Posted: September 2nd, 2022

Advanced Pharmacology

Advanced Pharmacology
Smoking has a major effect on the effectiveness of drugs in the body. The nicotine in cigarettes affects the functionality of the liver. Impaired functionality affects the pharmacodynamics and pharmacokinetics of a drug (Wegler et al., 2017). Clinicians should consider the behavior factors of a patient such as smoking to prevent adverse effects such as an increase in blood pressure or side effects of a drug.
Patient Factor
Patient behavior factors can influence the dosage of drugs prescribed for patients suffering from various diseases. One of the major patient behavior factors is smoking. Smoking is associated with impaired function of the liver which is also important in drug metabolism. The liver functions by converting the drug components to water-soluble metabolites which can be excreted by the kidney (Polosa et al., 2016). Therefore, smoking has a major effect on the pharmacodynamics and pharmacokinetics. For example, patients who are currently smoking or who are ex-smokers may require an adjusted dosage of warfarin. The reason is that when a person smokes the liver makes more enzymes to eliminate toxic substances and in the process eliminates more warfarin. Additionally, tobacco smoke affects drug metabolism, absorption, distribution, and elimination (Polosa et al., 2016). Therefore, a higher dosage is required for smokers to enhance the effectiveness of the drug. A clinician should assess the condition of the liver to determine the dosage.
Drug Therapy
Patients who are smokers are at risk of poor metabolism and elimination of a drug. Clinicians are thus required to adjust drug therapy to ensure the effectiveness of a drug. For example, if a patient quits smoking the dosage of warfarin may be adjusted since the functionality of the liver will be altered (Wegler et al., 2017). On the other hand, the administration of atenolol may be affected since people who smoke experience an increase in systolic blood pressure. Additionally, patients who smoke may require a higher dosage of glyburide compared to patients who are non-smokers (Oliveira, Ribeiro, Donato & Madeira, 2017). It is thus important for the clinicians to check the drug interaction with smoking to prevent adverse effects on the health condition of a patient (Anderson & Chan, 2016). For example, the patient described in the case study has hypertension which can increase severely upon taking the atenolol.
Drug Therapy Plan
The drug therapy plan can be improved by assessing the condition of a patient to determine their frequency of smoking. Patients who are stop smoking may require an adjustment in their prescription (Saladini et al., 2016). The purpose of adjusting the drug therapy plan is to ensure the effectiveness of the drug, improve metabolism and reduce toxicity. For example, an alternative of atenolol can be prescribed to patients who are smokers to prevent an increase in systolic blood pressure. On the other hand, the dosage of glyburide should be increased to patients who smoke cigarettes. Additionally, Motrin prescription may require an alternative drug since smoking increases the side effects of the drugs (Anderson & Chan, 2016). The changes are necessary since they will prevent a patient from experiencing severe side effects which may put them at risk of death.
Conclusion
Smoking affects the functionality of the liver by increasing the enzymes responsible for the elimination of toxic substances. Patients who smoke may require a different dosage in terms of amount or type of drug due to the altered metabolism of the drug. For example, systolic blood pressure increases when smokers take atenolol. Therefore, it is important to change drug therapy to prevent adverse drug effects on the body.

References
Anderson, G. D., & Chan, L. N. (2016). Pharmacokinetic drug interactions with tobacco, cannabinoids and smoking cessation products. Clinical Pharmacokinetics, 55(11), 1353-1368.
Oliveira, P., Ribeiro, J., Donato, H., & Madeira, N. (2017). Smoking and antidepressant pharmacokinetics: a systematic review. Annals of General Psychiatry, 16(1), 17.
Polosa, R., Morjaria, J., Caponnetto, P., Battaglia, E., Russo, C., Ciampi, C., … & Bruno, C. (2016). Blood pressure control in smokers with arterial hypertension who switched to electronic cigarettes. International Journal of Environmental Research and Public Health, 13(11), 1123.
Saladini, F., Benetti, E., Fania, C., Mos, L., Casiglia, E., & Palatini, P. (2016). Effects of smoking on central blood pressure and pressure amplification in hypertension of the young. Vascular Medicine, 21(5), 422-428.
Wegler, C., Gaugaz, F. Z., Andersson, T. B., Wiśniewski, J. R., Busch, D., Gröer, C., … & Joos, T. O. (2017). Variability in mass spectrometry-based quantification of clinically relevant drug transporters and drug-metabolizing enzymes. Molecular Pharmaceutics, 14(9), 3142-3151.

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Tags: Advanced Pharmacology