Case study
LM is an 86-year-old female admitted to the emergency department with delirium. Her
spouse is with her and verifies that LM adheres to the medications she is currently prescribed. She does not self-monitor her BP or heart rate at home.
PMH:
A Fib diagnosed 1 month ago
HTN x 10 years
Chronic Kidney Disease x 5 years
Osteoarthritis x 7 years
GERD x 20 years
Medications:
Digoxin 0.25 mg QD
Metoprolol XL 25mg QD
Warfarin 3 mg QD
APAP 650 mg TID
Omeprazole 20mg QD
Multivitamin QD
Allergies: NKDA
Social History:
Married to husband for 57 years
No smoking, alcohol, limited daily exercise (short walks each morning)
Family History:
None reported
Vitals: Labs:
Wt 113 lbs Ht 54 Na+ 138 K+ 4.0
BP 101/58, HR 52 Cl- 99 CO2 27
BUN 33 Cr 1.2
Gluc 109 INR 3.8
Dig 2.4
PE:
Elderly female with altered level of consciousness, no signs of bruising, bleeding, or other injuries.
Review the case study assigned by your Instructor for this Assignment.
Select one of the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patients pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patients recommended drug therapy.
Think about how you might improve the patients drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
Write a 2- to 3-page paper that addresses the following:
Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
Describe how changes in the processes might impact the patients recommended drug therapy. Be specific and provide examples.
Explain how you might improve the patients drug therapy plan and explain why you would make these recommended improvements.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.
Textbook: Lehne\’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants – With Access 2ND 21
Pharmacology
Name
Institution
Date
Pharmacology
The case study presents an elderly female patient with several comorbidities such as chronic kidney disease, hypertension, GERD, and osteoarthritis. She has been brought to the clinic with altered consciousness. The patient’s conditions have made her be put on different medications to manage her symptoms as well as improve her organ functioning. The chosen factor is the patient’s age, which is likely to determine the pharmacokinetics and pharmacodynamics processes thus affecting the drug’s absorption into the body and at the same time inhibiting the desired effect of the prescribed drugs on the patient’s body.
Aging is a natural process that is characterized by a decline of a person’s functional reserve of the body systems and organs influencing the drug disposition. Aging has been associated with a slowed first-pass metabolism (Rosental & Burchum, 2020). Among the elderly patients, the total body water and body mass decrease while the body fat increases. The impact of aging on drug pharmacokinetics includes but is not limited to decreased drug absorption, impaired drug dissolution, and a high rate of absorption of high clearance drugs among others (Drenth-van Maanen et al., 2019). Due to the above impact, the potential effects may range from decreased bioavailability of drugs, and an increase in the plasma concentration to the inadequacy of the standard dose. More so, drugs, which have a high-hepatic extraction ratio, show a reduction in the systemic clearance from the body. The elderly therefore are more vulnerable to polypharmacy and comorbidity, which communicates the need for the clinicians to adopt the dosing aphorism of low drug dosages that should be increased gradually when necessary.
The patient’s drug plan includes medications such as Digoxin, Metoprolol, Omeprazole, Warfarin, and omeprazole. Metoprolol is a beta-blocker and beta-blockers are contraindicated among elderly patients due to the physiological changes among individuals aged 60 years and above. Some of the issues that make the drug to be contraindicated include low cardiac output, reduced renal blood flow, glomerular filtration rate, high peripheral resistance, and low plasma renin activity. The dosage should be maintained at 25 mg to prevent adverse effects or contraindication with other prescribed drugs such as Digoxin. The patient has been prescribed Digoxin 0.25 mg whose distribution into the body is directly affected by the patient’s decreased lean body mass and water resulting in increased plasma concentration. It would therefore require the clinician to lower the loading dose so that the drug may have the desired effect on the patient’s body system. Due to the risk of bleeding among the elderly patients put on Warfarin, the dosage should be maintained at low levels. Age has been identified as a predictor of bleeding among elderly Warfarin users (Shendre et al., 2018).
Based on the patient’s age, and the physiological changes associated with age, some of the changes that would ensure the drug benefits from the drug plan would be lowering the dosages as well as recommending the administration of some drugs at different intervals of the day. For example, there would be a need to change the timing for administration of Digoxin and Metoprolol, which should be taken at different intervals during the day to minimize the side effects while at the same time allowing for effective drug absorption and distribution into the body systems.
Aging is an important factor, which should be addressed when prescribing medication to patients. Elderly patients have a decreased body organ functioning ability due to physiological body changes such as a reduction of body mass and water. Similarly, due to existing, comorbidities, the patients’ drug plans should be customized to minimize adverse events while improving their health outcomes.
References
Drenth‐van Maanen, A. C., Wilting, I., & Jansen, P. A. (2020). Prescribing medicines to older people—How to consider the impact of ageing on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921-1930.
Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice providers.
Shendre, A., Parmar, G. M., Dillon, C., Beasley, T. M., & Limdi, N. A. (2018). Influence of Age on Warfarin Dose, Anticoagulation Control, and Risk of Hemorrhage. Pharmacotherapy, 38(6), 588–596. https://doi.org/10.1002/phar.2089