Therapeutic Drug Monitoring
Modern medicine has seen significant healthcare developments in research, technology, facilities, drug administration, and monitoring. Therapeutic drug monitoring is a medical procedure of assessing specific treatments at specified intervals to retain a constant concentration in a patient’s bloodstream. The whole process includes vigorous testing that makes sure that the physician administers drugs that are both safe and effective.
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The primary objective of therapeutic drug monitoring is to individualize medicine prescriptions by retaining blood concentrations in a certain therapeutic limit to undergo treatment without harmful side effects. The procedure evaluates different body responses towards medications, depending on age, gender, and previous medical histories such as antiretrovirals and anti-cancer drugs. The outcome measures any unfavorable reactions, healing rates, mortality rates, and ultimately saves on cost and time by reducing hospitalization.
Drug monitoring in the past has helped to determine how age affects drug absorption, metabolization, and excretion. As age increases, it is inevitable that the roles of body tissues and organs progressively decrease regardless of these individuals observing a healthy lifestyle. The consequence of this makes old age the main risk factor for illness and reduced responsiveness to therapeutic interventions even though the majority of treatment is usually for the elderly.
Age affects drug absorption such that there is reduced gastric pH, which impacts how the body dissolves and absorbs drugs. Furthermore, there is a possibility of reducing the quantity of particular cells in the ileum, leading to a significant deficiency in surfaces that absorb drugs and a reduction in intestinal blood flow (Bender, 2017). Ultimately, this leads to a reduction in passive and active diffusion in the elderly.
There is the possibility of aging, resulting in decreased metabolization and excretion regarding the liver and kidney’s functioning. There is decreased hepatic blood flow, mass liver reduction, and the number of parenchyma cells, which reduces the metabolic capacity while reduced renal flow and glomerular filtration rate lower the liver functions inhibiting excretion of drugs (Yartsev, 2020). Generally, all these deteriorating body functions lead to a lot of sensitivity to medications causing harmful reactions.
The majority of the elderly take salt substitutes, mainly associated with sodium and potassium, to balance the solutes’ level in their body. However, using these substitutes with other medications such as ACE inhibitors and potassium-sparing diuretics like triamterene may lead to a severe case of hyperkalemia (Stoppler, 2019). The treatments decrease potassium’s excretion, leading to high blood potassium levels, causing abnormal heart rhythms, and affecting skeletal muscles’ functioning.
Some elderly individuals do not adhere to the prescribed medication by just forgetting their dosage due to frequent memory loss or the utter disregard for the doctors’ advice. This behavior results in harmful health implications for these patients, which has led to their constant hospitalization due to disease progression in the body and death. Most of the elderly with chronic illnesses such as diabetes and hypertension are discouraged by medication costs, dosing frequency, side effects, and administration methods.
Drug monitoring has shown that the elderly need constant interventions to prevent any form of medical nonadherence to limit the associated risks. Educational interventions that promote knowledge of illness, medication, and health literacy go hand in hand with behavioral interventions like adherence therapy to generate belief discrepancies and attitudes on drug use barriers. Health educators and physicians carry out these interventions through counseling sessions complemented with house calls and regular video or audio telephoning to remind them of treatment adherence.
In conclusion, drug monitoring is an essential part of administering any form of treatment to ensure that the drugs are entirely safe. The elderly face many decreased bodily functions, which affect their usage of some of these drugs; thus, it is necessary to monitor their response to any new treatment. In conjunction with promoting drug adherence, monitoring them will lead to healthy elderly individuals, thereby sustaining and promoting their lives.
As people age, the functions of tissues and organs in the body decline gradually. Because of this decline in organs function, drug absorption, distribution, metabolism and excretion in elderly people are affected more than in younger individuals. For that reason older people are at higher risk for medication-related complications. The metabolism becomes slow, the liver and the kidneys which are the major organs where many drugs metabolized, due to decrease in enzyme activity and the ability to filter and break them down, more medications can remain in the bloodstream. In addition, elimination declines, the ability for the kidneys to filter out your blood in order to remove some drugs from the body through urine diminished. Kidneys function become less efficient causing more drugs to remain in your system, as a result medication levels build up. Some medications are strictly excreted via the kidneys; diminished function put the elderly at risk for toxicity. This is the reason why people with kidney disease may require lower doses or be prescribed a medication that does not required to be eliminated by the kidneys. Furthermore, drug effects increase, because the amount of water in your body decreases, and body fat increases, so drugs that dissolve in water reach higher concentrations, drugs that dissolve in fat are distributed in greater volume, leading to an accumulation that makes the drug last longer (Holten, 2016). Some of the complications as a result of drug mal-absorption, impaired metabolism and excretion are: increase side effects, toxicity, and drug interactions. Health care professional need to educate the elderly on safety measures to prevent medication-related complications. For instance, encourage the use of one pharmacy for all prescriptions, give each provider a list of current medications, making sure that the patient understand each medication and which condition it treats, how and when to take it, and possible side effect, and awareness of food and drug interaction, finally the danger of using prescribed medications with supplements or over the counter drugs.
The use of salt substitutes can cause hyperkalemia in older adult when use in conjunction with potassium-sparing diuretics such as spironolactone, amiloride and triamterene. Potassium-sparing diuretics case increased urine production and lower blood pressure while increasing serum levels of potassium. When taking these drugs for management of hypertension, patients should avoided potassium supplement and salt substitute except under very close supervision (Langford & Cox, 2007).
The most common reasons for drugs nonadherence in older adults include the cost of drugs, side effects or fear of side effects, complex scheduling, age-related changes such as cognitive impairment, changes in vision, and a belief that the drugs are unnecessary or ineffective (Meiner & Yeager, 2018). When I used to be a home health care nurse, I encountered this issue with many of my patients. Cultural background, poverty, and educational level play a big role in adherence to medications regimen, I have noted. One of the most effective approaches towards preventing and evaluating risk factors in older adult is to try your best to know your patient as much as you can. What I mean by that is to ask appropriate questions to determine the level of education, cultural background and the patient’ s belief in modern medicine. The home health agency that I used to work for, made a lot of efforts to hire nurses from different background, because they realized that it was best to send a nurse who speak the same language as the patient and is knowledgeable of his or her cultural background. In addition, educating patients about their medications and ways to afford them such as assist them to make the best health insurance selection that fits their needs, assisting them to find cheaper pharmacy, and advise to ask their physicians for an alternative drugs that cost less, family involvement with the teaching is also important.
Week IV Discussion
While reading the assigned textual and graphical information, I was most struck and impressed by how the authors of the book present their ideas to the target audience. Many maps and pictures are used to emphasize the central sense and the important data that generates new information. It was interesting to learn more about the purification rites in the Shinto religion when the followers bathe in the waterfalls, or the ocean water for the ritual cleansing. I was encouraged to read about the harvest festival called Kinensai that is held to greet the deities and multiply the fertility of the land. I enriched my knowledge about the places of worship in Zoroastrianism, including temples with water wells used for purification in devotion to one God Ahura Mazda. According to Shebu, the polytheism of Zoroastrianism, “where ritualism, ceremonialism, priesthood, and all other vices were prevalent everywhere, made their life very complex (Shehu, 2020).” Despite all these complicated issues, the practice of such rituals contributes to the community growth in ethical virtues and its self-actualization.
Week 4 Discussion
While reading this week’s chapters, one thing that was very interesting to me was in the religion Zoroastrianism, the young child Yasmin was in a ceremony called Navjote in which she must memorize prayers and bathe in a purification ritual. She then would have to be clothed in a cotton cloth called sedreh, which would be worn on top of her outer garment. Then the second garment is kusti, which is around her waist. After that, the priest would give his benediction and he would bless Yasmin with health, long life, and piety. Zoroaster’s new faith was founded on the vision he had received by the river and the answers given to his continual prayers. It rested on five principles: The supreme god is Ahura Mazda, Ahura Mazda is all-good, His eternal opponent, Angra Mainyu, is all-evil, Goodness is apparent through good thoughts, good words, and good deeds, and Each individual has free will to choose between good and evil.
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