You will be presented with a case study and some pre-set data. Using this information and the
prompting questions provided, you are to submit an essay to demonstrate your understanding and
critical thinking skills associated with material delivered in Weeks 1-12 inclusive. The case study
and questions, along with further instructional information, will be made available on LEO by the end
2 Risk of Heart attack and Zocor Topic 1: Reproduction David and his wife are keen to start a family but have had no success so far. Considering David’s blood test results, indicate whether there is need for further investigation. Your discussion should include the homeostatic regulation of male reproductive physiology and the relevant glands, cells, and hormones. David’s blood tests suggest his testosterone levels to be 154 ng/dL and GnRH levels to be low. Testosterone and other hormones usually control the making up of the sperm. David’s testosterone levels are found to be on the lower side exhibiting their effect on sperm production. Also, David’s Gonadotropin Releasing Hormone (GnRH) levels are on the lower side. Lower hormone levels in David’s system can affect fertility by inhibiting the production of sperm and also reducing sex drive. The risk factors for David’s low hormone levels could be his age, increased weight, alcohol consumption, and diabetes (Dutta et al., 2019). Low levels of testosterone and GnRH cannot directly affect infertility but rather decreases sperm production. As a reason, investigations such as semen analysis, genetic testing, testicular biopsy’s, sperm functioning tests, Ultrasonography, etc. needs to be carried out for further confirmation. The regulation of the male reproductive system is a complex process. The male testis is known to secrete two components, the sperm, and the testosterone. The synthesis of these components is regulated by the hormones of the endocrine system. These hormones are released from the pituitary, hypothalamus, and within the testis. Hypothalamus and pituitary produce GnRH and other gonadotrophins through the conserved regulatory pathways. GnRH controls the biosynthesis and release of gonadotropins whereas Luteinizing hormone (LH) and Follicle stimulating hormone (FSH) aid in the regulation of the development and functioning of the testis (Matzuk & Lamb., 2008). LH also assists in the production of testosterone by Leydig cells and also stimulates spermatogenesis and sperm maturation. Further FSH along with testosterone also promotes sperm production. Homeostatic regulation of David’s reproductive system is mainly by negative the feedback system through the action of hormones of testicles at the endocrine glands to attune the production of GnRH and gonadotropins, respectively (Bu et al., 2017). Topic 2: Respiratory system David is late for work and the lift is broken; he must run up six flights of stairs to make it on time. Describe the gas exchange occurring between David’s blood and the skeletal muscles in his legs. Discuss how the rate of gas exchange was affected during the run up the stairs (i.e., during exercise). Gas exchange between David’s blood and the skeletal muscles takes place through diffusion. The skeletal muscles represent elevated carbon dioxide concentration whereas the bloodstream represents elevated oxygen concentration. There will be a diffusion of oxygen from the bloodstream to the muscles and a diffusion of carbon dioxide from skeletal muscles into the blood. During a run up of the stairs David’s lungs require more gas exchange due to an imbalance between oxygen consumption and carbon dioxide production. There will be increased use of oxygen and increased release of Carbon dioxide. Also, ventilation of alveoli is elevated because of the high respiratory rate and tidal volume. As a result, the gas exchange rate is also increased (Mezzani et al., 2018). As muscles work hard during exercise David’s body will utilize more oxygen and produces more carbon dioxide. To cope with this extra utilization and production of gasses makes breathing increase during rest and exercise. Topic 3: Digestion/metabolism After speaking to his doctor, David has decided to try to lose weight and he going to start a diet…tomorrow. Tonight, David is enjoying his last high carbohydrate/high fat meal for a while. Discuss the potential impact of David’s gall bladder removal upon his ability to digest his dinner. The primary function of the gallbladder is to collect and concentrate the bile in order to release it for the digestion process. When the gall bladder is removed bile is not concentrated and thus drains rapidly into the intestines. Gall bladder removal usually has long-term and short-term nutritional and metabolic consequences. As David’s gall bladder is removed, he may exhibit certain dysfunctioning in the liver profile. Thus, his body is not able to store excess bile synthesized by the liver. Bile will directly reach the small intestine and as a reason food moves quickly to the digestive tract and thus destroys the microbiome. Moreover, he will exhibit reduced ability to emulsify fats present in the small intestine. Therefore, he may also exhibit a reduced ability to digest his high-fat dinner making it harder and longer for his system to digest fat. State the hormone that is MOST active in maintaining David’s blood glucose levels at this time. Explain your answer. As David has had a dinner high in carbohydrates, his glucose levels get elevated. This is due to the supply of glucose from the intestine which results in increased levels of insulin and temporarily decreased levels of glucagon per se the pancreas turns on insulin synthesis and turn off glucagon synthesis. Glucose present in the bloodstream enters liver cells modulating the ability of different enzymes that aid in the conversion of glucose into glycogen due to increased insulin. Thus, the liver absorbs most of the glucose at this stage due to high carbohydrate intake. Insulin is known to attach to the muscle and fat tissue receptors enabling the uptake of glucose into them and hence reducing blood sugar levels. The overall process eliminates the glucose present in the bloodstream. As David has undergone gall bladder surgery, he may also undergo abnormal metabolic consequences such as alteration in glucose levels and insulin resistance (Di Ciaula et al., 2018). Topic 4: Pharmacology Under the advice of his doctor, David has taken Zocor® tablets each evening for the past 18 months. Discuss the route of administration, which route the drug is likely to be excreted after administration, and its likely bioavailability. Justify your response by discussing whether the drug would be subjected to hepatic first pass. David has been prescribed Zocor® tablets to control his cholesterol levels. The route of its administration is through the mouth. Zocor® is well absorbed after oral administration. Zocor® is mainly excreted in the feces. Biliary excretion is one of the vital means of drug elimination (Sung et al., 2021). Usually, a reduced percentage of an active forms of Zocor® is found to be present in the stool. Zocor® undergoes hepatic metabolism by the enzyme Cytochrome P450 3A4. The pharmacokinetic parameters are impacted by Cirrhosis thereby reducing the first-pass effect, protein binding, and hepatic clearance (Krishna et al., 2009). As it undergoes metabolism in gut wall and extensive first-pass metabolism in the liver, the bioavailability of the drug in the systemic system is very low. To help with weight loss, a friend has advised David to drink grapefruit juice with his meals. As a health care professional, would you consider this to be a good idea for David? In your answer, discuss the role of the liver in the administration of Zocor and grapefruit juice? Grapefruit juice along with meals for weight loss is a good idea for David as its rich in fiber and water content. Grapefruit will keep David’s stomach full all the time so that he can have less intake of calories. It also helps him to regulate insulin levels as he is a diabetic. Apart from these grape fruits juice provides health benefits for heart disease, and lowering of cholesterol and blood pressure as it contains vital antioxidants like vitamin C, lycopene, carotene, etc. This also helps in the prevention of chronic disorders. But, as David is taking Zocor for lowering cholesterol, he should be very careful before taking grapefruit juice along with Zocor. This is due to the fact that grapefruit juice might contain ingredients that can intervene with the ability of his body to metabolize the drug Zocor (Adio et al., 2022). The level of Zocor in the blood is thus elevated making the body more prone to adverse effects. References Adio, W. S., Ogunwole, A. C., & Mary, F. I. (2022). A review on drug-diet interaction. World News of Natural Sciences, 43, 108-125. Bu, P., Yagi, S., Shiota, K., Alam, S., Vivian, J. L., Wolfe, M. W., Rumi, M., Chakraborty, D., Kubota, K., Dhakal, P., & Soares, M. J. (2017). Origin of a rapidly evolving homeostatic control system programming testis function. The Journal of endocrinology, 234(2), 217–232. Di Ciaula, A., Garruti, G., Wang, D. Q., & Portincasa, P. (2018). Cholecystectomy and risk of metabolic syndrome. European journal of internal medicine, 53, 3–11. Dutta, S., Biswas, A., & Sengupta, P. (2019). Obesity, endocrine disruption and male infertility. Asian Pacific Journal of Reproduction, 8(5), 195. Krishna, R., Garg, A., Jin, B., Keshavarz, S. S., Bieberdorf, F. A., Chodakewitz, J., & Wagner, J. A. (2009). Assessment of a pharmacokinetic and pharmacodynamic interaction between simvastatin and anacetrapib, a potent cholesteryl ester transfer protein (CETP) inhibitor, in healthy subjects. British journal of clinical pharmacology, 67(5), 520–526. Matzuk, M. M., & Lamb, D. J. (2008). The biology of infertility: research advances and clinical challenges. Nature medicine, 14(11), 1197–1213. Mezzani, A., Pistono, M., Agostoni, P., Giordano, A., Gnemmi, M., Imparato, A., ... & Corrà, U. (2018). Exercise gas exchange in continuous-flow left ventricular assist device recipients. PLoS One, 13(6), e0187112. Sung, S., Al-Karaghouli, M., Kalainy, S., Cabrera Garcia, L., & Abraldes, J. G. (2021). A systematic review on pharmacokinetics, cardiovascular outcomes and safety profiles of statins in cirrhosis. BMC gastroenterology, 21(1), 120. ASSIGNMENT 3: Written assessment You will be presented with a case study and some pre-set data. Using this information and the prompting questions provided, you are to submit an essay to demonstrate your understanding and critical thinking skills associated with material delivered in Weeks 1-12 inclusive. The case study and questions, along with further instructional information, will be made available on LEO by the end of Week 6 of semester. Due date: Weighting: Length and/or format: Purpose: Learning outcomes assessed: How to submit: Return of assignment: Assessment criteria: REFERENCING Exam week 1; by 4pm Monday 31 October 35% 1200+10%-word essay