NURS 6521 Week 2 Case Assignment: Advanced Pharmacology
NURS 6521 Week 2 Case Assignment: Advanced Pharmacology
Week 2 Case Assignment
The case portrays a patient, HM, with a history of atrial fibrillation and a transient ischemic attack (TIA). He has been diagnosed with hypertension, type 2 diabetes, dyslipidemia, and ischemic heart disease. He is currently on Warfarin, Aspirin 81 mg OD, Metformin 1000 mg BD, Glyburide 10 mg BD, Atenolol 100 mg OD, and Motrin 200 mg every 6 hours PRN. This paper seeks to discuss how age impacts pharmacokinetics and pharmacodynamics and how I would improve the patient’s drug plan.
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How Age May Impact the Pharmacokinetic and Pharmacodynamic Processes
[elementor-template id="165244"]Age can be associated with the patient’s comorbid illnesses, which have resulted in a complex treatment plan. Age-associated GI changes include decreased absorption by the small intestine, GI motility, and splanchnic blood flow (van den Anker et al., 2018). The changes result in reduced drug absorption of oral drugs. Furthermore, aging is associated with a decreased liver mass and blood flow, resulting in a reduced first-pass metabolism. These increase the bioavailability of drugs that undergo extensive first-pass metabolism. In addition, the changes can also lead to reduced first-pass activation of pro-drugs (van den Anker et al., 2018). Aging is also associated with a reduced hepatic blood flow and hepatocyte mass, which decreases hepatic drug clearance rate affecting the excretion. Renal changes in aging, such as sclerotic changes in the glomerular and a decreased glomerular filtration rate, impairs renal function. The changes adversely affect the renal clearance of hydrosoluble drugs.
Aging influences pharmacodynamics, such as increasing the sensitivity of individuals to anticoagulants, cardiovascular, and CNS drugs. For example, most CNS drugs result in an exaggerated response in elderly persons due, the influence of aging on pharmacodynamics processes with aging (van den Anker et al., 2018). Furthermore, the Antagonism-adrenergic stimulation of Beta-blockers reduces with aging secondary to alterations in the signal transduction pathways.
How Changes in the Processes Might Impact the Recommended Drug Therapy
The aging-related reduced hepatic function may reduce warfarin metabolism and result in impaired synthesis of clotting factors. Lower doses of Warfarin may be required since they will effectively achieve a therapeutic level for anticoagulation (Longo et al., 2019). A reduced kidney function can impact therapy with Metformin since it is contraindicated in patients with kidney impairment. Metformin may be stopped if the patient has a reduced kidney function (Longo et al., 2019). Besides, aging-related renal insufficiency may affect the excretion of Glyburide due to a decreased clearance rate and necessitate reducing the dose of Atenolol. In addition, Motrin may need to be stopped if there is an impaired renal function due to aging because it is excreted through urine.
Improving the Patient’s Drug Therapy Plan
I would improve the drug therapy by modifying the drugs and doses based on the patient’s age and current diagnoses. For instance, I would lower Warfarin to 2.5 mg because of the increased anticoagulant effect caused by aging. I would increase Aspirin to 162.5 mg to prevent TIA in the future since he has T2DM and dyslipidemia, which are risk factors of cardiovascular events (Oza et al., 2017). In addition, I would add Atorvastatin 40 mg daily to treat dyslipidemia and prevent cardiovascular disease (Oza et al., 2017). Lastly, if HM is aged 80 years and older, I would stop Metformin and decrease Glyburide to 5 mg because of a reduced renal function.
Conclusion
Increased age is attributed to major changes in the body’s drug handling, pharmacodynamic response, and physiological reserve. Pharmacokinetic processes impacted by aging include rescued absorption, decreased first-pass metabolism, increased bioavailability, and decreases hepatic drug clearance. Aging increases the sensitivity of CNS, cardiovascular, and anticoagulants. I would improve the drug plan by reducing doses of Warfarin and Glyburide, increasing Aspirin, adding Lipitor, and stopping Metformin.
References
Longo, M., Bellastella, G., Maiorino, M. I., Meier, J. J., Esposito, K., & Giugliano, D. (2019). Diabetes and aging: from treatment goals to pharmacologic therapy. Frontiers in endocrinology, 10, 45. https://doi.org/10.3389/fendo.2019.00045
Oza, R., Rundell, K., & Garcellano, M. (2017). Recurrent ischemic stroke: strategies for prevention. American family physician, 96(7), 436-440.
van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58, S10-S25. https://doi.org/10.1002/jcph.1284
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