Expectations

Peer Response:

• Length: A minimum of 100 words, not including references
• Citations: At least one high-level scholarly reference in APA from within the last 5 years

Q1. Explain the cause of this patient’s difficulty in maintaining her balance.

Diazepam affects the neuromuscular processing related to body balance and control. Cutson et al. (2015), In research done on senior citizens in relation to the effect of Diazepam, observed that older citizens, when exposed to diazepam, developed condition and balance issues occasioned by the increased muscle latency. 

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

The first-pass effect relates to phenomena where “a drug such as Diazepam is metabolized at a specific location in the body resulting in reduced concentration of the active drug upon getting to the target site of action or the systemic circulation area (Herman & Santos, 2019). To circumvent the effect, other methods of drug administration should be considered. In the case study context, the patient should consider other administration methods, such as sublingual.

Q3. What is likely causing the signs of confusion?

Diphenhydramine contains a substance called antihistamine, which is also known as Benadryl. The substance affects the brain because it inhibits cell communication by blocking acetylcholine’s action. The result of the inhibition of communication occasions is confusion. 

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

Crader (2017) notes that Warfarin is metabolized through the action of the cytochrome P450 system, which occurs in the presence of CYP2C9, 1A2, and 3A4. The scholars note that the drug has the capacity to cross over the placenta barrier. As a result, it is feared that the drug occasions teratogenic risk during the early stages of pregnancy (Crader, 2017). 

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?

Notes that the hepatic drug metabolism for children 1 year and older is akin to that of an adult. However, for newborns, drug excretion from the kidney is undeveloped. As a result, children are more likely to be affected by drugs as compared to adults (Yokoi, 2009).

Q6. Explain protein binding in the neonate.

Protein binding relates to the process of a drug’s reversible association with the blood plasma proteins. Plasma binding protein levels in newborns are lower than in adults and gradually increase with age. Human serum albumin (HSA) concentrations are near to adult levels (75%-80%) at birth, but alpha 1-acid glycoprotein (AAG) concentrations are initially half of adult levels.

References:

Crader, M. F., Johns, T., & Arnold, J. K. (2017). Warfarin drug interactions.

https://europepmc.org/article/nbk/nbk441964 

Herman, T. F., & Santos, C. (2019). First pass effect.

https://europepmc.org/books/nbk551679 

Yokoi, T. (2009). Essentials for starting a pediatric clinical study (1): Pharmacokinetics in children. The Journal of Toxicological Sciences, 34(Special_), SP307-SP312.

https://www.jstage.jst.go.jp/article/jts/34/Specia…

 I need to answer the question: 

What is BEERS criteria, and what is it used for?