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Patient Characteristics
Patient Characteristics
Patient Characteristics
57-year-old woman.
The fall occurred while having lunch with recently introduced grapefruit juice.
The patient has been experiencing dizziness for the past week.
Blood pressure today in clinic was 85/55 after suffering from a fall.
The patient have variations in their Cytochrome P450 genes that causes differences in
drug metabolism.
Another important patient characteristic is the recent introduction of grapefruit juice into
the patient’s diet. Chen, Zhou, Fabriaga, Zhang, and Zhou (2018), reported that grapefruit
juice can act as an inhibitor of first pass metabolism for drugs metabolized by
As per Arcangelo, Peterson, Wilbur, and Reinold (2017), grapefruit juice can alter the
Patient Diagnosis
The persistent feelings of dizziness for the past week, in addition to the recent episode of
Arcangelo et al. (2017) reported that the effects of Procardia are exacerbated with the
consumption of grapefruit juice and therefore, the patient’s blood pressure would be
The patient’s blood pressure on presentation to the clinic was 85/55, which falls within
Procardia (Nifedipine)
A calcium ion influx inhibitor that exerts its action by blocking the activity of slow
calcium ions, thereby reducing the membrane contractility of vascular smooth muscle and
medication since it will not severely disrupt other electrochemical processes that depend
on the exchange of calcium cations. Procardia is metabolized by CYP3A4 in the liver and
Lipitor (Atorvastatin)
(Skidmore-Roth, 2018).
As stated above, grapefruit juice inactivates CYP3A4, and the enzyme is responsible for
Inhibition of CYP3A4 increases the longitudinal effects of atorvastatin and this could
potentially exacerbate some side effects of the medication, including muscle and liver
The potential side effects caused by inappropriately elevated level of serum atorvastatin
do not explain the unusual side effects experienced by Ms. Rose. Therefore, it is unlikely
Glucophage (Metformin)
glucose, and increases insulin sensitivity. The overall effect of Metformin is a reduction
The exact mechanism of action of Metformin is not entirely understood, however, some
evidence suggest that it leads to activation of AMP-activated protein kinase and elevation
Metformin is an unusual drug in that it is not metabolized by the body but is cleared by
tubular secretion in the kidneys. The drug has a half-life of approximately six hours and
therefore, the effects of the medication will persist until cleared by tubular epithelium
(Skidmore-Roth, 2018).
The metabolism of the medication is not modified by different physiological states, i.e.
intense exercise or caloric input, and thus, the medication exerts a consistent effect on the
Hayanga et al. (2009) reported that grapefruit juice is unlikely to affect the action of
Metformin and given its mode of excretion, the ingestion of grapefruit juice is unlikely to
Drug Interactions
Arcangelo et al. (2017) reported that there are multiple drug-drug interactions for
Procardia. In fact, Procardia has moderate drug interactions with both Lipitor and
Metformin.
CASE STUDY 4
Both drug-drug interactions involve an increase of the effects of both Metformin and
atorvastatin when combined with Procardia. This is due to the competition of Procardia,
Lipitor, and Metformin for the cytochrome enzymes involved in their metabolism or
secretion by the body (Skidmore-Roth, 2018). Procardia has a greater affinity for the
Plan of Care
controlled.
One method of decreasing the progression of kidney damage is the combined use of
(ARBs). These medications act by causing dilatation of efferent arterioles in the kidney,
These medications are effective for lowering blood pressure and the discontinuation of
Procardia is warranted with the substitution of an ACE inhibitor and ARB combination.
The Lipitor and Metformin can remain a component of the patient’s medication regimen
Although not explicitly stated, one could assume that the health education of the patient
was poor prior to this clinic presentation. Therefore, it is essential that thorough
education is completed about the medications that the patient will be taking and their
The patient should be instructed that certain dietary products can modify the metabolism
performed prior to any persistent changes in their diet. Per Arcangelo et al. (2017),
education on the consumption of grapefruit juice, St. John’s wort, and other herbal
Once verbalized understanding with teach back has been performed, the patient should
References
Boron, W. F., & Boulpaep, E. L. (2016). Medical physiology e-book. Saint Louis, MO: Elsevier
Health Sciences.
Chen, M., Zhou, S. Y., Fabriaga, E., Zhang, P. H., & Zhou, Q. (2018). Food-drug interactions
precipitated by fruit juices other than grapefruit juice: An update review. Journal of Food
Hayanga, J. A., Ngubane, S. P., Murunga, A. N., & Owira, P. M. (2016). Grapefruit juice
Skidmore-Roth, L. (2018). Mosby's 2019 nursing drug reference e-book. Saint Louis, MO:
Watson, D. G. (2015). Pharmaceutical analysis e-book: A textbook for pharmacy students and