Pharmacodynamics and Pharmacokinetics: Case Study on Pain Management

This case study explores the principles of pharmacodynamics and pharmacokinetics, focusing on pain management in elderly patients. It addresses the increased susceptibility of the elderly to chronic pain and related conditions, including diabetes, bone and joint problems, and cancer. The study highlights the risks associated with non-steroidal anti-inflammatory drugs (NSAIDs), particularly gastrointestinal side effects. It also examines cancer-induced hyperalgesia and the role of NSAIDs in managing cancer-related pain, including bone pain. The analysis delves into the mechanisms of central sensitization, the efficacy of COX-2 inhibitors, and the limitations of current treatment strategies. The case study references multiple research studies and meta-analyses to support its findings, offering a comprehensive overview of pharmacological interventions in elderly patients experiencing pain.

Running Head: PHARMACODYNAMICS AND PHARMACOKINETICS: CASE STUDY
PHARMACODYNAMICS AND PHARMACOKINETICS: CASE STUDY
Name of the Student:
Name of the University:
Author Note:

2PHARMACODYNAMICS AND PHARMACOKINETICS: CASE STUDY
Question 1)
Elderly persons are more prone to suffering than any other group of the
population. While the number of individuals over the age of 65 continues to climb, frailty
and chronic pain-related conditions (Dodwad, Savage, Scharschmidt & Patel, 2014)are
expected to increase. Primary care doctors will also encounter major pain control
problems in older adults. Elderly individuals are most prone to suffer from diabetes,
bone and joint problems, tumors and other serious pain-related diseases. About 25%
and 50% of the elderly living in the city have serious pain issues. The incidence of
suffering in care facilities for the aged is much greater, and is reported to be between
45% and 80%. The most dangerous and lives-threatening complications associated with
NSAIDs (Wong, Karppinen & Samartzis, 2017) are the gastrointestinal side effects like
those of ulcers and bleeding. NSAIDs have now become a significant cause of
hospitalization particularly in the elderly and could even increase the chance of death
from ulceration more than 4-fold.
Question 2)
Cancer-induced hyperalgesia includes core and lateral sensitization. The
responsiveness of the ganglia and its nerves improves through the constant peripheral
stimulus and the pain tolerance decreases, culminating in hyperalgesia. The pathway
for central sensitization describes that neurochemical modifications in the spinal
cord, cause astrocyte hypertrophy and intensified dynorphin and c-Fos
expression, which reduces the pain threshold. Since ages, non-steroidal anti-

3PHARMACODYNAMICS AND PHARMACOKINETICS: CASE STUDY
inflammatory medications have been in use to improve pain management with certain
diseases. A meta-analysis of 25 randomized clinical trials (Ahmad et al., 2018) relating
to the usage of NSAIDs in cancer pain showed that while NSAIDs greatly decreased
cancer-related pain over placebo, their function in the treatment of metastasis-related
bone pain is still being considered. They do have an anti-inflammatory effect which
renders them an effective medication for swelling induced by some types of cancer
during comprehensive intrusion and degradation of tissue. Most specifically, 42
research studies have completed a Cochrane analysis on the application of NSAIDs in
cancer distress. These had been studied both individually and in tandem with opioids.
The primary contract ignored proof of one NSAID's superior potency (Wong, Karppinen
& Samartzis, 2017) or protection to the other. The essential theory behind this drug is to
inhibit the cyclooxygenase (COX) enzymes involved in the production of prostaglandin
in order to regulate different cell functions including pain sensing. COX-2 has been
decreasing in tumor cell growth. Hence rising COX behavior will also impede pain
perception. In favor of this hypothesis, immediate application of selective COX-2
inhibitors to rodents with cancer-induced bone pain was administered and the
procedure demonstrated attenuated (pain) activities, whereas continuous therapy often
decreased tumor pressure, and osteoclast damage, in addition to substantial pain relief.
The only downside is that due to the brief length of the operation and lack of long-lasting
consequences the results are minimal.

4PHARMACODYNAMICS AND PHARMACOKINETICS: CASE STUDY
Reference:
Ahmad, I., Ahmed, M. M., Ahsraf, M. F., Naeem, A., Tasleem, A., Ahmed, M., &
Farooqi, M. S. (2018). Pain management in metastatic bone disease: A literature
review. Cureus, 10(9).
AKTAŞ, İ., AKGÜN, K., Palamar, D., & SARIDOĞAN, M. (2014). Thoracolumbar
junction syndrome: An overlooked diagnosis in an elderly patient. Turkish Journal
of Geriatrics/Türk Geriatri Dergisi, 17(2).
Dodwad, S. N. M., Savage, J., Scharschmidt, T. J., & Patel, A. (2014). Evaluation and
treatment of spinal metastatic disease. In Orthopaedic Oncology (pp. 131-150).
Springer, Cham.
Dodwad, S. N. M., Savage, J., Scharschmidt, T. J., & Patel, A. (2014). Evaluation and
treatment of spinal metastatic disease. In Orthopaedic Oncology (pp. 131-150).
Springer, Cham.
Kaloostian, P. E., Yurter, A., Zadnik, P. L., Sciubba, D. M., & Gokaslan, Z. L. (2014).
Current paradigms for metastatic spinal disease: an evidence-based
review. Annals of surgical oncology, 21(1), 248-262.
Song, K. C., Seo, J. Y., Song, S. B., Ryu, W. H., Kim, D. R., Jeon, Y. H., ... & Ryu, G. H.
(2018). A Case Report of Patients Diagnosed with ThoracoLumbar Junction
Syndrome Treated by Megadose Pharmacopuncture with Korean Medicine
Treatment. Journal of Korean Medicine Rehabilitation, 28(2), 127-134.

5PHARMACODYNAMICS AND PHARMACOKINETICS: CASE STUDY
Wong, A. Y., Karppinen, J., & Samartzis, D. (2017). Low back pain in older adults: risk
factors, management options and future directions. Scoliosis and spinal
disorders, 12(1), 14.