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[ANSWERED] 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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