The increased levels of serum mean that, as part of the effects, the individuals experience an increased frequency of dose-dependent adverse effects. As part of the pathway, furanocoumarins, found in grapefruit juice, inhibits CYP3A from accomplishing its work leading to the absorption of more drug.
Safe administration requires appropriate monitoring. Therefore, the administration of Zocor requires close monitoring, though not continuous, for safety. For example, the lipid profile has to be monitored one month after administration and periodically thereafter for potential dose adjustments. Liver function tests are also accomplished at baseline and thereafter to examine potential liver toxicities (Talreja et al., 2019). Race or ethnicity may also affect the metabolism of medications. For example, statins used in reducing LDL-C have been shown to prevent cardiovascular events in both Western and Eastern patients. However, the dose and the degree of cholesterol reduction have been shown to be different between Western and Asian patients, demonstrating the impact of race and ethnicity.
Another Medication Combination That Would Affect the Metabolism of Medications in the Cytochrome P450 System
Drug-drug interactions are an important issue in patient care, and the interactions are usually explained by the alterations in the embolic enzymes found in the liver and extra-hepatic tissues. Most of the interactions between medications are due to P450. Apart from the interactions between grapefruit juice and Zocor, there are other medication combinations that would affect the metabolism of medication in the cytochrome P450 system. For example, the interaction of erythromycin and terfenadine; their interaction and combination prolong the electrocardiographic QT intervals (Manikandan & Nagini, 2018). Such a phenomenon triggers a particular cardiac dysrhythmia. It is caused when a nitro compound demethylated by P450 turns into a complex. The safe prescription of these drugs requires that the prescriber considers the patient’s underlying conditions such as cardiac conditions. Monitoring of erythromycin entails monitoring for QT prolongation. Terfenadine should also be monitored for prolongation of QT interval and cholestatic hepatitis.
Conclusion
Drug-drug interactions can cause adverse effects and harm patients. Hence professionals should appropriately monitor various medications for possible interactions. In addition, certain foods, such as grapefruit juice, have been shown to interact with certain medications containing statins, inhibiting certain actions, which then lead to increased serum levels. An example is an interaction of Zocor and grapefruit juice, which leads to changes in metabolism.

References
Lilley, L. L., Collins, S. R., & Snyder, J. S. (2022). Pharmacology and the nursing process E-Book. Elsevier health sciences.
Manikandan, P., & Nagini, S. (2018). Cytochrome P450 structure, function and clinical significance: a review. Current Drug Targets, 19(1), 38-54. https://doi.org/10.2174/1389450118666170125144557
Talreja, O., Kerndt, C. C., & Cassagnol, M. (2018). Simvastatin. https://www.ncbi.nlm.nih.gov/books/NBK532919/#article-29036.s7
Tornio, A., Filppula, A. M., Niemi, M., & Backman, J. T. (2019). Clinical studies on drug–drug interactions involving metabolism and transport: methodology, pitfalls, and interpretation. Clinical Pharmacology & Therapeutics, 105(6), 1345-1361. https://doi.org/10.1002/cpt.1435

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Describe the effect of grapefruit juice on the metabolism of Zocor. Explain the pathways involved and the monitoring required for safe administration of this medication. Include how race/ethnicity may affect the metabolism of medications.

Identify another combination of medications that would affect the metabolism of medications in the cytochrome P450 system. Explain the safe prescribing and monitoring of these drugs.

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