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Metformin

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Introduction

The research for this task will primarily focus on Metformin, an oral diabetes treatment.

This medication is used to treat type 2 diabetes and, in conjunction with a healthy diet, regular

exercise, and other diabetes medications, to help diabetic patients control their blood glucose

levels. This research paper's learning outcomes include understanding the pharmacology of anti-

diabetic medication, specifically how it interacts with the human body and other medications. In

addition, the research's intention is to look at medical acts and legal and ethical frameworks for

effective medication management and administration.

Introduction to the medication

Metformin is the only oral diabetes medication in the biguanides drug class. Biguanides'

three main goals are to "prevent the production of glucose in the liver, improve the body's insulin

sensitivity, and reduce the amount of sugar absorbed by the intestines." Metformin must

therefore be appropriately administered and monitored for diabetic patients who cannot control

their blood sugar levels through diet and exercise alone. This antihyperglycemic medication

differs from other anti-diabetic medications because it does not directly affect insulin release or

lower blood sugar levels like hypoglycemic medications.

The recommended starting dose of Metformin for adults with type 2 diabetes is 500 mg

for 12 hours, followed by 850 mg once daily for two weeks (Bailey, 2017). For maintenance, the

drug can be taken in 8-12 hour doses of 1500-2550 mg daily. Given the medication's potential to

impair renal function in this population, metformin dosage for elderly patients should be adjusted

based on renal function. In this case, renal function should have regular monitoring. Metformin

500 mg should be the starting dose for children (10-16 years old) with diabetes mellitus.
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Pharmacology of Metformin

Pharmacology is the study of how medications and treatments operate. It is a branch of

medicine, biology, and pharmacy. A drug is any molecule that has a biochemical or

physiological effect on a cell, tissue, organ, or organism, whether created in a lab, discovered in

nature, or created by the body's immune system ( Satoskar and Bhandarkar, 2020).

Pharmacodynamics and pharmacokinetics are the two most significant aspects of pharmacology.

Pharmacodynamics is concerned with how medications influence living things, whereas

pharmacokinetics is concerned with how drugs affect living things. Pharmacokinetics studies

how chemicals are absorbed, transported throughout the body, broken down, and eliminated.

Metformin helps persons with type 2 diabetes manage their sugar levels. The medicine

causes the liver to produce less glucose, makes it difficult for the gut to absorb glucose, and

reduces the effectiveness of insulin (CDC, 2021). The medicine works by increasing the body's

intake and utilization of glucose.

Pharmacokinetics

Metformin is only 50% to 60% bioavailable when taken by mouth while fasting. The

Cmax of immediate-release Metformin is attained in 1-3 hours, but extended-release Metformin

takes 4-8 hours. Metformin's significant apparent volume of distribution reflects its poor plasma

protein binding (300–1000 L after a single dose). It takes 1-2 days to reach a stable state (Rena et

al., 2017).

Metformin is not metabolized. It is gone from the body unchanged in the urine 24 hours

after a single oral dose and cannot be identified in blood plasma. The half-life of plasma is 6.2

hours (Dumitrescu et al., 2015). Metformin is a drug that accumulates in red blood cells and has
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a half-life of 17.6 hours. (The period ranged from 18.5 to 31.5 hours in a single-dose trial of

adults without diabetes.)

Polypharmacy

Most people who take many drugs are elderly folks with chronic illnesses. Polypharmacy

is common in older adults with multiple subspecialists but no primary care doctor. Residents at

long-term care homes are additionally vulnerable because they are older, frailer, and have health

and cognitive issues that necessitate drug therapy. Every day, 91% of persons in long-term care

take five medications (Wakeman & Archer,2020).

With many therapies and methods available, young individuals with fibromyalgia or

developmental difficulties may develop polypharmacy. Diabetes, heart disease, stroke, and

cancer are why young people take multiple medications. Polypharmacy is frequently overlooked

in patients suffering from mental illnesses. People with these illnesses are frequently prescribed

psychotropic drugs, which have side effects, and other medications may be used to mitigate those

effects. Chronic medical and mental health disorders may necessitate using more than one

medication to allow the person to function optimally and prevent the sickness from worsening.

However, this prudent usage of many drugs may increase the risk of adverse drug responses.

Polypharmacy risk factors might arise from either the patient or the system. If

prescriptions that are no longer needed are not deleted and automatically refilled, or if a doctor

receives an automated refill request for a drug that is no longer needed, it can lead to

polypharmacy. Metformin helps persons with type 2 diabetes control their blood sugar levels

more efficiently. It is considered safe and is the most widely used oral diabetic medication.

Metformin use has been associated with a decrease in Vitamin B12 levels, but it is unclear what
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these implications are for diabetic peripheral neuropathy. Metformin and other drugs might cause

a deficiency of vitamin B12, which can aggravate diabetic neuropathy (Hitner et al.,2022).

Metformin and other medicines inhibit carbonic anhydrase, increasing the risk of lactic

acidosis. These medications result in a non-anion gap and a decrease in serum bicarbonate.

Examples include topiramate, zonisamide, acetazolamide, and dichlorphenamide. Metformin,

Ranolazine, vandetanib, cimetidine, and dolutegravir are all medications that may increase the

risk of lactic acidosis. These medications make it more difficult for the kidneys to eliminate

Metformin. Metformin, thiazides, and corticosteroids can all make blood sugar control more

difficult.

Legal and ethical administration

The Medications Act of 1968 and the Misuse of Drugs Act of 1971 cover most of the

rules governing medicines in the United Kingdom. Because they specify "who can do what with

which medications," these Acts influence all healthcare providers who work with medicines,

including paramedics (Ferner & Aronson, 2022). We would be breaking the law and committing

a crime if we, as health practitioners, did anything that violated the laws in these Acts.

The 1968 Drug Act

This act governs how medications are manufactured, sold, and distributed in the United

Kingdom. Its primary purpose is to keep people safe by ensuring that medicines are safe and

effective. The Medications Act is enforced by the medicines and the Medicines and Healthcare

Products Regulatory Agency (MHRA). The MHRA is the government organization ensuring that

medicines and medical equipment perform correctly and are safe (Dixon-Woods et al., 2011).

Prescription-only medicines (POM) can only be purchased from a pharmacist if a doctor, dentist,

optometrist, or nurse prescribes them; pharmacy medicines (P) can only be purchased from a
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pharmacist but do not require a prescription; and general sales list (GSL) medicines, which can

be purchased from any store without a prescription.

The act regulates the sale of the drugs covered but does not define what it means to have

a drug. If the drug is controlled under the Misuse of Drugs Act of 1971, having it without a

prescription is a felony. Metformin is a prescription medication; thus, this act affects it and

causes it to plummet.

The 1971 Misuse of Drugs Act

The 1971 Misuse of Drugs Act regulates drugs that are hazardous or damaging in other

ways. These are known as "restricted medications" (C.D.s). The Misuse of Drugs act's principal

purpose is to prevent C.D.s from being misused. This is accomplished by making it illegal to

possess, sell, manufacture, import, or export controlled medicines unless one obtains a license

from the Secretary of State or is permitted by rules (Stothard, 2021). The revised Misuse of

Drugs Regulations 2001 state that C.D.s can be used in medicine. In other words, while the act

deems it illegal to do anything with C.D.s, certain health practitioners are permitted to do so.

Metformin can be harmful if taken incorrectly; thus, this legislation governs how it can be used.

Ethics

Ethics is known as the study of what is ethically right and wrong, as well as what should

be done. Ethics requires us to tell the truth, honour our promises, and assist those in need. Every

day, we live by moral principles that help us make sound judgments and keep us from doing

unjust things. Beauchamp and Childress first discussed the Four Principles in their work

Principles of Biomedical Ethics. They are now regarded as the accepted manner of approaching

ethical dilemmas in medicine. Beneficence is the concept of doing what is best for the other
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person. According to the concept of justice, people should be treated fairly and equitably. The

right to make one's judgments is known as autonomy, while the Hippocratic Oath's precept of

"above all, do not harm" is known as non-maleficence.

Knowledge and applications of the safe administration, ordering, receiving, storage, and

disposal of Metformin

When this medication is purchased, it usually comes with a patient information page.

Before one begins taking any medication, make sure that one has thoroughly read and

comprehended the directions. If the patient has any questions, a doctor should be consulted.

Make sure to stick to the eating plan prescribed by the doctor (Grosvenor et al., 2021). This plan

is vital to ensure that the medicine works as it should and is also a vital element of treating one's

sickness. In addition, one should stay active and follow the doctor's instructions for testing sugar

levels in the blood and urine. Metformin should be taken with food to reduce the likelihood of

stomach or intestinal side effects during the first few weeks of treatment. When taking a pill or

extended-release tablet, consume it with a full glass of water. It should not be chewed, broken, or

crushed. While taking the extended-release tablet, some pills may pass through one's faeces after

the body has used the medicine (Diggle, 2019). This medication is entirely regular and causes no

concern. One can use a medicine cup, an oral syringe, or a spoon with a mark to measure the oral

fluids. An average teaspoon, which is found in most homes, may not be able to hold enough

liquid. Use the dose cup provided to measure the blended extended-release oral suspension

correctly. If one does not have a dosing cup, speak with the pharmacist about obtaining one. Use

only the brand of this medication recommended by the doctor or nurse. Different brands may

have different results; therefore, one may see an improvement in the ability to regulate blood
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sugar in one to two weeks, but the full effect of regulating the blood sugar may not be evident for

another two to three months. If one has any queries regarding this, one should consult the doctor.

The medication should be stored in an airtight container at room temperature, away from

heat and moisture sources, and out of direct sunlight. Prevent the water from freezing. Make sure

that children cannot get their hands on it. Medicines past their expiration date or no longer

required should not be kept. If one no longer requires a medication, consult the doctor about how

to dispose of it properly.

Patient Group Directions

PGDs, also known as "patient group directions," is a legal framework that allows certain

certified health practitioners to deliver specific prescriptions to a pre-defined group of patients

without the patients first seeing a prescriber. PGDs should be used when they improve patient

care and do not jeopardize patient safety. PGDs are legislative guidelines that allow certain

registered health professionals to give or give certain drugs to a specific group of people without

first seeing a prescriber (Stothard, 2021). On the other hand, most nurses believed that keeping

records and conducting administrative tasks contributed to their workload. Nurses lack trust in

the use of pharmacology and therapeutics. Nurses did not trust their patients' understanding of

applied pharmacology and therapeutics, despite patients being happy with nurses writing

prescriptions for them(Terry, 2012). This required nurses to receive more scientific training, and

they feared becoming overconfident and writing prescriptions outside their expertise.

Conclusion

Metformin has been used to treat diabetes for a long time, and its effectiveness as a

diabetes drug has repeatedly been proven over the years. Metformin works well in treating type 2

diabetes, as shown by the fact that 236 people have given it a rating of 5.9 out of 10. (45% of
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reviewers had a good experience, while 32% had a bad one.) Even though it might make some

people feel bad, it does not break any medical laws or rules. Because of this, it looks like it will

be on drug store shelves for longer before a good replacement is found.

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