Understanding Balance Issues and First-Pass Metabolism in a 70-Year-Old Patient Taking Diazepam Question One: The Cause of the Patient’s Difficulty in Maintaining Her Balance

As with other benzodiazepines, diazepam (valium) works on the central nervous system (CNS). It affects how brain neurotransmitters work and how related chemicals are released. Thus, Valium aids nerves in communicating with other nerves. Prolonged use can impair the aging nervous system, causing the 70-year-old woman to have a dizzy feeling and things around her turn around.

Question Two: First-Pass Effect

The first pass effect occurs when a drug gets metabolized at a certain location in the body, leading outside of the target site, reducing the concentration and action of the active ingredient on the site of action (Zaidat et al., 2018). The first-pass effect in orally administered diazepam is affected by gastrointestinal, gut wall, bacterial, and hepatic enzymes. To circumvent this, a change of the mode of administration is required. The use of intranasal delivery reduces the chances of enzyme action on the active ingredients and also creates a larger surface area for absorption.

Question Three: Causes of The Signs of Confusion

Acetaminophen action in the body of the 75-year-old woman is the cause of the confusion. Acetaminophen poisoning in older adults leads to liver toxicity and acute liver failure, leading to functional impairment (Ramachandran & Jaeschke, 2018). The impaired liver functions allow the accumulation of toxins within the circulatory system, affecting the lady’s psychomotor and cognitive function, which explains her episodes of confusion.

Question Four: Warfarin Metabolism

Warfarin has a half-life of 20 to 60. It is metabolized in the liver by the CYP-2CP microsomal liver enzymes (Grayson et al., 2018). If taken during pregnancy, warfarin may cause fetal plasma levels to equal the mother’s values as the drug can cross the placental barrier.

Question Five: The Hepatic Drug Metabolism of Children 1 Year and Older

Hepatic metabolism in children is controlled by the activities and expression of drug-metabolizing enzymes based on maturity. In addition, hepatic blood flow, active transport processes, and related plasma protein binding also affect the metabolism’s efficiency (Krekels et al., 2017). Hepatic drug metabolism in children and adults differs due to body age, body weight, and functions. The liver weight and hepatic blood flow rate per unit liver weight in children is higher than in adults, thus affecting drug pharmacokinetics.

Question Six: Protein Binding in Neonates

Protein binding is how drugs attach to protein in the blood. Drug-binding proteins in neonates determine the disposition and action of drugs as they control drug distribution throughout the body. If a high competition for binding proteins between neonates and other substrates exists, then a decreased protein binding in neonates may be experienced.

References

Grayson, L., Vines, B., Nichol, K., & Szaflarski, J. P. (2018). An interaction between warfarin and cannabidiol, a case report. Epilepsy and Behavior Case Reports, 9, 10–11. https://doi.org/10.1016/j.ebcr.2017.10.001

Krekels, E. H. J., Rower, J. E., Constance, J. E., Knibbe, C. A. J., & Sherwin, C. M. T. (2017). Hepatic Drug Metabolism in Pediatric Patients. Drug Metabolism in Diseases, 181–206. https://doi.org/10.1016/B978-0-12-802949-7.00008-0