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.

QUESTION

PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

Assignment

Write a 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

RUBRIC FOR GRADING

Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. = The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

This criterion is linked to a Learning OutcomeDescribe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. = The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy. … Accurate, complete, and aligned examples are provided to support the response.

Explain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements. = The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan. … The response includes an accurate and detailed explanation to support the recommended improvements.

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. = Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation. = Uses correct grammar, spelling, and punctuation with no errors

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. Uses correct APA format with no errors.

ANSWER

Pharmacotherapy for Cardiovascular Disorders: Influence of Age on Drug Therapy

Introduction

Pharmacokinetic and pharmacodynamic processes can be influenced by various factors, including genetics, gender, ethnicity, age, and behavior. In the case of LM, an 89-year-old female with multiple comorbidities and declining ambulation, age is a significant factor that can impact the pharmacotherapy for her cardiovascular disorders (Mangoni & Jackson, 2003). This paper will explore how age influences the pharmacokinetic and pharmacodynamic processes in LM and discuss the potential impact on her recommended drug therapy. Furthermore, recommendations for improving LM’s drug therapy plan will be provided.

Influence of Age on Pharmacokinetics and Pharmacodynamics

Pharmacokinetics

Absorption: Age-related changes, such as decreased gastric acid secretion and decreased intestinal motility, can affect drug absorption. This may lead to delayed onset of action or altered bioavailability of certain medications. Example: LM’s decreased ambulation may contribute to reduced gastric motility, potentially affecting the absorption of orally administered drugs like Amlodipine and Celecoxib.

Distribution: Age-related changes in body composition, such as increased adipose tissue and decreased muscle mass, can affect drug distribution. These changes can alter the volume of distribution and the concentration of drugs in the bloodstream. Example: LM’s decreased muscle mass and increased adipose tissue may lead to altered distribution of hydrophilic drugs like Furosemide, potentially affecting their therapeutic efficacy.

Metabolism: Age-related changes in liver function, including decreased hepatic blood flow and reduced enzyme activity, can impact drug metabolism. This may result in altered drug clearance and increased risk of adverse effects. Example: LM’s age-related decline in liver function may affect the metabolism of medications like Donepezil and Glyburide, potentially necessitating dose adjustments to maintain therapeutic levels.

Elimination: Age-related changes in renal function, such as decreased glomerular filtration rate and renal blood flow, can influence drug elimination. Reduced renal function can lead to prolonged drug half-life and increased risk of drug accumulation (Garza, 2022). Example: LM’s reduced renal function, as indicated by her decreased estimated glomerular filtration rate (eGFR), may affect the elimination of drugs like Metformin and require dosage adjustment to prevent toxicity.

Pharmacodynamics

Age-related changes in receptor sensitivity and organ function can affect the pharmacodynamic response to medications. Example: LM’s reduced cardiovascular reserve due to aging may result in an altered response to antihypertensive agents like Amlodipine, requiring careful monitoring and adjustment of the dosage to achieve optimal blood pressure control.

Impact on Drug Therapy and Recommendations

Amlodipine (10 mg QD): Considering LM’s age-related decline in cardiovascular reserve and the risk of orthostatic hypotension, a lower initial dose or gradual titration may be necessary to minimize the risk of falls. Regular blood pressure monitoring should also be performed.

Celecoxib (200 mg QD): Due to the increased risk of adverse gastrointestinal effects in older adults, especially with long-term NSAID use, it may be advisable to discontinue Celecoxib and consider alternative options for managing LM’s osteoarthritis pain, such as topical analgesics or physical therapy.

Furosemide (40 mg QAM): Given LM’s bilateral lower extremity edema, careful monitoring of electrolytes and renal function is crucial (Oh & Han, 2015). Consideration should be given to optimizing the dose based on LM’s renal function to avoid over-diuresis and electrolyte imbalances.

Metformin (500 mg, 1 BID) and Glyburide (5 mg, 1 BID): Considering LM’s reduced renal function, Metformin may need to be discontinued or the dose adjusted to prevent lactic acidosis. Glyburide, being primarily renally eliminated, may also require dose adjustment to minimize the risk of hypoglycemia.

Conclusion

Age-related changes in pharmacokinetics and pharmacodynamics can significantly impact the efficacy and safety of drug therapy in older adults. In the case of LM, age-related factors should be considered when designing her drug therapy plan. Dose adjustments, discontinuations, and alternative treatment options may be necessary to optimize therapeutic outcomes and minimize the risk of adverse effects. Close monitoring and regular reassessment of LM’s drug therapy plan are essential to ensure appropriate management of her cardiovascular disorders.

References

Garza, A. Z. (2022, July 11). Drug Elimination. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK547662/ 

Mangoni, A. A., & Jackson, S. P. (2003). Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. British Journal of Clinical Pharmacology, 57(1), 6–14. https://doi.org/10.1046/j.1365-2125.2003.02007.x 

Oh, W. K., & Han, S. W. (2015). Loop Diuretics in Clinical Practice. Loop Diuretics in Clinical Practice, 13(1), 17. https://doi.org/10.5049/ebp.2015.13.1.17