NURS-6521 Week 2 Walden: PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS
BN is a 74-year-old African American male who is seeing his PCP because he noticed when he woke up that his “heart was not beating right; it feels like it is going to slow.” NURS-6521 Week 2: Assignment
BY DAY 7 OF WEEK 2
Write a 2- to 3-page paper that addresses the following:
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- 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.
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Case Study
BN is a 74-year-old African American male who is seeing his PCP because he noticed when he woke up that his “heart was not beating right; it feels like it is going to slow.” He denies chest pain, SOB, N/V. He notes feeling dizzy earlier in the day. 6 weeks earlier his PCP started him on Diltiazem CD to further lower his BP to goal. His Metoprolol was lowered at that time as well from 75 mg to 50 mg BID. His PCP recommends he be admitted to the hospital.
Upon presentation to the hospital:
PMH:
- HTN x 7 years
- Type II DM
- CAD s/p angioplasty 2 years ago
- MI 3 years ago
- EF = 60%
- PVD s/p left femoral to posterior bypass
- Hx of A Fib x 4 years
Medications:
- Digoxin 0.25 mg QD KCl 40 mEq QD Vitamin C 500 mg QD
- Diltiazem CD 180 mg QD ASA EC 325 mg QD Vitamin E 400 IU QD
- Metoprolol 5- mg BID Warfarin 5 mg QD Ibuprofen 200 mg 2 tabs prn headache
- Lisinopril 20 mg QD Famotidine 20 mg QHS Multivitamin QD
- Imdur 30 mg QD Lantus 26u QHS Ca++/Vit D 500mg/200 IU BID
- HCTZ 12.5 mg QD Humalog 8u with meals
PE:
- BP 110/50 Pulse 38 bpm Resp 14/min
- Rest of physical exam unremarkable
Labs:
- K+ 6.9 WBC 5,800/mm3
- Na+ 135 Hct 35%
- Cr 1.9 Dig 2.78
- BUN 35 INR 2.3
- Gluc 102
Pharmacodynamics and Pharmacokinetics in Older Patients
When people get older, they often face various health problems like high blood pressure, diabetes, and heart diseases. To treat these conditions, they may need to take multiple medications. However, as people age, their bodies change, and this can affect how these drugs work. This article explores how getting older can influence how drugs work in a patient, focusing on one specific case. We’ll discuss what happens to the way drugs move through the body and how they interact with it in older individuals.
Factors Affecting How Drugs Work in Older Patients
Age plays a significant role in how drugs work in the body. When we talk about how drugs move through the body, it’s called “pharmacokinetics.” In older patients, some important changes can occur. For instance, as people age, their bodies may not process drugs as quickly as they used to. This means that drugs can build up in the body, potentially leading to harmful effects.
Aging can also affect how drugs are absorbed into the body. In older individuals, the absorption process can slow down, which means it takes longer for a drug to start working. For example, a drug called Lisinopril might not kick in as fast as it would in a younger person because of these changes. Moreover, aging can lead to an increase in body fat and a decrease in total body water, affecting how some drugs, like metoprolol, are distributed in the body.
Pharmacodynamics looks at how drugs interact with the body. In older patients, the effectiveness of a drug can vary from what you might see in younger individuals. These differences are often due to how the drug interacts with receptors in the body, the body’s responses to it, and any changes in different organs over time. For example, older patients can be more sensitive to certain drug effects, like those caused by medications with anticholinergic properties. Anticholinergic drugs include antidepressants, drugs for high blood sugar, antihypertensives, and urinary medications. Patients taking these drugs need close monitoring because they can have stronger effects in older individuals.
How Changes Affect Recommended Drug Therapy
The changes that come with aging can have a big impact on how recommended drug therapies work. For example, due to age-related factors like increased gastric pH, reduced stomach surface area, and slowed drug excretion, the absorption of drugs like Lisinopril may be affected, potentially leading to changes in its effectiveness. Additionally, aging can lead to a decrease in the overall liver metabolism of some drugs, which means these drugs are cleared from the body more slowly. This can increase the risk of toxic effects. For instance, the liver metabolism of diltiazem might slow down, potentially raising the risk of toxicity.
Aging can also result in reduced kidney elimination of certain drugs, which can affect the risk of toxicity. Drugs like digoxin and Lisinopril may take longer to leave the body, increasing the potential for harmful effects. Additionally, changes in body composition, such as an increase in body fat and a decrease in total body water, can impact the movement of some drugs in the body. In the case of patient BN, the distribution and uptake of metoprolol and digoxin may be reduced, leading to important clinical implications.
Furthermore, age-related changes in sensitivity to different drug concentrations can affect how drugs work in the body. For patient BN, the response to diltiazem might be different compared to a younger patient.
Improving the Patient’s Drug Therapy Plan
To optimize drug therapy for patient BN, healthcare providers can take several steps. They should carefully select the right drugs and dosages for older patients, closely monitor their effectiveness and any potential side effects, and educate patients about possible health risks. For patient BN, some adjustments might be needed. For example, the dosage of diltiazem could be lowered due to the changes in metabolism and increased distribution in the body. The effectiveness of the dose should be closely watched, and if it’s working well, there’s no need to increase the dosage.
Digoxin should be used cautiously in older patients because of the slower elimination, which can increase the risk of toxicity. It’s important to adjust the dosage, starting at a lower amount, like 0.125 mg, and then adjust it based on the patient’s response. The same goes for metoprolol and Lisinopril, which have reduced renal elimination. Their dosages should start low, and only increase if needed.
In addition to these dosage adjustments, educating patients about potential side effects of the medications is crucial. With these changes to the drug therapy plan, patient BN can achieve the best possible health outcomes.
In Conclusion
In summary, age can significantly impact how drugs work in the body, affecting both how they move through the body (pharmacokinetics) and how they interact with it (pharmacodynamics). Older patients experience various changes in their bodies, including altered metabolism, absorption, distribution, and excretion of drugs. These changes can be due to factors like increased gastric pH, reduced bowel surface area, increased body fat, reduced total body water, and decreased renal elimination. To ensure the safety and effectiveness of drug therapy for older patients, healthcare providers must carefully choose the right drugs and dosages, monitor patients closely, and provide education about potential side effects. By doing so, optimal health outcomes can be achieved for older individuals like patient BN.
References
Andres, T. M., McGrane, T., McEvoy, M. D., & Allen, B. F. S. (2019). Geriatric pharmacology. Anesthesiology Clinics, 37(3), 475–492. https://doi.org/10.1016/j.anclin.2019.04.007
Sleder, A. T., Kalus, J., & Lanfear, D. E. (2015). Cardiovascular Pharmacokinetics, pharmacodynamics, and pharmacogenomics for the clinical practitioner. Journal of Cardiovascular Pharmacology and Therapeutics, 21(1), 20–26. https://doi.org/10.1177/1074248415590196
Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anaesthesiology, 33(1), 109–113. https://doi.org/10.1097/aco.0000000000000814
PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS – BN is a 74-year-old African American male who is seeing his PCP because he noticed when he woke up that his “heart was not beating right; it feels like it is going to slow.” NURS-6521 Week 2: Assignment
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