Cardiovascular system custom essay
Glipizide is a medication used for the management of high blood pressure in patients
suffering from type 2 diabetes. It is combined with the management of diet and exercise but may
also be combined with other medications (Li et al.,2017). It is a second generation sulfonylurea
that acts by stimulating the production of insulin from beta cells of pancreatic islet tissues. The
pharmacodynamics is dependent on the functioning of the cells. The effects of glipizide are
dependent on food intake thus they increase the levels of insulin production after a meal and they
do not help in fasting insulin. Thus, an increase in age will lead to a reduction in the response of
beta cells in the production of insulin. It is metabolized in the liver through hydroxylation into
hydroxyglipizide and eliminated through the kidneys in urine in inactive hydroxylation products
and polar conjugates. With aging the hepatic and nephritic functions become reduced which lead
to slower metabolism and elimination of the parent compounds.
HCTZ (hydrochlorothiazide) is a thiazide diuretic that is used in management of
hypertension through promotion of water loss. The pharmacodynamics is based on the ability to
increase reabsorption of Na + and Cl – reabsorption from the distal convoluted tubules. They cause
an increase in the serum uric acid and loss of K + (Brown et al.,2016). They also result to
vasodilation through calcium potassium gated channels whose activity is dependent on the
cellular activities. Age affects the rate of response of the kidneys and vasodilation by slowing
dysregulation. The drug is not metabolised but instead eliminated in the kidneys whose action
are dependent with age of the patient.
Atenolol is a beta blocker which acts by decreasing heart rate, cardiac contractility, and
electrical conductivity through the production of norepinephrine from peripheral nervous system.
it enables reduction of BP through reduced peripheral vascular resistance and cardiac output. It
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also acts on the renin aldosterone angiotensin system (RAAS) which reduces the blood pressure.
The response is age dependent as the cardiovascular system and the nervous system activity is
determined by aging. Volume of distribution is 12-17litres within 3hrs for central compartments,
4hrs for shallow compartments, and 6hrs for peripheral. Based on the age of the patient, the
distribution is higher for the younger ones.
Hydralazine works by reducing the workload of the heart and increasing the oxygen
supply to the heart. Increased age results to a reduction in the response of medication as the heart
activity is reduced. It has a protein binding capacity of 87% and undergoes extensive first pass
metabolism by genetic polymorphic acetylation which increases its bioavailability especially
with younger patients (Tampe et al.,2017). Due to hepatic metabolism and urinary elimination,
advanced age is a major factor inhibiting the pharmacokinetics.
Simvastatin is a lovastatin in methylated form which helps in managing
hypercholesterolemia through reduction of LDL cholesterol and plasma triglycerides as well as
apolipoprotein B. It inhibits the production of HMG CoA reductase which is higher in the
elderly. It has a protein binding capacity of 85% on oral administration and achieves peak plasma
concentration after 3hrs of administration. However, the levels are reduced and slowed in
patients with aged hepatic systems.
Verapamil is a L type calcium channel blocker which is found in two components; R-
enantiomer and S-enantiomer with the later being 20times more potent. However, R-enantiomer
is the most effective in reducing increased BP. It inhibits voltage dependent calcium channels
specifically the L type and causes a reduction in ionotropy and chronotropy thus reducing BP. It
has a binding capacity of 90% and metabolism through the git. Thus an advance in age reduces
the metabolism, absorption, and elimination of verapamil. To improve the drug therapy is
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enabled by reducing the number of medications and only putting the patient under the necessary
and most effective medications.
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References
Brown, M. J., Williams, B., Morant, S. V., Webb, D. J., Caulfield, M. J., Cruickshank, J. K., … &
Mackenzie, I. S. (2016). Effect of amiloride, or amiloride plus hydrochlorothiazide,
versus hydrochlorothiazide on glucose tolerance and blood pressure (PATHWAY-3): a
parallel-group, double-blind randomised phase 4 trial. The Lancet Diabetes &
Endocrinology, 4(2), 136-147.
Li, Q., Wen, H., Jia, D., Guan, X., Pan, H., Yang, Y., … & Pan, W. (2017). Preparation and
investigation of controlled-release glipizide novel oral device with three-dimensional
printing. International journal of pharmaceutics, 525(1), 5-11.
Tampe, B., Steinle, U., Tampe, D., Carstens, J. L., Korsten, P., Zeisberg, E. M., … & Zeisberg,
M. (2017). Low-dose hydralazine prevents fibrosis in a murine model of acute kidney
injury–to–chronic kidney disease progression. Kidney international, 91(1), 157-176.
