Pharmacokinetics and pharmacodynamics of oral Metoprolol Essay Example for Free

Pharmacokinetics and pharmacodynamics of oral Metoprolol Essay The patient, Roger Smith, is a forty year old man and came to the doctors office yesterday morning presenting a chief complaint of on and off headaches. Every now and then he felt dizzy and would complain about blurred vision. He mentions that he does not have any allergies to food or medicines. He admits that he doesnt do any regular exercise. He favors salty food and eats plentiful of it everyday and prefers to drink alcohol two to three times per week. He was an only child and both his father and mother are deceased. The patients mother had hypertension and so did his mothers father. When he was a child he only had varicella zoster. He also mentioned that he sought medical attention a year ago and was diagnosed with essential hypertension. After that, the patient did not visit his previous doctor for a follow up on his medical health. The patient confesses that he did not follow his previous doctor’s prescription. Dr. Robert Jones, took the patients blood pressure and it read as 140/90 mm Hg. The patient was asked to undergo laboratory test for the patients blood creatinine (National Kidney Function, 2008). On the following day, Dr. Robert Jones, measured the patient’s blood pressure again and it read 140/90 mm Hg. The patient told the doctor that he took note of his blood pressure several days ago and it also had the same reading and it never went down. The doctor asked the patient to present him the laboratory result for the patients glomerular filtration rate. The glomerular filtration rate is the test to measure the patients kidney functions level. It is important to find out what the result is to prevent the progression of a kidney disease due to hypertension (National Kidney Function, 2008). The patients glomerular filtration rate value (GFR) was 72 mL/min/1.73 m2. The doctor interpreted to the patient that his glomerular filtration rate is normal and his kidneys are not affected yet by the hypertension. The GFR is calculated by the serum creatinine of the patient which is 1.4 mg/dL, the age of the patient is forty years old, the patients race is African American and the gender is male. The normal glomerular filtration rate value is 70  ± 14 mL/min/m2 for the male and 60  ± 10 mL/min/m2 for the female (National Kidney Function, 2008). The doctor explained that essential hypertension or primary hypertension is the blood pressure thats consistently higher than the normal value, 120/80 mm Hg, and there is no cause found for the high blood pressure. It can be controlled with normal exercise, a well-balanced diet, proper treatment and constant monitoring of the blood pressure. If it is left untreated, it will lead to heart attack, heart failure, damage to the kidney and it might cause the patient to lose his vision. (PSMHMC, 2006). The patient needs to lower the systolic and diastolic blood pressure (BP) to treat his hypertension as this is an important cardiovascular risk factor (Koenig, 2001). The doctor educated the patient to maintain his weight level near to the normal and eat a well-balanced diet. He was instructed to limit the salt intake everyday to 2,000mg or even lower. Exercise regularly and avoid drinking too much alcohol and limit the intake of caffeine. All these are needed to be followed to control the blood pressure. The patient was also educated about taking care of his blood pressure because it will cause the kidney to fail. In order to prevent this from happening, his blood pressure must be controlled (DailyMed, 2006). The doctor prescribed the patient to take metoprolol tartrate 100mg for the first four weeks and then increased the dose to 200mg for another four weeks. The patient is instructed to orally take metoprolol once daily (Koenig, 2001). Metoprolol is a beta-adrenergic blocking agent that decreases the heart rate, decreases the contraction force of the heart muscle and it lowers the the blood pressure. Metoprolol targets the sympathetic nervous system by blocking its action in order to stimulate the heart beats pace. (Hildemann, et. al., 2002). The doctor further explained that metoprolol helps relax the blood vessels and will help the heart beat at a more regular rate. In this way, high blood pressure is reduced. Other heart diseases, for example stroke or heart attack will be prevented (Koenig, 2001). The medicine is taken through the mouth and will pass through the digestive tract before it can reach the bloodstream for absorption. The onset of action of metoprolol as an anti-hypertensive if taken orally is 1 1/2 to 4 hours. It will last for ten to twenty hours and will be absorbed at a percentage of 95%. For its metabolism, it is extensively hepatic through CYP2D6; significant first-pass effect. The half-life elimination period is three to four hours (Koenig, 2001). Metoprolol will be excreted through the urine with the percentage of 3% to 10% as an unchanged drug (DailyMed, 2006). According to the explanation of the doctor, metoprolol is metabolized in the liver by the cytochrome P450 2D6. Therefore, metabolization of the drug depends on the genetic polymorph that determines the hepatic hydroxylation rate. Metoprolol is excreted by the kidney as metabolites and is absorbed within seventy-two hours by glomerular filtration. The patient is further informed that while he is taking metoprolol, he is advised not to take in any other medicine. He should follow the correct dosage at the right time, in other words, the patient is not allowed to change the dosage or the time hes supposed to take the medicine. The medicine should not be taken in with an antacid (DailyMed, 2006). The patient will feel fatigue or dizziness. He should inform the doctor any changes like unusual weight gain or muscle fatigue, swellings of any part the extremities, constipation or should he develop a cough. The patient should maintain a blood pressure of less than 140/90mm Hg. He should take his pulse prior to taking metoprolol orally. The patient will be able to keep himself healthy and fit if he continues to follow the doctors prescription. The systolic and diastolic blood pressure (BP) will be lower when the patient follows the intake of metoprolol as prescribed by the doctor (Koenig, 2001). After eight weeks, the patient came to visit Dr. Robert Jones and had his blood pressure is already 120/80 and his glomerular filtration rate value remains at the normal level. The patient is instructed by the doctor to constantly maintain a healthy diet, regularly exercise and take note of his blood pressure everyday (Koenig, 2001). References: Dailymed (2006). METOPROLOL TARTRATE and HYDROCHLOROTHIAZIDE   Ã‚  Ã‚  Ã‚  Ã‚   TABLETS, USP50 mg/25 mg, 100 mg/25 mg and 100 mg/50 mgBeta   Ã‚  Ã‚  Ã‚  Ã‚   Blocker/Diuretic Antihypertensive. Retrieved February 8, 2008, from   Ã‚  Ã‚  Ã‚  Ã‚   http://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?id=2522type=display Indian Journal of Pharmacology. (2008) Metoprolol Pindolol: A comparative study in   Ã‚  Ã‚  Ã‚  Ã‚   essential hypertension. Retrieved February 8, 2008, from http://www.ijp-online.com/article.asp?issn=02537613;year=1990;volume=22;issue=2;spage=85;epage=88;aulast=Gugli;type=0 S.K. Hildemann, H. Fischer, D. Pittrow, V. Bohlscheid (2002). Metoprolol Succinate SR Plus  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚   Hydrochlorothiazide (Beloc-Zok ® Comp) in Patients With Essential Hypertension in   Ã‚  Ã‚  Ã‚  Ã‚   General Practice. Medscape Today. Retrieved February 10, 2008, from   Ã‚  Ã‚  Ã‚  Ã‚   http://www.medscape.com/viewarticle/444414_1 Penn State Milton S. Hershey Medical Center College of Medicine (2006). Essential   Ã‚  Ã‚  Ã‚  Ã‚   Hypertension. Retrieved February 10, 2008, from   Ã‚  Ã‚  Ã‚  Ã‚   http://www.hmc.psu.edu/healthinfo/e/essentialhypertension.htm National Kidney Function (2008). Glomerular Filtration Rate (GFR). Retrieved from   Ã‚  Ã‚  Ã‚  Ã‚   February 10, 2008, http://www.kidney.org/kidneydisease/ckd/knowGFR.cfm Wolfgang Koenig, on behalf of the Multicentre Study Group, Department of Internal   Ã‚  Ã‚  Ã‚  Ã‚   Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany   Ã‚  Ã‚  Ã‚  Ã‚   (2001). Efficacy and Tolerability of Metoprolol Tartrate in Patients With Mild-to-   Ã‚  Ã‚  Ã‚  Ã‚   Moderate Essential Hypertension: A Randomised, Double-Blind, Multicentre   Ã‚  Ã‚  Ã‚  Ã‚   Trial. Retrieved from February 10, 2008, from   Ã‚  Ã‚  Ã‚  Ã‚   http://www.medscape.com/viewarticle/406240

Anointed King :: essays research papers

Within Shakespeare’s play Richard II there are many questionable and untrusting characters. Truth and duty are only illusions within the play. Lust for power and control override the order of England and its ordained king. It’s believed that it is by the will of God that Richard is king. No mortal man can come between what God has set before them as rule. The final decision is God’s and the only way that God’s choice can be changed is by God himself, and no one else. God takes the Garden of Eden from Adam, and like Adam, England is taken from Richard. It is questionable if Bolingbroke acts against God’s will or through God’s will. Richard is king, and though a sad choice, he has been ordained by God as king and ruler of England. It is not for his followers to decide if he is to be replaced by someone that they feel would be a better caretaker of the “garden';. In Richard II , by overtaking the crown and replacing R ichard with Bolingbroke, society is going against its own belief that Richard is ordained by God. From an Englishman’s point of view it could be argued that God is somewhat responsible for the state that England is in, because they believe Richard was chosen by God. Within Richard II , God is believed to be forsaken so that England can become a great kingdom again, and this is done in hope that Richard’s wrongs can be made right by Bolingbroke. Richard’s opposition - York, Bolingbroke, and Northumberland - believe that what they are doing is done to regenerate the badly tended “garden';. They want to replant it with Bolingbroke as king, and this they believe will restore England to order. By judging and replacing Richard they are going against what their society believes is God’s will. This is the worst mistake of all, because as the saying goes “two wrongs don’t make a right';. They are playing against a power fa r greater than anything they could imagine Richard being able to do. Their worries should not be of what Richard will do to them if they do not succeed, but what God will do to them at any given time. Northumberland tells of how the kingship will be restored and the garden revived. "If then we shall shake off our slavish yoke,/ Imp out our drooping country’s broken wing,/ Redeem from broking pawn the blemished crown,/ Wipe off the dust that hides our scepter’s gilt,/ And make high majesty look like itself," (Richard II II.

Cigarettes: United States Constitution and American Medical Association Essay

Should the production and sale of cigarettes be made illegal? Cigarettes have had a declining reputation ever since they were linked to various forms of cancer, and other debilitating conditions. Cigarettes were not seen as harmful until public awareness was raised about the issue. Now, there are many advocates for cigarettes and many against them, but does the government have the right to make decisions for the public? Sadly, in the democracy we live in today, there is not much democracy at all. If the government wanted cigarettes to be banned, cigarettes would be banned. The government follows its own agenda, regardless of the general public opinion. The government will always find a way to put a facade over the law and argue that no rights are being violated. According to the United States Constitution, under the authority of Article 1, Section 8, Clause 3, better known as the commerce clause, it reads, â€Å"The congress shall have power †¦ To regulate commerce with foreign nations, and among the several states, and with the Indian tribes†¦Ã¢â‚¬ . This states that the federal government has the authority to govern and regulate any commerce within the states. Article one also states, â€Å"The congress shall have power†¦ provide for the common defense and general welfare of the United States†¦Ã¢â‚¬ . So if the government decided to ban cigarettes they could use this Article to argue that they are looking out for the best of the public. It is under this law that the government is able to place bans on uncontrolled substances as well. So, if the Supreme Court holds power to ban an uncontrolled substance, like marijuana, but not cigarettes, it would be inconsistent. If it has the power to ban one, it has the power to ban both, under United States law. Both marijuana and cigarettes are considered parts of commerce amongst the states, so the federal government is able to place bans where they find applicable on both. How constitutional this is is infinitely arguable, and all bans placed on uncontrolled substances have been narrowly constitutional; however, it is the law. Cigarettes should not be banned because of the amount of money the government would lose from tobacco taxes. The government makes a considerable amount of money every year from cigarette taxes. Banning cigarettes would also create a black-market for the product and cause more trouble than good. Also, a ban on cigarettes would cause an increase in unemployment worldwide. Even with tens of thousands of people becoming unemployed, the potential for black-market cigarette retail, and a proportional loss in revenue for the government, critics argue cigarettes need to be banned. The problem with these critics is that their points of argument are thin at best, and fail to give substantial reasons for banning cigarettes. Most notably, the outcry of non-smokers claiming they have to pay extra taxes for old-aged smokers that have acquired costly health problems. An interesting proposal when there are so many studies that suggest the opposite. An article from The Journal of the American Medical Association suggests that in order to have full fairness, smokers should be paid between 22 cents and $1. 28 by non-smokers for each pack smoked. This would balance out the societal costs and savings from the smokers habits (Manning 261:1604). So, while statistics say smokers get cancers, heart disease and other conditions that require costly care at a younger age, the same statistics state that smokers die at an earlier age. Therefore, they are not collecting their full potential of pension and social security benefits in their older age. They also do not cause long-term geriatric or nursing home bills like non-smokers do. Another point to make is that when a non-smoker gets lung cancer it is blamed on genetics, but when a smoker gets lung cancer it is assumed it was from smoking. Who is to say that the smoker’s lung cancer was not genetics as well? It should also be noted that lung cancer is a quick, degenerative form of cancer that kills fast which again, supports the claim that smokers cost less for taxpayers. The American Medical Association was not the only organization making these claims. Later in 1993, The U. S.  Office of Technology Assessment stated, â€Å"Reduction or elimination of smoking would improve health and extend longevity, but may not lead to savings in health care costs. In fact, significant reductions in smoking prevalence and the attendant increase in life expectancy could lead to future increases in total medical spending, in Medicare program outlays, and in the budgets of the social security†¦Ã¢â‚¬  (OTA 60). If that is not enough to convince one, the Congressional Research Service conducted a similar study with similar conclusions in 1994 which was then published in 1997 in the reputable New England Journal of Medicine. The Congressional Research Service stated, â€Å"Health care costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers, but in a population in which no one smoked the costs would be 7 percent higher among men and 4 percent higher among women than the costs in the current mixed population of smokers and nonsmokers. If all smokers quit, health care costs would be lower at first, but after 15 years they would become higher than at present. In the long term, complete smoking cessation would produce a net increase in health care costs† (Barendregt et al 337). If you are interested in learning more about cigarette smokers and their cost to the public, read From Cash Crop to Cash Cow, by W. Kip Viscusi. So smokers end up not costing as much as the public thinks in terms of healthcare, but what are some other reasons cigarettes should not be banned? How about the large chunk of money the government would lose from tobacco taxes? This is a very valid point seeing how revenue from tobacco taxes are used by the government as funding for hospitals, schools and other public amenities. Banning cigarettes would directly affect the amount of money the government has for these building costs. This would have a negative effect on the general public, particularly, their wallets. According to the United States treasury, in their fiscal year 2013 budget planning documents, the total federal revenue for tobacco is mentioned at over fifteen billion dollars for 2011. (U. S. Dept. of Treasury 16). With a lack of money coming from tobacco sales, the government would have to find another way to get funding for these projects and that would become evident with increases in property, income or alcohol taxes. Banning cigarettes would cause a general disturbance amongst smokers. To be able to smoke freely one day then for it to become illegal the next day would cause a lot of commotion. Harmless people in society would soon turn to illegal activities, such as smoking a cigarette, and be prosecuted for it. People are addicted to cigarettes, so a ban would not stand in the way of a lot of smokers trying to get what they want. Not only would there be a lot of irritable citizens, there would be a lot of productive and useful citizens being booked for petty crimes like possessing cigarettes. A black-market would ensue the ban and cause more trouble for the government than good. Foreign countries notorious for black-market activity would hop on the bandwagon as soon as they got word of the ban and start selling cigarettes illegally to under the table distributors in the United States. In the end, the government would end up spending more money monitoring the illegal sales of cigarettes instead of spending it on more beneficial things to society like finding and prosecuting murderers, kingpins, and organized crime. Overall, it would not be worth it. Loss of jobs needs to be accounted for as well. Not just the cigarette industry but also all the workers that contribute to the process of making a pack and selling it to distributors. There are people employed to make the cardboard-like cigarette boxes, people employed to make the paper that wraps around the cigarettes, people employed that make the designs on the packs, people employed to make the cellophane that wraps the outside of the pack. Also the truck drivers that deliver the cigarettes, and the engineers that keep the machines running in the cigarette factories, and the people who harvest tobacco, and all of the executive positions within all of these companies. The North Carolina Department of Agriculture and Consumer Services stated 662,400 people are employed with tobacco related jobs in the United States alone and worldwide, in the tens of millions (NCDA&CS 2). What people against cigarettes do not realize is how far the ban would reach and affect the livelihoods of a massive amount of people across the globe. Banning cigarettes would cause more problems and be another thing to worry about for the government and the citizens. The government would lose money from its tobacco tax, a black-market for cigarettes would be made, forcing the government to take action, and most importantly tens of millions of employed people would be without a job. It would not make sense to stir up commotion because a few people are concerned about health risks or smokers causing extra taxation for healthcare. As stated before, smokers cost less than non-smokers and a complete cessation of smoking would cause an increase in health care taxes in the long run. For the critics saying how bad smoking is for someone’s health, they have no authority to tell people how they should live their lives. People have the freedom to choose what they do to their bodies. The general public is able to make their own decisions and the government should not be able to make decisions for the public in regards to what they put in to their bodies. Even though constitutional law saws congress has the power to make choices for the welfare of its citizens, it still should not be allowed. What personal freedoms do we have if the government starts telling us we cannot smoke cigarettes? Soon they will be telling us to stop eating so much and sleeping so little. The government will say it is for the better of the people and that they are trying to keep the public healthy, but since when does the government genuinely care about the public? The government runs its own agenda regardless of the public. It is well known that the government is not planning on banning cigarettes anytime soon. Whichever party is responsible for that decision will lose a very large amount of its support network and neither political party is willing to take that risk. Plus why take that risk when there is a chance for the government to make more money by increasing cigarette taxes? The government just wants money. The government is addicted to cigarette taxes as much as smokers are to cigarettes.

People Who Suffer From Eating Disorders Essay - 2293 Words

Group Work:People Who Suffer From Eating Disorders Eating Disorders are illnesses that are obtained by irregular eating habits. This can affect how an individual sees him or himself. How much or how little an individual eats can damage his or her body. The most common forms of eating disorders are:Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Eating disorders can affect both genders from any age group however children and adolescents are mainly targeted. Eating disorders are labeled as a medical illness and can be treated. Although eating disorders can be treated, this illness if not treated over a long period of time can lead to death. Eating disorders can go hand to hand with other illness such as: anxiety, depression, and or substance abuse. History The first person to develop anorexia was Saint Catherine of Siena during the 1950s. She completely stopped eating from a spiritual sense. 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