When it comes to medication management for a PACE participant, the process of medication metabolism plays a significant role. The human body metabolizes, or breaks down, substances in order to remove them from the body.
Food, liquids, and medications are absorbed, distributed throughout the body, metabolized, and then eliminated. This is accomplished through a complex and complicated process involving a host of your body’s enzymes.
Obviously, knowing how slow or how quickly a medication is metabolized and eliminated from the body is crucial when prescribing medications for health issues.
When multiple medications are involved, as is the case with the average PACE participant, the issue becomes even more complicated. Let’s take a look at the role medication metabolism plays.
Medication Metabolism & the PACE Participant
Most medication metabolism occurs in the liver, kidneys, and small intestine. Water-soluble, or hydrophilic medications, are more readily excreted by the body. Conversely, it is more difficult for fat-soluble, or lipophilic medications, to be eliminated without being changed.
Therefore, extremely water-soluble medications may bypass metabolism in the liver and be eliminated completely unchanged by the kidneys. And a largely lipid-soluble medication may undergo numerous phases of metabolism in order to provide a compound that can be excreted by the body. The basic understanding is:
- As lipid solubility increases, the need for metabolism also increases.
- As water solubility increases, the need for metabolism decreases.
It is commonly, and incorrectly, believed that all medications require extensive metabolism.
The human body is highly efficient, and only conducts those metabolic processes that are necessary. The amount and types of reactions depend on the individual’s body chemistry and the chemical structure of the medication.
Factors Affecting Medication Metabolism in the PACE Participant
A person’s genes dictate how the body functions. This affects the enzymes that metabolize medications.
A PACE participant may metabolize poorly, another about average, and yet another quite efficiently. This will affect how quickly a medication is used and eliminated from the body.
There are other factors that affect medication metabolism. There is some evidence in animals and humans that drug metabolism diminishes with age, although the effect has not been well studied.
A PACE participant of advanced years may have more difficulty metabolizing certain medications than younger participants.
Hereditary or genetic factors can play a part in how the PACE participant metabolizes medications—and especially certain combinations of medications. Some may enjoy a genetic predisposition to metabolize complex substances rather rapidly and without complications, while others may struggle to break them down for longer periods of time.
In humans, there have been a few reports of gender differences in metabolism. For instance, nicotine and aspirin seem to be metabolized differently in women and men.
On the other hand, gender differences can become significant in terms of drug-drug interactions based on the drug’s metabolism.
Pharmacy Solutions for the PACE Participant
In order to protect against unwanted adverse medication reactions, doctors and PACE pharmacy providers would want to choose a medication that is metabolized adequately by the individual. Clearly, knowing the health background and medical condition of each PACE participant is crucial to providing quality pharmacy solutions.
Jennifer Devinney is the Chief Clinical Officer for Grane Rx. In this role, she works with clinical pharmacists and nurses in conjunction with facility staff to develop and oversee clinical initiatives. Additionally, she is the clinical EHR integration specialist.
Categories: Clinical Care Advantage