Posted: September 4th, 2023

LM is an 89-year-old female resident of a long-term care

Write a 3- to 4+ page paper that addresses the following:
Explain how the factor (i.e. genetics, gender, ethnicity, age or behavior) 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 patient’s recommended drug therapy. Be specific and provide examples.
Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Would you discontinue any medications, change the dosage, and/or add medications to the patient’s regimen? DISCUSS EACH MEDICATION.
Case study assigned
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 88 mcg 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+ 3.4, Cl 99, CO2 25,
BP: Supine = 177/82 Glucose 101
HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1, Plt 255
BUN 42, Cr 1.6, UA Clear
eGFR: 45 ml/min
PE:
HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI
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
I look forward to reading your papers. The week 1 threaded discussion has been graded; the week 1 assignment will be graded by Thursday nighBy Day 7 of Week 2 (by Sunday, 11:59 pm MT) Write a 2- to 3+ page paper that addresses the following:
Explain how the factor (i.e. genetics, gender, ethnicity, age or behavior) 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 patient’s recommended drug therapy. Be specific and provide examples.
Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Would you discontinue any medications, change the dosage, and/or add medications to the patient’s regimen? DISCUSS EACH MEDICATION.
Case study assigned
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 88 mcg 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+ 3.4, Cl 99, CO2 25,
BP: Supine = 177/82 Glucose 101
HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1, Plt 255
BUN 42, Cr 1.6, UA Clear
eGFR: 45 ml/min
PE:
HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI
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

Pharmacokinetics and Pharmacodynamics Factors Influencing Drug Therapy in an Elderly Patient

Introduction:

Pharmacokinetics and pharmacodynamics play crucial roles in determining the efficacy and safety of a drug. The study of pharmacokinetics evaluates the processes that affect drug absorption, distribution, metabolism, and elimination, while pharmacodynamics refers to the actions and effects of drugs on the body. Several factors can influence the pharmacokinetic and pharmacodynamic processes, such as genetics, gender, ethnicity, age, and behavior. This paper will examine how age, specifically in an 89-year-old female patient, may impact the pharmacokinetics and pharmacodynamics of the drugs that she is taking. Additionally, it will explore how changes in these processes may affect the recommended drug therapy, and finally, it will suggest improvements to the patient’s drug therapy plan.

Factors influencing pharmacokinetics and pharmacodynamics in the elderly:

The elderly population is particularly susceptible to the effects of pharmacokinetics and pharmacodynamics factors. Age-related changes such as decreased renal and hepatic function, decreased muscle mass, and decreased blood flow can affect the metabolism and elimination of drugs. Additionally, elderly patients may have comorbidities that may further impact drug therapy, such as cardiovascular disease, diabetes, and dementia.

In the case of LM, the 89-year-old female patient with a medical history of hypertension, Alzheimer’s disease, hypothyroidism, osteoarthritis, and diabetes, several of the drugs she is taking may be affected by age-related changes in pharmacokinetics and pharmacodynamics. The patient’s renal function, as measured by eGFR, is reduced, which may impact the clearance of drugs that are primarily eliminated by the kidneys, such as furosemide. Furthermore, the patient’s decreased muscle mass may result in a reduced volume of distribution, which could affect the dosing of drugs that are highly protein-bound, such as celecoxib. The patient’s age and comorbidities may also increase the risk of drug interactions and adverse drug reactions, making it essential to closely monitor drug therapy.

Impact of pharmacokinetics and pharmacodynamics on drug therapy:

The impact of pharmacokinetics and pharmacodynamics on drug therapy is critical to consider when treating elderly patients. In the case of LM, changes in the pharmacokinetics and pharmacodynamics of her current medications may impact the efficacy and safety of her drug therapy. For example, the patient is taking furosemide, which is primarily eliminated by the kidneys. Given the patient’s reduced renal function, the clearance of furosemide may be impaired, leading to increased drug concentrations and an increased risk of toxicity. The patient is also taking glyburide, which is primarily metabolized by the liver. The patient’s reduced hepatic function may result in decreased metabolism of glyburide, leading to increased drug concentrations and an increased risk of hypoglycemia.

Improving the patient’s drug therapy plan:

Several strategies can be implemented to improve the patient’s drug therapy plan, including discontinuing medications, changing the dosage, and adding medications to the patient’s regimen.

Amlodipine:

The patient is taking amlodipine, which is a calcium channel blocker used to treat hypertension. Given the patient’s reduced renal function, the dosage of amlodipine may need to be adjusted to prevent toxicity. The recommended dose for patients with renal impairment is 2.5 mg once daily. Therefore, the patient’s amlodipine dose may need to be reduced to 2.5 mg once daily.

Donepezil:

Donepezil is a cholinesterase inhibitor used to treat Alzheimer’s disease. The patient is taking the maximum recommended dose of 10 mg daily. However, the patient’s MMSE score indicates a significant decline in cognitive function. It’s important to note that Donepezil is not a cure for Alzheimer’s disease, and while it can improve cognitive function and slow down the progression of the disease, it may not work for everyone.

If the patient’s MMSE score indicates a significant decline in cognitive function despite taking the maximum recommended dose of Donepezil, it’s important to consult with a healthcare professional. The healthcare professional may consider adjusting the dose of Donepezil, or adding other medications to the treatment plan.

It’s also important to note that Alzheimer’s disease is a progressive disease, and while medications such as Donepezil can help to slow down the progression of the disease, it cannot reverse the damage that has already been done to the brain. Caregiving, therapy, and support can also play a vital role in managing the symptoms of Alzheimer’s disease and improving the quality of life for both the patient and their caregivers.

Sample Sources
Journal article:
Author, A. A., Author, B. B., & Author, C. C. (2021). Title of article. Title of Journal, volume number(issue number), page range. DOI or URL

Book:
Author, A. A. (2020). Title of book. Publisher.

Website:
Author, A. A. (2022). Title of webpage. Website Name. URL

Conference proceedings:
Author, A. A., Author, B. B., & Author, C. C. (2022). Title of paper. In Editor, A. A. (Ed.), Title of proceedings (page range). Publisher.

Dissertation/Thesis:
Author, A. A. (2021). Title of dissertation/thesis (Doctoral dissertation/Master’s thesis). Name of Institution, Location. URL or DOI (if available)

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from:
PubMed: This is a database of medical research articles maintained by the National Library of Medicine. You can search for articles on Alzheimer’s disease and donepezil specifically, and find peer-reviewed research studies.

The Alzheimer’s Association: This is a non-profit organization that funds research on Alzheimer’s disease and provides resources and support for patients and caregivers. Their website has information on the latest research and clinical trials.

The Cochrane Library: This is a database of systematic reviews of medical research studies. You can search for systematic reviews on Alzheimer’s disease and donepezil specifically to get an overview of the available evidence.

The Journal of Alzheimer’s Disease: This is a peer-reviewed medical journal that publishes research on Alzheimer’s disease and related topics. You can search their archives for articles on donepezil.

ClinicalTrials.gov: This is a database of clinical trials of medical treatments. You can search for ongoing or completed clinical trials on donepezil and Alzheimer’s disease to see what the latest research is showing.

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