Treatment or provide an alternative treatment option for the patient.
Case Study:
LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.
PMH:
• HTN
• Alzheimer’s disease
• Hypothyroidism
• Osteoarthritis
• Diabetes
MEDICATIONS:
• Amlodipine 10 mg QD
• Donepezil 10 mg QHS
• Levothyroxine 0.88 mg QAM
• Celecoxib 200 mg QD
• Furosemide 40 mg QAM
• Metformin 500mg, 1 BID
• Glyburide 5mg, 1 BID
ALLERGIES: NKA
SOCIAL HISTORY:
Widowed with 2 adult children living in town, retired photographer and owner of an art supply store
VITALS: LABS:
Weight: 129 lbs TSH 2.45 Free T4 0.98
Height: 64 inches Na 135, K+ 3.8, Cl 99, CO2 25,
BP: Supine = 177/82 Glucose 101, SCr 0.9, BUN 42
HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1
Plt 255
Cr: 1.6 UA: Clear
eGFR: 45 ml/min
PE:
• HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes
• CV: RRR
• Respiratory: Clear to auscultation bilaterally
• Abdomen: Soft, non-tender, no masses or guarding
• G/U: Skin intact, assisted with toileting and personal hygiene by staff
• Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
• Neuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months.
PAIN ASSESSMENT:
Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severe
• Review the case study assigned by your Instructor for this Assignment.
• Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
• Explain on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
• Explain how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
• Explain how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug
Sample Solution
Age is one of the factors that can influence a patient’s pharmacokinetic and pharmacodynamic processes. As a patient gets older, their body’s ability to process and metabolize drugs decreases due to changes in organ function. Additionally, elderly patients often have altered drug absorption due to decreased gastric acid production,
slowed intestinal motility and reduced renal clearance of drugs. These changes can lead to an increased risk for adverse effects from medications due to prolonged drug exposure with higher concentrations in the bloodstream.
In this case study, LM is 89 years old and has multiple chronic conditions which are being managed with various medications including amlodipine (hypertension), donepezil (Alzheimer’s disease) levothyroxine (hypothyroidism), celecoxib (osteoarthritis), furosemide (diuretic) metformin/glyburide combination pill (diabetes). Due to her age, she may be more likely than younger patients to experience adverse reactions such as hypotension or electrolyte imbalances from these medications due to her altered pharmacokinetics/dynamics.
To improve LM’s drug therapy plan based on her age-related physiologic changes, I would recommend that her physicians should closely monitor for any signs of adverse effects from the medications. Additionally, it might be beneficial for her physicians to consider prescribing lower doses or switching LM over time onto alternative therapies that are known to be better tolerated in elderly populations such as ACE inhibitors instead of calcium channel blockers like amlodipine. Lastly, it might also be beneficial for LM’s care team incorporate non-pharmacological interventions like physical therapy into her treatment plan since these interventions can help minimize falls risk while providing other benefits such as improved mobility and quality of life without adding additional burdensome medication regimens.