Problem Set #8 (In-class submission is not required. On-line LG work is due on 07/19/2010)
A. Compare the enzymatic sulfation and glucuronidation reactions and discuss their similarities and differences
(a). Similarities:
(b). Differences:
B. Case study, Page 323, Foye’s
“WH-L is a 62-year-old, Beijing-born scientist attending an international scientific meeting in your hometown. While delivering his groundbreaking paper on the neuroprotective action of some unique bicyclic molecules he has synthesized, WH-L experienced a very rapid and irregular heart rate, followed by a tight, gripping pain in his chest. Recognizing that he was having a myocardial infarction (MI), WH-L immediately took an aspirin tablet while his colleagues called an ambulance to take him to a nearby hospital. Fortunately, his quick action has averted a fatality, although the medical staff cannot get his heartbeat to stabilize. His situation is considered dire, and the decision is made to put him on an antiarrhythmic agent until he is well enough to return home to consult with his personal physician. It also is decided that β-adrenergic blocking therapy is in order. WH-L has evidence of coronary artery disease and elevated blood pressure. He is taking rosuvastatin calcium (Crestor' 20 mg q.d.) to keep his serum cholesterol levels in check and flurbiprofen potassium (Ansaid, 50 mg q.i.d.) for mild–moderate arthritis pain.
As the pharmacist-in-charge on the drug therapy decision team, you consult with WH-L and learn that he recently had an oral abscess that resulted in a tooth extraction and used codeine sulfate to treat his significant, but short-term, postsurgical pain. A few years ago, he experienced a deep vein thrombosis that was treated for 12 weeks with standard doses of warfarin sodium (Coumadin). A decision is made to initiate warfarin therapy again post-MI. WH-L does not consume alcohol but loves grapefruit juice, which he always has for breakfast and often once or twice again during the course of the day. He has asked for it routinely while in the hospital. Given this medical history, and keeping the drug metabolism pathways firmly in mind, select one antiarrhythmic agent and one β-blocker that would best suit the needs of this patient. Assume that all drug choices would be therapeutically effective for the disease they are intended to treat.”
(a). Identify the therapeutic problem(s) for which the pharmacist's intervention may benefit the patient.
(b). Identify and prioritize the patient-specific factors that must be considered to achieve the desired therapeutic outcomes.
(c). Conduct a thorough metabolic analysis of all therapeutic alternatives provided in the case.
(d). Evaluate the metabolic findings against the patient-specific factors and desired therapeutic outcomes and make a therapeutic decision.
(e). Counsel your patient.
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