[ANSWERED 2023] Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension

Written By: Dan Palmer, RN

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension

Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.

Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.

Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.

Think about 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.

Write a 2- to 3- page paper that addresses the following:

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:

Warfarin 5 mg daily

MWF and 2.5 mg daily T, TH, Sat, Sun Aspirin 81 mg daily

Metformin 1000 mg po bid

Glyburide 10 mg bid

Atenolol 100 mg po daily

Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

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 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. 

Expert Answer and Explanation

The presence of multiple disorders in patients is a chief contributor to lower quality of life, longer hospital stays, hospital admissions, and the loss of physical functioning. Most patients who have more than one chronic disease can also become victims of the severe effects polypharmacy, which can also affect their ability to take some of the recommended drugs (Mery, 2018).

In the case of patient HM, who has hyperlipidemia, ischemic disease, hypertension, and diabetes and also a history of Transiet Ischemic Attack (TIA) and artrial fibrillation, there are multiple changes in the drug processes that can help him achieve a smooth recovery process despite the presence of influential factors such as age.

How the Selected Factor has an Influence on the Pharmacodynamic and Pharmacokinetic Processes of Patient

Age is a significant factor that may influence the pharmacokinetic and pharmacokinetic processes showed by patient HM. Specifically, patients who are at least 65 years may have a relatively slower reaction to drugs as their body cells have a higher death rate compared to the ‘birth’ rate, which largely influences the processes of drug absorption, drug metabolism, excretion, and distribution (Mercy, 2018).

Ageing patients also have decreased body water, decreased lean body mass, higher levels of body fat, among other body compositions that make them relatively unhealthy compared to their younger counterparts (Shen Lu & Hughes, 2018). These factors are among the key contributors of lower organ functions among the older individuals.

Some of the vital organs of the body such as the brain, lungs, kidney, and the heart may also be affected by this gradually decreasing organ function, causing abstract changes in wellness. Regarding the uptake of drugs, the liver is involved in the metabolism of all the drugs taken by mouth, and hence its malfunction may cause a defective uptake across the body (Rosenthal & Burchum, 2021). Hence, the factor of age is a significant influence on the various pharmacokinetic and pharmacodynamics processes of the patient.

How Changes in the Processes may Impact the Recommended Therapy of the Patient

If the process changes may lead to the defective function of the liver, the physician may have to revise the entire therapy plan of the patient to avoid including in the plan any drug that is taken orally. This is because all oral drugs cannot bypass the metabolism in the liver unless they are taken in the form that makes it easy to reach the target organs.

For such cases, the patient may have to adopt i.v. and i.m. therapy where the drugs are delivered directly to the blood vessels and muscles respectively, making the bioavailability 100% (Rosenthal & Burchum, 2021). Also, the fact that the patient could develop resistance to some of the drugs such as metformin may require them to be given other alternatives that would enhance the action of metformin (Rosenthal & Burchum, 2021).

Similarly, the patient may have to cut on the usage of warfarin as it is known to cause joint pains and discomfort to patients who are older than 65 (Rosenthal & Burchum, 2021). Lastly, since artenolol may be associated with kidney problems in older patients, the patient may have to reduce its dosage or find other suitable alternatives.

Improving the Patient’s Drug Therapy Plan

  • Increase the dosage of sum drugs such as metformin from its current dosage to 2500 mg po bid so as to improve its bioavalaility and hence its level of utilization by the patient (Wang et al., 2017).
  • Decrease the Ibuprofen levels to 200mg bid
  • Change Glyburide 10mg bid dosage to Byetta while monitoring symptoms
  • Replace warfarin with Tylenol so as to reduce the chances of joint pain
  • Only take aspirin when patient is anaemic
  • Decrease atenolol levels to 50mg po daily so as to prevent the occurrence of kidney challenges. The dosage could also be titrated by 25mg monthly while monitoring the adverse effects but should not exceed 200mg.

Conclusion

The factor of age can affect the wellness of the patient in that it influences the utilization of drugs in multiple ways. Among the common ways in which age affects the pharmacokinetic and pharmacodynamics processes is the fact that some drugs such as atenolol, when taken by ageing patients can increase their susceptibility to joint problems. Ageing patients could also be victims of polypharmacy’s negative effects as they are often involved in treatment with multiple disorders.

They could also experience other higher challenges such as neglect from family members. Among the changes that should be initiated for patient HM is the Decrease in the Ibuprofen levels to 200mg bid, Change of Glyburide 10mg bid dosage to Byetta while monitoring symptoms, only take aspirin when patient is anaemic, and decreasing atenolol levels. All these changes could increase the ability of the patient to recover promptly while facing the negative influences of age on their condition.

References

Rosenthal, L., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants-E-Book. Elsevier Health Sciences. http://iaibojonegoro.com/wp-content/uploads/2019/06/Lehnes-Pharmacotherapeutics-for-Advanced-Practice-Providers.pdf

Mery, M. W. (2018). Assessment and Improvement in the Elderly. Perioperative Care of the Elderly Patient, 246. https://books.google.co.ke/books?hl=en&lr=&id=JpNADwAAQBAJ&oi=fnd&pg=PA246&dq=Mery,+M.+W.+(2018).+Assessment+and+Improvement+in+the+Elderly.+Perioperative+Care+of+the+Elderly+Patient,+246.+&ots=FRbONJbPxf&sig=hQZouYAlXvtZDzzVCPpR0Zq3nzk&redir_esc=y#v=onepage&q&f=false

Shen, J., Lu, G. W., & Hughes, P. (2018). Targeted ocular drug delivery with pharmacokinetic/pharmacodynamic considerations. Pharmaceutical research35(11), 217. https://doi.org/10.1007/s11095-018-2498-y

Wang, C. P., Lorenzo, C., Habib, S. L., Jo, B., & Espinoza, S. E. (2017). Differential effects of metformin on age related comorbidities in older men with type 2 diabetes. Journal of diabetes and its complications31(4), 679-686. https://doi.org/10.1016/j.jdiacomp.2017.01.013

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How does age affect pharmacodynamics?

Age can have significant effects on pharmacodynamics, which refers to how drugs interact with the body to produce their effects. Here are some ways age can impact pharmacodynamics:

  1. Absorption: As we age, changes in the gastrointestinal tract can affect how drugs are absorbed. For example, the stomach may produce less acid, which can reduce absorption of certain drugs.
  2. Distribution: As we age, changes in body composition can affect how drugs are distributed throughout the body. Older adults tend to have less body water and more body fat, which can cause certain drugs to become more concentrated in the body.
  3. Metabolism: As we age, changes in liver and kidney function can affect how drugs are metabolized and eliminated from the body. Older adults may metabolize drugs more slowly, which can lead to longer-lasting effects and increased risk of adverse drug reactions.
  4. Receptor sensitivity: As we age, changes in the number and sensitivity of drug receptors can affect how drugs produce their effects. Older adults may be more sensitive to the effects of certain drugs, which can increase the risk of side effects.
  5. Comorbidities and medications: Older adults are more likely to have comorbidities (i.e., multiple health conditions) and take multiple medications, which can increase the risk of drug interactions and adverse drug reactions.

How does age affect drug action?

Age can have a significant impact on drug action, which refers to the pharmacological effects of a drug on the body. Here are some ways age can affect drug action:

  1. Pharmacokinetics: This refers to how drugs are absorbed, distributed, metabolized, and eliminated from the body. As people age, changes in organ function, body composition, and blood flow can alter drug pharmacokinetics. For example, older adults may have decreased liver and kidney function, which can lead to slower drug metabolism and elimination, resulting in higher drug levels and increased risk of toxicity.
  2. Receptor sensitivity: Receptors are proteins that interact with drugs to produce their effects. As people age, changes in receptor number and sensitivity can affect drug action. For example, older adults may have fewer receptors for certain drugs, leading to decreased drug effectiveness.
  3. Comorbidities: Older adults are more likely to have multiple health conditions, which can impact drug action. For example, a drug used to treat one condition may interact with a drug used to treat another condition, resulting in decreased drug effectiveness or increased risk of adverse effects.
  4. Polypharmacy: Older adults may be taking multiple medications, which can impact drug action. The use of multiple drugs can lead to drug interactions, resulting in decreased drug effectiveness or increased risk of adverse effects.
  5. Adherence: Older adults may have difficulty adhering to medication regimens due to factors such as cognitive impairment, physical limitations, or cost. Poor adherence can impact drug action and result in decreased effectiveness or increased risk of adverse effects.

Age related changes in pharmacokinetics and pharmacodynamics

Age-related changes can significantly impact both pharmacokinetics and pharmacodynamics of drugs.

Pharmacokinetics refers to how drugs are absorbed, distributed, metabolized, and eliminated from the body. Here are some age-related changes that can impact pharmacokinetics:

  1. Absorption: The rate and extent of drug absorption may decrease with age due to decreased blood flow to the gastrointestinal tract, changes in gastric pH, and changes in the intestinal wall.
  2. Distribution: Changes in body composition, including increased body fat and decreased muscle mass, can lead to changes in drug distribution. For example, lipophilic drugs may accumulate in adipose tissue, resulting in decreased drug concentrations in the blood.
  3. Metabolism: Liver and kidney function may decrease with age, leading to slower drug metabolism and excretion. This can result in higher drug levels in the blood and increased risk of adverse effects.
  4. Elimination: Renal clearance may decrease with age, leading to slower drug elimination and increased risk of drug accumulation.

Pharmacodynamics refers to how drugs produce their effects on the body. Here are some age-related changes that can impact pharmacodynamics:

  1. Receptor sensitivity: Changes in the number and sensitivity of drug receptors can occur with age, which can affect drug response. Older adults may be more sensitive to the effects of some drugs, while less sensitive to others.
  2. Comorbidities: Older adults are more likely to have multiple chronic medical conditions, which can impact drug response. For example, comorbidities such as heart failure or liver disease can alter drug metabolism and eliminate, resulting in decreased effectiveness or increased toxicity.
  3. Polypharmacy: Older adults often take multiple medications, which can lead to drug-drug interactions and impact drug response. For example, some drugs may interfere with the metabolism of other drugs, leading to increased drug levels in the blood and increased risk of adverse effects.

3 physiological changes that happen in older adults that can affect medication metabolism

There are several physiological changes that occur in older adults that can affect medication metabolism, but here are three examples:

  1. Decreased Liver Function: Liver function declines with age due to changes in the liver’s blood supply, a reduction in liver mass, and a decrease in the number of liver cells. As a result, older adults may metabolize drugs more slowly, leading to an increased risk of drug accumulation and adverse effects.
  2. Reduced Renal Function: Kidney function also declines with age due to a decrease in the number of functional nephrons. This can lead to a decrease in renal clearance and an increased risk of drug accumulation and toxicity. Older adults are also more susceptible to dehydration, which can further decrease renal function and exacerbate drug toxicity.
  3. Changes in Gastrointestinal Function: Gastrointestinal function changes with age, including a decrease in gastric acid secretion and a reduction in gastrointestinal motility. This can affect drug absorption, particularly for drugs that require an acidic environment for absorption. In addition, delayed gastric emptying can lead to prolonged drug exposure, while reduced absorption can result in lower drug levels and decreased effectiveness.

These changes can lead to altered pharmacokinetics and pharmacodynamics of medications in older adults. It is important for healthcare providers to consider these physiological changes when prescribing and dosing medications for older adults, as well as to monitor for potential adverse effects and drug interactions. Adjusting medication dosages based on age-related changes can help optimize medication therapy in older adults.

How does age affect drug metabolism

Age can have major effect on drug metabolism, which refers to the process by which drugs are broken down and eliminated from the body. Here are some ways age can affect drug metabolism:

  1. Liver function: The liver is responsible for metabolizing many drugs, and its function decreases with age. Age-related changes in liver function include a reduction in liver mass, decreased blood flow to the liver, and a decrease in the number of functional liver cells. These changes can lead to slower drug metabolism and an increased risk of drug accumulation and toxicity.
  2. Renal function: The kidneys are responsible for excreting many drugs and their metabolites from the body. As people age, renal function declines due to a decrease in the number of functional nephrons. This can lead to a decrease in renal clearance and an increased risk of drug accumulation and toxicity.
  3. Enzyme activity: Many drugs are metabolized by enzymes in the liver and other tissues. Age-related changes in enzyme activity can impact drug metabolism, leading to slower drug metabolism and an increased risk of drug accumulation and toxicity.
  4. Protein binding: Some drugs bind to proteins in the blood, and the amount of protein available for binding can decrease with age. This can lead to higher free drug concentrations, which can increase the risk of drug toxicity.

Overall, age-related changes in drug metabolism can lead to altered pharmacokinetics and pharmacodynamics of medications in older adults. It is important for healthcare providers to consider these changes when prescribing and dosing medications for older adults, as well as to monitor for potential adverse effects and drug interactions. Adjusting medication dosages based on age-related changes can help optimize medication therapy in older adults.

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