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Posted: May 15th, 2023
LM is an 89-year-old female resident
Case Study:
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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
Assignment
• 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 treatment or provide an alternative treatment option for the patient.
APA format must be 2-3 pages and at least 3 references. Must be scholar references
_____________________________________________
The Impact of Age on Pharmacokinetics and Pharmacodynamics
As people age, their bodies undergo a number of changes that can affect the way they metabolize drugs. These changes can lead to altered pharmacokinetics and pharmacodynamics, which can impact the effectiveness and safety of drug therapy.
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Factors Affecting Pharmacokinetics in the Elderly
There are a number of factors that can affect the pharmacokinetics of drugs in the elderly, including:
Reduced body weight and lean body mass: As people age, they tend to lose weight and muscle mass. This can lead to a decrease in the volume of distribution of drugs, which can increase the concentration of the drug in the blood.
Changes in liver and kidney function: The liver and kidneys are responsible for metabolizing and excreting drugs. With age, these organs can become less efficient, which can lead to a decrease in the clearance of drugs. This can increase the half-life of the drug in the body, which can lead to toxicity.
Changes in gastric emptying and intestinal absorption: The rate at which drugs are absorbed from the stomach and intestines can change with age. This can affect the peak concentration of the drug in the blood, as well as the overall bioavailability of the drug.
Factors Affecting Pharmacodynamics in the Elderly
There are also a number of factors that can affect the pharmacodynamics of drugs in the elderly, including:
Changes in receptor sensitivity: Receptor sensitivity can decrease with age. This can lead to a decrease in the response to drugs that act on these receptors.
Changes in drug-drug interactions: The risk of drug-drug interactions can increase with age. This is because the elderly are more likely to take multiple medications, which can increase the potential for interactions.
Changes in overall health status: The overall health status of the elderly can also affect the way they respond to drugs. For example, patients with chronic diseases such as heart disease, kidney disease, or liver disease may be more sensitive to the effects of drugs.
Impact of Age on Drug Therapy
The changes in pharmacokinetics and pharmacodynamics that occur with age can impact the effectiveness and safety of drug therapy. For example, a drug that is effective in younger adults may not be effective in the elderly, or it may cause more side effects. It is important to consider the age of the patient when selecting and dosing medications.
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Conclusion
The aging process can have a significant impact on the way drugs are metabolized and how they affect the body. It is important to be aware of these changes when prescribing medications to older adults. By carefully considering the patient's age, health status, and other factors, healthcare providers can help to ensure that older adults receive safe and effective drug therapy.
References
American Geriatrics Society. (2019). Pharmacotherapy in older adults: AGS clinical practice guideline. Journal of the American Geriatrics Society, 67(1), 1-48.
Blaschke, T. F., & Hansten, P. D. (2012). Drug therapy in the elderly: Principles and practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Cossart, A.R., Cottrell, W.N., Campbell, S.B., Isbel, N.M. and Staatz, C.E., 2019. Characterizing the pharmacokinetics and pharmacodynamics of immunosuppressant medicines and patient outcomes in elderly renal transplant patients. Translational andrology and urology, 8(Suppl 2), p.S198.
Foley, J.F., Goelz, S., Hoyt, T., Christensen, A. and Metzger, R.R., 2019. Evaluation of natalizumab pharmacokinetics and pharmacodynamics with standard and extended interval dosing. Multiple Sclerosis and Related Disorders, 31, pp.65-71.
Rowland, M. (2015). Pharmacokinetics and pharmacodynamics in the elderly. Clinical Pharmacokinetics, 54(12), 1313-1331.
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