Prescription, Nonprescription, and Herbal Medication - Research Paper Example

Prescription, Nonprescription, and Herbal Medication Prescription, Nonprescription, and Herbal Medication Introduction The geriatric population has proven to be highly sensitive when administering drugs. The fact that the group is defined by advancing age, which presents numerous physiologic changes, explains why it is overly sensitive to medication. In many cases, the elderly group lacks the capacity to communicate effectively and consult widely concerning different drugs. The geriatric population presents a higher rate of adverse drug reactions because of the physiologic changes that occur with aging. Other factors such as gender, ethnicity, marital status, educational level, and household income determine the efficiency with which the population can take drugs effectively. The geriatric population exhibits a diverse range of medical conditions compelling healthcare providers to practice polypharmacy. The issue of polypharmacy serves to increase the adverse drug reactions that are more prevalent in this population. This paper will highlight some of the factors predisposing the geriatric population to adverse drug reactions. In addition, the paper will present some examples of the major drug categories and their mechanisms of action. Section 1: Physiologic Changes That Occur With Aging and How They Affect Absorption, Distribution, Metabolism, and Excretion of Drugs The aging process is defined by numerous impairments of several regulatory processes that play a critical role in cells and organs. In addition, other physiological changes are evident in advanced age, and have the capacity to affect the absorption, distribution, metabolism, and excretion of drugs. The geriatric population exhibits cardiac dysfunctions. Notably, the relaxation and contraction of heart muscles change remarkably a one ages. Therefore, blood flow becomes slower, a factor that may affect drug distribution. In addition, aging brings about the reduction of renal mass. Fewer nephrons define the reduction of renal mass. In some older patients, there is evidence of intrarenal vascular changes. There is a remarkable decrease in the glomerular filtration rate (Lin, Yeh, & Lau, 2013). In other cases, advancing age serves to introduce the inability of the kidney to deal with acid loads. There is a notable delay in the kidney functions, a factor that affects the elimination of drugs. The gastrointestinal system is also affected by aging because elderly people have lower rates of hydrochloric acid and pepsin. Research has highlighted that aging may contribute to potential changes in the enzyme secreting cells or hormonal glands a factor that minimizes the efficiency of the gastrointestinal system. In the small intestines, absorption of some substances reduces with age, while in the colon, the transit time may prove to be slower. Other digestive enzymes such as lipase and trypsin usually decrease as one age. The liver is a critical organ in the metabolism of drugs. With advancing age comes a remarkable reduction in the liver blood flow. In other cases, the liver structure may change over time while enzymes may cease to function effectively (Lin, Yeh, & Lau, 2013). Therefore, the metabolism and the elimination of some drugs prove to be difficult. Section 2: Factor that Predispose Older Patients to Adverse Drug Reactions As highlighted above, there are more adverse drug reactions among the elderly patients compared to other populations. One of the reasons why there are increased adverse reactions in the elderly is the drug-disease interactions. In some cases, healthcare providers may misinterpret some of the drug effects as new symptoms. Worth noting is the fact that the aging population exhibits a diverse range of symptoms, and some of them are age related. In a case where adverse drug effects are misinterpreted for symptoms, the patient may be compelled to take a new drug. The combination of such drugs has the potential to cause undesirable effects. Drug-drug interactions are also common among the elderly. Since medical practitioners practice polypharmacy when handling this group, there is a higher chance of a drug interactions (Stolfi, Simone, Pallone, & Monteleone, 2013). In addition, the elderly patients are more likely to take dietary supplements as well as medicinal herbs without informing medical practitioners. Inadequate monitoring of drug administration also contributes to the increased adverse effects associated with drugs. The older patients are less likely to document an emerging indication for new drugs. In addition, medical practitioners may fail to have a comprehensive list of all the drugs used by the patient. If medical practitioners do not constantly review the drugs used by the elderly, adverse drug reactions become more frequent. There are reports indicating that inappropriate drug selection for the older patients may trigger adverse drug reactions. In some cases, therapy may be duplicated or the patient may receive the inappropriate drug or the wrong dosage. In such cases, adviser drug reactions become more evident (Stolfi, Simone, Pallone, & Monteleone, 2013). Even in cases whereby proper administration occurs, lack of patient adherence may serve as a risk factor for the development of adverse drug reactions. Financial and physical constraints may introduce a challenge for the geriatric population to access the appropriate medication. Other older patients have cognitive problems, a factor that affects their ability to take drugs as prescribed. Some older patients fail to abide by the drug dosage instructions, and lack the awareness of managing adverse effects. If healthcare practitioners do not give consideration to age-related changes, they may overdose the older patients, increasing the chances of adverse drug reactions. Without a doubt, the geriatric population is highly sensitive and medical practitioners need to follow specific guidelines while prescribing the drugs to this population (Stolfi, Simone, Pallone, & Monteleone, 2013). Moreover, the older patients need more advice and guidelines on how to take the drugs in an effort to minimize the adverse drug reactions. Section 3: Classes of Medications and their Mechanisms of Action 3.1: The Selected Classes of Medications 1. Analgesics 2. Antihistamines 3.2: Commonly Prescribed Medications Analgesics a. Fentanyl Fentanyl is an opioid prescribed to patients in pain, especially cancer patients. The drug has the capacity to penetrate the blood-brain barrier. Fentanyl mechanism of action has its basis on activating opioid receptors. The receptors are available in the central nervous system as well as the spinal code. Therefore, the drug operates at a cellular level through the activation of these receptors. Activated opioid receptors may lead to the reduction of cyclic adenosine monophosphate secretion and hyperpolarization by increasing potassium efflux. Other effects include the closure of sensitive calcium channels (Fredheim, Mahic, Skurtveit, & Borchgrevink, 2015). b. Codeine Codeine is an additional opioid prescribed to patients in pain. However, it has a lower capacity and a lower affinity for the opioid receptors. It functions by binding to the receptors and activating them. However, specific details of its mechanism are yet to be described. It has been noted that it binds to specific central nervous system opioid receptors and plays a critical role in the perception of analgesic effects. It has the capacity to relax a patient and depress their respiratory system (Kestenbaum, Vilches, Messersmith, Connor, Fine, Murphy, & ... Muir, 2014). c. Toradol Toradol is a nonsteroidal anti-inflammatory drug (NSAID). The drug has the capacity to bring about anti-inflammatory effects by inhibiting cylooxygenase-1 (COX-1) and cylooxygenase-2 (COX-2). The inhibition of COX-1 and COX-2 prevents the synthesis of prostaglandin. The inhibition of prostaglandin synthesis and activity is responsible for the therapeutic effects of Toradol. If Toradol inhibits the synthesis of other substances, related to pain receptors, it may have additional analgesic effects. Antihistamines a. Clarinex Clarinex, which is Desloratadine is an antihistamine used to reduce allergic reactions. The drug has the capacity to compete for the v receptors either in the blood vessels, bronchioles smooth muscles, the gastrointestinal tract and the uterus. When the drug binds to the antihistamine receptors, it prevents the action of antihistamine, which is responsible for the development of allergic reactions. Through this mechanism, clarinex relieves watery eyes, and nasal congestion. b. Atarax Hydroxyzine is an additional antihistamine, which functions through binding to the histamine receptors. It has the capacity to compete with histamine and inhibit the effects of histamine such as edema, flare, pruritus. Hydroxyzine also has the capacity to act on the subcortical level of the central nervous system triggering sedative effects. c. Azelastine Azelastine functions in a similar way with other antihistamines by competing for the histamine receptors that are available on different effector cells. It serves as an effective antagonist as it prevents the release of histamine and other related mediators, which are responsible for allergic reactions. 3.3 Commonly Used Nonprescription Medications Analgesic a. Aspirin Acetylsalicylic acid has positive effects in the treatment of moderate pain. It exhibits both anti-inflammatory and antipyretic characteristics. It functions through irreversible inhibition of cylooxygenase-1 (COX-1) and cylooxygenase-2 (COX-2). For this reason, it decreases the synthesis of prostaglandin precursors. Therefore, acetylsalicylic acid blocks the formation of thromboxane from arachidonic acids. Aspirin has the advantage that it cause irreversible inhibitions compared to other analgesics that trigger reversible inhibitions (Stolfi, Simone, Pallone, & Monteleone, 2013). b. Ibuprofen Ibuprofen also serves as an inhibitor of cyclooxygenase (COX), therefore, blocking the arachidonic acid pathway. Unlike other analgesics, Ibuprofen serves as a nonselective inhibitor of COX. After successful inhibition of prostaglandin formation, the drug relieves pain, which may have resulted from fever and inflammation. Ibuprofen has an active role in the hypothalamus, a factor that leads to vasodilation. Vasodilation consequently increases peripheral blood flow. Ibuprofen also has anticoagulant effects through its inhibition of COX (Stolfi, Simone, Pallone, & Monteleone, 2013). After inhibition, Ibuprofen ensures that arachidonic acid is converted to thromboxane A2. c. Paracetamol (acetaminophen) Paracetamol is a common over the counter (OTC) analgesic, which treats moderate pain. It is usually prescribed in cases of persistent pain. Its mechanism of action is based on the inhibition of prostaglandin production. It has the capacity to inhibit cylooxygenase-2 (COX-2). It proves to be a weak inhibitor of COX-1. Modern research has revealed that paracetamol has the capacity to activate descending serotonergic pathways, causing a central analgesic effect (Stolfi, Simone, Pallone, & Monteleone, 2013). Antihistamines a. Brompheniramine Brompheniramine is a common over the counter antihistamine, which serves as an antagonist of the histamine receptors in different effector cells. It functions in a similar manner like other antihistamine agents by getting rid of the histamine-mediated effects after blocking histamine release. b. Diphenhydramine Diphenhydramine is also an over the counter antihistamine that competes with histamine for histamine receptor sites. Like other antihistamine agents, Diphenhydramine serves as an antagonist, and minimizes the effects of histamine-mediated processes. c. Chlorpheniramine Chlorpheniramine also functions by binding to histamine receptors that are available on effector cells. If has antagonistic effects on histamine and has the capacity to minimize the negative allergic symptoms resulting from histamine-mediated processes. 3.4 Alternative or Complimentary Therapies for Analgesics and Antihistamines Alternative Therapies for Analgesics a. Neurostimulation Transcutaneous Electrical Nerve Stimulation is one of the complimentary therapies of minimizing localized pain resulting from arthritis and tumor pains. Neurostimulation proves to be effective only for localized pain, and does not have any effects on diffused pain. Neurostimulation has the capacity to ease the pain by activating neurons in the localized site. b. Acupuncture Acupuncture is an alternative therapy for pain management commonly used in Asian countries, but becoming an aspect of western medicine. Acupuncture makes use of needles that are placed at identified regions of the body. There are different types of acupuncture processes that have different effects in their capacity to reduce pain. The mechanism of action associated with acupuncture has not been specified. However, the relationship between the therapist and the patient serves as a psychological support, which may serve to reduce pain. c. Cordotomy In serious cases of pain, surgery may be performed in order to ease the pain. Cordotomy involves the interruption of the spinaltheramic tract, which has the responsibility of transmitting pain and temperature signals. Surgeons use different equipment in disrupting the functionality of the tract and easing pain in the end. Alternative Therapies of Antihistamines a. Quercetin Quercetin is a flavonoid found in fruits such as apples and vegetables such as onions. Quercetin is also available in green tea, raspberries, broccoli, tomatoes, and leafy greens it has the antioxidant capacity, and activates the pathway leading to glutathione synthesis. It has the capacity to stabilize mast cells, a factor that prevents histamine production. Therefore, it is regarded as a potential antihistamine. b. Vitamin C Vitamin C has the capacity to reduce histamine levels in the blood. It destroys the imidole ring, which is found in the histamine molecule. With such effects, it reduces allergic reactions mediated by histamines. However, an individual must take remarkable amounts of vitamin C if it is to relieve allergies. c. Stinging Nettle Stinging Nettle is a herb prescribed by specialists who practice natural medicine. It has the capacity to antagonize histamine effects. It has high levels of vitamin C, which has the capacity to destroy the histamine molecule by attacking the imidole ring. Section 4: Potential Drug Interactions Resulting from Analgesic and Antihistamines Drug interactions in older patients need to be given a critical analysis in order to minimize adverse drug effects. In the case of analgesics ;such as Ibuprofen, aspirin and paracetamol, which are commonly sold over the counter, there is a need to give considerations to potential drug interactions. For example, ibuprofen interacts with warfarin triggering fatal hemorrhage. The continued use of aspirin and paracetamol can also trigger similar effects. Ibuprofen also interacts with frusemide and other diuretics enhancing their natriuretic effects. There is a salient need to monitor lithium plasma concentrations when administering ibuprofen because it has the capacity to increase lithium levels. In addition, patients taking paracetamol should not combine with carbamazepine, because the drug interactions may lead to liver damage. However, paracetamol combined with metoclopramide may enhance the pain relieving effects. Paracetamols should not be combined with cholestyramine and lixisenatides, because the drug interactions limit paracetamol’s capacity to relieve pain (Raiff, Vaughan, & McGee, 2014). In other cases, paracetamol may slow down the action of busulfan. Nursing practitioners should inquire whether patients taking aspirin may be combining with warfarin and other salicylates in order to reduce adverse drug effects through drug interactions. Moreover, nursing practitioners should be keen when prescribing opioid analgesics and take measures of minimizing drug interactions. For example, fentanyl may react with monoamine oxidase inhibitors and other antagonistic analgesics bringing forth undesirable effects. On the other hand, codeine should not be mixed with antagonistic analgesics or antidepressants because they may trigger undesirable effects. In addition, nursing practitioners should ensure that they do not prescribe opioid analgesics together with anticholinergics because it may result in a high levels urinary retention. In the prescription of Toradol, nursing practitioners should ensure that they do not combine with furosemide as it reduces the diuretic effect. In addition, monitoring of lithium levels in the blood plasma is important when administering Toradol (Kestenbaum et al., 2014). Toradol should not be administered with probenecid because it affects the clearance rate. In the administration of azelastine, nursing practitioners should consider whether the patient is taking other drugs such as antianxiety drugs, muscle relaxants, other antihistamines, and other psychiatric medicines because there is a salient need to monitor potential interactions. The administration antihistamines should be done carefully with consideration of any other drugs the patient is taking that may create undesirable effects. Many of the drug interactions associated with antihistamines are similar because they function in a similar way. Conclusion Without a doubt, the geriatric population needs medical practitioners to be keen when administering drugs. Notably, the advancing age in this population contributes to physiological changes that alter the absorption, distribution, metabolism, and elimination of drugs. Therefore, these factors should be given proper consideration before any prescription to an older patient. There is a salient need to protect older patients from adverse drug reactions, which may occur regularly. In the administration of analgesics described above, nurses should consider the mechanism of action as well as the potential drug interactions before making any prescription. On the other hand, antihistamines need a similar caution when prescribing in order to minimize drug interactions. References Fredheim, O. S., Mahic, M., Skurtveit, S., & Borchgrevink, P. C. (2015). Use of nasal fentanyl for cancer pain: A pharmacoepidemiological study. Palliative Medicine, 29(7), 661-666. doi:10.1177/0269216315575252 Kestenbaum, M. G., Vilches, A. O., Messersmith, S., Connor, S. R., Fine, P. G., Murphy, B., & ... Muir, J. C. (2014). Alternative Routes to Oral Opioid Administration in Palliative Care: A Review and Clinical Summary. Pain Medicine,15(7), 1129-1153. Lin, J., Yeh, T., & Lau, H. (2013). Elderly patients with inappropriate medication correlations with adverse drug events or unexpected illnesses in long-term care institutions. Aging Male, 16(4), 173-176. doi:10.3109/13685538.2013.832193 Raiff, D., Vaughan, C., & McGee, A. (2014). Impact of Intraoperative Acetaminophen Administration on Postoperative Opioid Consumption in Patients Undergoing Hip or Knee Replacement. Hospital Pharmacy, 49(11), 1022-1032. doi:10.1310/hpj4911-1022 Stolfi, C., Simone, V. D., Pallone, F., & Monteleone, G. (2013). Mechanisms of Action of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Mesalazine in the Chemoprevention of Colorectal Cancer. International Journal Of Molecular Sciences, 14(9), 17972-17985. doi:10.3390/ijms140917972 Read More