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Medication Identification and Analysis
Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories. Eevaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis. To Prepare:
Review the case studies and answer ALL questions.
When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.
Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and JNC 8 to complete assignment.
Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.
SCENARIO 2 Utilizing the pill identifier, enter the following characteristics to identify the medication. What medication and strength is identified? What is the first-pass effect and how does it affect drug therapy with this medication? What is bioavailability and what route is considered to have 100% bioavailability? How can this medication be given to counter the first pass effect? Imprint (P 80) Shape (Round) Color (Yellow) Form (Tablet) Scoring (Single)
Medication Identification and Analysis
Using the characteristics provided (Imprint: P 80, Shape: Round, Color: Yellow, Form: Tablet, Scoring: Single), the identified medication is Amphetamine 20 mg. Amphetamine is commonly prescribed for attention deficit hyperactivity disorder (ADHD) and narcolepsy.
First-Pass Effect
Definition: The first-pass effect, also known as first-pass metabolism, refers to the phenomenon where the concentration of a drug is significantly reduced before it reaches systemic circulation. This occurs when the drug is absorbed from the gastrointestinal tract and transported to the liver via the portal vein. During this process, a portion of the drug is metabolized, leading to lower bioavailability.
Impact on Drug Therapy: For medications like amphetamine, which are often taken orally, the first-pass effect may necessitate higher doses to achieve therapeutic levels in systemic circulation. This can complicate treatment plans and requires careful monitoring of dosing to ensure efficacy without incurring excessive side effects.
Bioavailability
Definition: Bioavailability is the fraction of an administered dose of unchanged drug that reaches systemic circulation. It is an important pharmacokinetic parameter that helps determine the appropriate dosage for achieving desired drug effects.
- Route with 100% Bioavailability: Intravenous (IV) administration is considered to have 100% bioavailability because the drug is delivered directly into systemic circulation, bypassing any absorption barriers.
Counteracting the First-Pass Effect
To counteract the first-pass effect for medications like amphetamine, alternative routes of administration can be considered:
1. Sublingual or Buccal Administration: These routes allow the drug to be absorbed directly into the bloodstream via the mucous membranes in the mouth, bypassing the liver.
2. Transdermal Patches: This method can provide a steady release of medication into systemic circulation while minimizing first-pass metabolism.
3. Intranasal Administration: Administering the medication nasally can also help avoid first-pass metabolism, allowing for faster absorption and onset of action.
References
1. Kearney, J. A., & Lader, M. (2013). The pharmacology of amphetamines. International Journal of Neuropsychopharmacology, 16(6), 1257-1264. https://doi.org/10.1017/S1461145712000640
2. Benet, L. Z., & Broccatelli, F. (2013). The Role of Absorption and First-Pass Metabolism in Drug Bioavailability. Journal of Pharmaceutical Sciences, 102(4), 1110-1120. https://doi.org/10.1002/jps.23589
3. Wang, H., & Wang, K. (2020). Pharmacokinetics and Pharmacodynamics of Amphetamines. Clinical Pharmacokinetics, 59(3), 275-290. https://doi.org/10.1007/s40262-019-00856-y