Physiological Changes that Occur in the Brain

In my past clinical experience, I assessed a 54-year-old AA female client who presented with obesity and complaints of increased thirst and excessive urine production. The patient was diagnosed with type 2 diabetes after having several FBS results of more than 130mg/dL on separate days. The patient was initiated on Metformin therapy 850mg orally once daily and Simvastatin 40 mg once daily, in addition to lifestyle modification interventions. The patient’s pharmacokinetic and pharmacodynamic processes caused by the underlying disease may alter her response to medication.

Diabetes may affect prescribed by affecting their absorption, secondary to alterations in blood flow in the subcutaneous adipose tissue, blood flow in the muscles, and gastric emptying. Metformin is widely distributed in various body tissues, including the liver, intestine, and kidney, through organic cation transporters (Zeng et al., 2020). Diabetes can affect the drug’s distribution as a result of the non-enzymatic glycation of albumin. Biotransformation of the drugs may also be affected by diabetes because of the regulation of enzymes and transporters involved in drug biotransformation (Rosenthal & Burchum, 2021). Furthermore, excretion of Metformin and Simvastatin may be affected by nephropathy. If the patient has a hepatic impairment, the Metformin’s pharmacokinetics would be altered, increasing the risk of lactic acidosis.

Reduced renal function and renal impairment would affect Metformin’s excretion since it is not metabolized and is excreted unchanged in the urine. Geriatric patients are highly likely to have reduced renal function, and thus Metformin is contraindicated in persons with renal impairment (Drzewoski & Hanefeld, 2021). The associated pharmacokinetic and pharmacodynamic processes may affect the patient’s response to Metformin, resulting in failing to attain the desired drug effects (Zeng et al., 2020). As a result, the patient’s blood sugar levels may fail to reduce as expected, resulting in constant hyperglycemic levels.

References

Drzewoski, J., & Hanefeld, M. (2021). The Current and Potential Therapeutic Use of Metformin-The Good Old Drug. Pharmaceuticals (Basel, Switzerland), 14(2), 122. https://doi.org/10.3390/ph14020122

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2^nd ed.) St. Louis, MO: Elsevier.

Zeng, Z., Huang, S. Y., & Sun, T. (2020). Pharmacogenomic Studies of Current Antidiabetic Agents and Potential New Drug Targets for Precision Medicine of Diabetes. Diabetes therapy : research, treatment and education of diabetes and related disorders, 11(11), 2521–2538. https://doi.org/10.1007/s13300-020-00922-x