Drug Response and Administration
People respond differently to drugs. Recent research indicates that the effectiveness of some drugs, such as penicillin, anthihistamine, and aspirin, is influenced by the individual`s biological clock.
A specific drug dosage may be more or less effective, depending on whether the dose is administered when the person`s physiological functions are at minimal or maximal levels. For example, the dosage of analgesics needed to relieve pain during the evening or dark hours is more than that needed during the activity period.
Circadian rhythms are also important factors in determining drug toxicity. A distinct 24-hour rhythm of vulnerability or resistance to drugs has been identified. Part of the toxicity rhythm is due to the rhythm of the liver enzymes, which are responsible for most drug detoxification. Before setting a drug`s toxic level, both the person`s biological clock and the drug dosage must be considered.
One area of chronopharmacology (study of cellular rhythm in relationship to drug therapy) which has been researched extensively is the relationship of adrenocortical function and corticosteroid drug administration. The secretion of corticosteroids by the adrenal cortex has a 24-hour-rhythm, with the highest corticosteroid values expected after the usual time of awakening. When corticosteroids are administered either daily or on alternate days, adrenal suppression and possibly growth disturbance can be minimized by timing to the circadian crest in adrenocortical function.
Without the aid of suitable measurement devices, it is impossible to determine a person`s biological clock. Drug administration is therefore usually based on other factors. Most medications are given before or after meals, at bedtime, or at the convenience of nursing personnel and patients. In the future, as knowledge of the internal clock increases, you, and nurse, will find yourself altering drug administration times to suit the person`s biological time. Perhaps you will be in change of a master computer that, after analyzing information about each person`s biological clock, will send the appropriate medication dose at the appropriate time.
References :
Aschoff, Juergen, “Circadian Systems in Man and Their Implications”, Hospital Practice, 11: No.5, 1976.
Murphy, Juanita, ed., Theoretical Issues in Professional Nursing. New York: Appleton—Century-Crofts, 1971.
United States Department of Health, Education, and Welfare, Public Health Service, Biological Rhythms in Psychiatry and Medicine. Chevy Chase, M.d.: National Institute of Mental Health, 1970.
Smolensky, M.H., and A. Reinberg, “The Chronotherapy of Corticosteroids: Practical Application of Chronobiologic Findings to Nursing”, Nursing Clinics of North America, 11: No.4, 1976.
Murray, RB and Zentner JP., Nursing Concepts for Health Promotion, Second Edtion, Prentice-Hall, Inc, Englewood Cliffs, N.J, 1979.
