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Pharmacology Questions
Question One: Case Study on Medication Errors
The Food and Drug Administration Organization of the United States defines medication errors as any avoidable incident that may result or lead to patient harm or improper use of drugs while the drug is under the control of a health care provider, consumer or the patient (Brunetti & Suh, 2012). These events may be interrelated to procedures, order communication, professional practice, packaging, product labelling, the process of prescribing, health care products, systems and processes. Others may be related to distribution, monitoring, compounding, use, dispensing or education (Brunetti & Suh, 2012). Medication errors cause several adverse drug events that may lead to several complications or death (Preventing Medication Errors and Improving Medication Safety, 2012).
The medication error that occurred on Mrs. C is related to administration of the drug. Drug administration errors occur when a drug gets administered via the wrong route (Merry & Anderson, 2011). The nurse intravenously injected crushed ciprofloxacin which was supposed to get administered via the NG tube. The error in the administration of the drug led to the death of the patient as the particles got trapped in the blood vessels in the brain, heart and lungs. Several factors could lead to the improper administration of medication. These factors include disruptions during the process of administering the drug, lack of the appropriate knowledge about a particular drug or due to systemic problems (Medication errors guide, 2015). In this scenario, the medication error can get attributed to three main factors. The first one is because of nurse RN. R did not have a prior experience of using the PICC lines and the appropriate syringes to use which led to confusion on medication that was supposed to get injected into the intravenous line. The second reason could be because of systemic errors which resulted in a confusion on the syringes which was appropriate for the intravenous line and the NG tube. The last reason could be the distraction of Nurse RN.R as she was administrating the medication. The instructions from the NIC and Nurse C most likely confused her during the process.
Nevertheless, the health care facilities are required to implement measures that reduce the likelihood of medication errors (Medication errors guide, 2015). At least three precautions would have prevented the medication error that occurred in this scenario. The first one is ensuring the continuous education of the staff (Merry & Anderson, 2011). Improved knowledge would have enabled the nurse to refrain from seeking the assistance of the colleague and NIC which eventually led to confusion. Health care facilities are supposed to ensure that their employees are updated on drug information, routes of administration and other changes. The use of infusion pumps to administer intravenous medications would have reduced the risk of administering oral medication through the PICC line (Brunetti & Suh, 2012). Lastly, Nurse RN.R would also have double-checked the drug together with the NIC which was at the bedside to ensure that the correct medication, patient, route and dose is adhered to before administering the drug. The professional standards of nursing require that all the nursing procedure should be done by two nurses to avoid such making preventable errors (Medication errors guide, 2015).
The scenario presents an example of an easily preventable adverse drug event that led to the early death of a patient. If the institution had implemented the appropriate measures, such a death could not have occurred. Therefore, the many deaths and complications that take place in the United States could get prevented through implementation of simple measures and adherence to the appropriate safety standards.
Question Two: Drug Pharmacokinetics
Medications pharmacokinetics is the description of the process that occurs in the body when a drug is administered (Clayton & Willihnganz, 2017). Pharmacokinetics involves four processes that occur after the drug gets administered until it gets eliminated from the body. The first process includes the absorption of the drug by the body tissues and into the bloodstream. The next process involves the distribution and the bioavailability of the medication into different organs via the blood and other means. Metabolism is the third process that includes the breakdown of the drug into either active or inactive metabolite. Lastly, the drug gets excreted from the body. All these processes get influenced by age (Clayton & Willihnganz, 2017).
Drug absorption in the elderly population gets decreased as compared to the youth especially when the medication gets administered via the oral route (Stegman, 2016). The older adults experience a significant loss of the mucosal surface of the stomach lining which delays the absorption of some medications via the oral route. Besides, most of them experience a reduction in the gastric acidity and a decline in blood flow to the gastrointestinal tract. Hence, drugs that require an acidic medium for absorption are slowly absorbed. The rate of absorption is also reduced due to decreased blood flow (Hogan et al., 2013).
Drug distribution involves the movement of the medications into the body tissues. Distribution is dependent on several factors such as lipid solubility and protein binding characteristics (Clayton & Willihnganz, 2017). Consequently, drug distribution is substantially affected by the physiological changes that occur in old age. Old age gets associated with alteration of the protein concentrations in plasma, a decrease in the intracellular fluid content and reduced body fats. Besides, reduced tissue and muscle mass and the declined blood flow to muscles also affect drug distribution. Active uptake of medicines also decreases in the elderly. The blood-brain barrier is also less efficient in the elderly as compared to young people (Hogan et al., 2013).
Metabolism of drugs occurs in the liver before elimination occurs. The process relies on the liver enzymes to convert the drugs into active metabolites or less harmful products that are eliminated by the kidney (Hogan et al., 2013). Old age gets associated with some changes in the liver such as a decrease in its size and blood flow. Resultantly, there is a reduction in the delivery and exposure to metabolizing enzymes. Moreover, most elderly patients are on polypharmacy. Some of these drugs inhibit while others induce metabolizing enzymes and thus, causes significant changes in drug metabolism (Pea, 2012).
Elimination of medications is also affected by old age. Old age gets associated with several renal changes such as the shrinkage of the kidney, decreased blood flow and decreased the number of functional nephrons (Clayton & Willihnganz, 2017). Kidney functions decrease by more than 35% from the age of 25 years to old age as determined by a decrease in GFR (Pea, 2012).  Moreover, old people have increased the prevalence of renal conditions that affect renal clearance such as obstruction by prostate cancer and chronic UTIs which also influence renal excretion. Such changes also affect the rate of elimination of drugs leading to retention of the medications in the body (McGavock, 2016).
Hence, it is crucial to take necessary precautions when administering medications to elderly patients. The first nursing intervention will be to reduce the dosage of the drugs based on patient’s age and measured GFR. Healthcare providers can avoid adverse drug events in the elderly by frequently monitoring the drug levels in the blood before administration of additional dosages. Lastly, the health care provider should determine all the medications the patient is taking including over-the-counter and herbal remedies before prescribing a drug (In Stegman, 2016).
In conclusion, pharmacokinetics is a description of the process by which medications get into, pass through and exit the body. Physiological changes that occur in old age impact on the drug pharmacokinetics. Hence, health care providers should have in mind the physiological changes that impact on pharmacokinetics to decrease chances of adverse drug effects in this group of patients.
Question Three

Pathophysiology of T1DM and T2DM

Diabetes mellitus is a chronic disease that gets associated with the body’s inability to regulate the blood glucose levels. The disease occurs as a metabolic disorder that involves the body’s failure to utilize the available glucose due to lack of insulin or insensitivity to insulin. The disease gets classified into several subtypes such as type 2 diabetes, gestational diabetes, and type 1 diabetes among other classes based on the etiological factors (WHO, 2016).
Type one diabetes mellitus occurs mostly in the young people and gets associated with hyperglycemia due to decreased insulin levels in the blood. Research indicates that T1DM occurs due to autoimmune destruction of beta cells in the pancreas that are involved in the production of insulin (Thomas & Philipson, 2015). Diabetes mellitus occurs when more than 85% destruction of the beta cells occurs leading to a severe decrease in insulin amounts. Insulin is required in the body to enhance the uptake of glucose by the cells, inhibit gluconeogenesis and promote lipogenesis. Reduced amount of insulin leads to an uninhibited process of gluconeogenesis and thus, an increase in the amounts of glucose in the blood (Shpakov, 2012).
Type two diabetes occurs as a result of the body’s insensitivity to insulin. The pancreas produces enough amounts of insulin, but the body cannot utilize the available insulin.T2DM occurs mostly in adults who are obese. Nonetheless, the condition can occur as a combination of increased action of glucagon, decreased insulin production and insulin insensitivity (WHO, 2016). The management includes administration of drugs that increase insulin sensitivity, insulin production or those that inhibit glucose uptake or glucagon action (Thomas & Philipson, 2015).

Brown is suffering from Type 1diabetes Mellitus because the disease is most common among the children (WHO, 2016). Besides, weight loss is more common in T1DM than in T2DM. Insulin is the most appropriate medication for this patient because the main problem is decreased insulin amounts in the body. Insulin administration will supplement his insulin leading to an improvement in the symptoms.
Mechanism of Action of Insulin

The administered Humulin R increases the amount of insulin in the body. Insulin is involved in the regulation of glucose metabolism (RxList, n.d). The drug decreases the glucose levels by stimulating increased peripheral uptake of glucose by fat and skeletal muscles. Moreover, insulin inhibits hepatic gluconeogenesis, proteolysis and lipolysis, but induces protein synthesis and lipogenesis (Mahendru, 2014). The primary targets of the drug include the liver, skeletal muscle and adipose tissue (Physiologic Effects of Insulin, n.d.).

Consideration for Insulin Administration

The nurse should be careful when administering insulin to patients because it causes complications such as hypersensitivity and hypoglycemia. The medication should be discontinued immediately in case of anaphylactic reaction. Precautions such as administration of insulin before meals and avoidance of skipping meals after insulin administration will prevent hypoglycemia. Frequent monitoring of blood glucose levels is essential to monitor patient’s response to insulin therapy (Insulin Signaling/Insulin Action, 2011).
Diabetes mellitus is a metabolic condition that revolves impaired action of insulin. Hence, insulin is the primary drug that is used to manage diabetes mellitus. However, appropriate precautions should be observed to prevent adverse drug events.
Brunetti, L., & Suh, D. (2012). Medication Errors: Scope and prevention strategies. Journal of Hospital Administration, 1(2). doi:10.5430/jha.v1n2p54
Clayton, B. D., & Willihnganz, M. J. (2017). Basic pharmacology for nurses.
Hogan, M. A., Burke, S. O., Gingrich, M. M., & Taylor, T. (2013). Pharmacology. Boston: Pearson.
Humulin N (Insulin (Human Recombinant)) Drug Information: Clinical Pharmacology – Prescribing Information at RxList. (n.d.). Retrieved from http://www.rxlist.com/humulin-n-drug/clinical-pharmacology.htm
In Stegman, S. (2016). Developing drug products in an aging society: From concept to prescribing.
Insulin Signaling/Insulin Action. (2011). Diabetes, 60(Supplement_1), A673-A680. doi:10.2337/db11-2552-2584
Mahendru, S. (2014). Chapter-01 The History of Insulin Therapy. Insulin Therapy: Current Concepts, 1-7. doi:10.5005/jp/books/12288_1
McGavock, H. (2016). How drugs work: Basic pharmacology for healthcare professionals.
Medication errors guide. (2015). The Pharmaceutical Journal. doi:10.1211/pj.2015.20200288
Merry, A. F., & Anderson, B. J. (2011). Medication errors – new approaches to prevention. Pediatric Anesthesia, 21(7), 743-753. doi:10.1111/j.1460-9592.2011.03589.x
Pea, F. (2012). Pharmacokinetics in everyday clinical practice. Torino: SEEd srl.
Physiologic Effects of Insulin. (n.d.). Retrieved from http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/pancreas/insulin_phys.html
Preventing Medication Errors and Improving Medication Safety. (2012). Mosby’s Dental Drug Reference, 1439-1441. doi:10.1016/b978-0-323-07960-0.00049-1
Shpakov, A. O. (2012). Alterations in Hormonal Signaling Systems in Diabetes Melitus: Origin, Causality and Specificity. Endocrinology & Metabolic Syndrome, 01(02). doi:10.4172/2161-1017.1000e106
Thomas, C. C., & Philipson, L. H. (2015). Update on Diabetes Classification. Medical Clinics of North America. https://doi.org/10.1016/j.mcna.2014.08.015
WHO. (2016). WHO | Diabetes programme. WHO.

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