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Advanced Pharmacology.

Advanced Pharmacology.

CASE STUDY 2: Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following: • Warfarin 5 mg po daily MWF and 2.5 mg daily T, TH, Sat, Sun • Aspirin 81 mg po daily • Metformin 1000 mg po bid • Glyburide 10 mg po bid • Atenolol 100 mg po daily • Motrin 200 mg 1–3 tablets every 6 hours as needed for pain Write a 2- to 3-page paper that addresses the following: Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Advanced Pharmacology.


The Obesity Factor and Its Effect on the Pharmacokinetics and Pharmacodynamics of Pharmacotherapeutic Agents Used to Treat a Patient With Type II Diabetes Mellitus, Hypertension, Hyperlipidemia, and Ischemic Heart Disease

Patient HM in this case study has been diagnosed with Type II diabetes mellitus, hypertension, hyperlipidemia, and ischemic heart disease. These are all medical conditions that are associated with being overweight or obese. In this paper, the obesity factor has been chosen and will be examined with focus on its effect on the pharmacokinetics and pharmacodynamics of the medications that this patient has been put on. Advanced Pharmacology.

This patient has been put on warfarin, acetyl salicylic acid (ASA), metformin, glyburide, atenolol, and motrin. Warfarin and ASA are agents that thin the blood and prevent the occurrence of cardiovascular events, since the patient already suffers from ischemic heart disease (Stahl, 2017). Metformin and glyburide on the other hand are oral glucose-lowering agents that are given to this patient to manage his Type II diabète mellitus. Atenolol is a beta-blocker aimed at managing any eventuality such as atrial fibrillation. He then takes motrin for pain relief (Stahl, 2017). Advanced Pharmacology.

Because of iys association with cardiovascular disease, Type II diabetes and other medical conditions, obesity is responsible for more than 2.8 million deaths worldwide per year (Malina & Kashyapb, 2014).


The factor of obesity has been shown to influence the pharmacokinetic and pharmacodynamic processes of drugs such as these that patient HM has been put on. Obesity causes the liver and other organs to be fatty and this affects their efficacy. In particular, when the liver is abnormally fatty, the effectiveness of its cytochrome P-450 enzymes responsible for drug metabolism (a stage in the process of absorption, distribution, metabolism, and excretion or ADME) is lowered (Telessy & Buttar, 2017). Obesity also makes the kidneys malfunction, hence excretion in the ADME chain of pharmacokinetics is affected. Likewise, because obesity causes changes in the gastrointestinal tract, the absorption phase of the ADME process of pharmacokinetics (PK) is also affected. In general, therefore, the pharmacodynamics (PD) of these drugs also end up being affected. Studies have proved that PK, PD, and overall clinical responses to drugs of patients who are obese compared to those who are lean are different (Telessy & Buttar, 2017; De Baerdemaeker et al., 2004). Advanced Pharmacology.


On the effect of obesity on the PD of drugs, glyburide has been shown to cause acute pancreatitis in obese patients being treated for Type II DM (Blomgren et al., 2002). This is as a result of their altered pharmacodynamics by obesity. On the other hand, metformin induces weight lossin overweight and obese persons being treated for concomitant Type II DM (Malina & Kashyapb, 2014). This it does by its pharmacodynamics being mediated by the effects of obesity. Metformin directly affects the neurons in the hypothalamus that regulate feeding. Weight loss has since been accepted as a favorable side effect of Type II DM treatment in obese patients (Malina & Kashyapb, 2014). Advanced Pharmacology.

These changes might impact this patient’s recommended drug therapy in that the glyburide dose may specifically need to be reduced to prevent the development of acute pancreatitis. This patient’s drug therapy plan can be improved therefore by monitoring his body mass index or BMI and then titrating the drug doses against it. Advanced Pharmacology.

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