Case Study Questions and Answers
Question
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 50 mg BID
Warfarin 5 mg QD
Ibuprofen 200 mg 2 tabs prn headache
Lisinopril 20 mg QD
Imdur 30 mg QD
HCTZ 12.5 mg QD
Humalog 8u with meals
Lantus 26u QHS
Ca++/Vit D 500mg/200 IU BID
Famotidine 20 mg QHS
Multivitamin QD
PE:
BP 110/50
Pulse 38 bpm
Resp 14/min
Rest of physical exam unremarkable
Labs:
K+ 6.9
Na+ 135
Cr 1.9
BUN 35
Gluc 102
Dig 2.78
INR 2.3
WBC 5,800/mm3
Hct 35%
Write a 2- to 3-page paper that addresses the following:
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.
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.


Solution
Case Study Questions and Answers
Question 1
Changes in the pharmacokinetic and
pharmacodynamic processes of the patient may impact their pharmacological
treatment. For example, if a patient’s renal function deteriorates, a lower
dose may be required to achieve the desired effect (Thürmann, 2020). In addition, if the patient’s heart function changes, the doctor
may need to adjust the medication dosage to ensure that the patient is
receiving the correct amount of medication. In addition, pharmacokinetics and
pharmacodynamics are affected by age (Thürmann, 2020). For example, drug clearance can be reduced as renal and hepatic
function declines with age, increasing drug concentration and side effects. In
addition, the pharmacodynamics of a drug may be affected by changes in cardiac
function as people age.
Question 2
The doctor may suggest monitoring the
patient’s renal and hepatic functions to improve the patient’s drug therapy
plan. Additional cardiac tests are performed to evaluate the patient’s cardiac
function (Byon et al., 2019). They
should also make any necessary adjustments to the patient’s drug therapy based
on test results and encourage the patient to stick to their drug therapy
regimen for the best results. The patient’s current pharmacological treatment
plan may be more effective. As a result, drug interactions and side effects are
possible. Furthermore, the patient’s blood pressure is unusually high. Therefore,
the patient’s medications should be changed to achieve the desired blood
pressure level (Byon et al., 2019). In
addition, the patient’s medication regimen is untrustworthy. Therefore, his
prescriptions should be changed so that he strictly follows the instructions.
The patient will also consume medications in large amounts. Therefore, his
medications should be adjusted to take the fewest doses possible while getting
the desired results.
Question 3
The patient’s age may influence the
pharmacokinetic and pharmacodynamic processes. For example, the ability of the
body to metabolize and excrete drugs is diminished with advancing age, which
may result in an increase in half-life and a decrease in clearance (Peeters et al., 2019). Because of this, the patient’s system may become saturated with
the medication, which raises the risk of experiencing adverse effects. In
addition, because older patients are likely to be more sensitive to the effects
of the drug, age may also play a role in the pharmacodynamics of the
medication.
Question 4
Changes in the patient’s pharmacokinetics
and pharmacodynamics may affect their treatment. For instance, if the patient’s
body cannot metabolize and eliminate the medication as effectively as it should,
the medication may continue to be present in the person’s system for a more
extended period. As a result, it increases the likelihood that the individual
will experience adverse effects from taking the medication (Peeters et al., 2019). In addition, the individual’s dose may decrease to prevent
unfavorable results if they are more sensitive to the adverse effects caused by
the medication.
Question 5
Adjusting the patient’s medicine dose will
help improve drug treatment. The dosage may need to be adjusted if the patient’s
body cannot effectively metabolize and excrete the medication (Reus et al., 2018). The dose will reduce if a patient is sensitive to the drug’s side
effects. Pharmacokinetics and pharmacodynamics are affected by heart disease (Reus et al., 2018). Drug interactions and side effects are found in patients with
cardiovascular disease. Their history of heart disease will impact their heart
function. There will be drug poisoning when drug elimination is reduced. The
ability of a patient to take medications is impacted by heart disease (Reus et al., 2018). Patients with heart disease may live shorter lives, limiting their
ability to take long-term medications.
References
Byon, W., Garonzik, S., Boyd, R. A.,
& Frost, C. E. (2019). Apixaban: a clinical pharmacokinetic and
pharmacodynamic review. Clinical pharmacokinetics, 58(10),
1265-1279.
Peeters, L. E. J., Kester, M. P.,
Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., &
Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in
the treatment of the elderly patient with hypertension. Expert opinion
on drug metabolism & toxicology, 15(4), 287-297.
Reus, V. I., Fochtmann, L. J.,
Bukstein, O., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., ... & Hong,
S. H. (2018). The American Psychiatric Association practice guideline for the
pharmacological treatment of patients with alcohol use disorder. American
Journal of Psychiatry, 175(1), 86-90.
Thürmann, P. A. (2020).
Pharmacodynamics and pharmacokinetics in older adults. Current Opinion
in Anesthesiology, 33(1), 109-113.




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