LM is an 89-year-old female resident

Posted: March 12th, 2023

Case Study:

LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.
PMH:
• HTN
• Alzheimer’s disease
• Hypothyroidism
• Osteoarthritis
• Diabetes
MEDICATIONS:
• Amlodipine 10 mg QD
• Donepezil 10 mg QHS
• Levothyroxine 0.88 mg QAM
• Celecoxib 200 mg QD
• Furosemide 40 mg QAM
• Metformin 500mg, 1 BID
• Glyburide 5mg, 1 BID
ALLERGIES: NKA
SOCIAL HISTORY:
Widowed with 2 adult children living in town, retired photographer and owner of an art supply store
VITALS: LABS:
Weight: 129 lbs TSH 2.45 Free T4 0.98
Height: 64 inches Na 135, K+ 3.8, Cl 99, CO2 25,
BP: Supine = 177/82 Glucose 101, SCr 0.9, BUN 42
HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1
Plt 255
Cr: 1.6 UA: Clear
eGFR: 45 ml/min
PE:
• HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes
• CV: RRR
• Respiratory: Clear to auscultation bilaterally
• Abdomen: Soft, non-tender, no masses or guarding
• G/U: Skin intact, assisted with toileting and personal hygiene by staff
• Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
• Neuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months.
PAIN ASSESSMENT:
Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severe

Assignment
• Review the case study assigned by your Instructor for this Assignment.
• Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
• Explain on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
• Explain how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
• Explain 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.
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Genetic Factors and Pharmacokinetics in an Elderly Patient

Introduction:
LM is an 89-year-old female with a complex medical history, including hypertension, Alzheimer’s disease, hypothyroidism, osteoarthritis, and diabetes. Her current medications include amlodipine, donepezil, levothyroxine, celecoxib, furosemide, metformin, and glyburide. She is experiencing multiple falls, some resulting in injuries, and her ambulation status has declined from independent to wheelchair level. This paper will explore how genetic factors may influence LM’s pharmacokinetic and pharmacodynamic processes and how changes in these processes may impact her drug therapy. Additionally, we will discuss potential strategies to improve her drug therapy plan based on pharmacokinetic and pharmacodynamic changes.

Genetic Factors and Pharmacokinetics:
Pharmacokinetics refers to the absorption, distribution, metabolism, and elimination of drugs by the body. Genetic variations can affect how drugs are metabolized and eliminated from the body. Genetic polymorphisms in drug metabolizing enzymes, such as cytochrome P450 (CYP) enzymes, can significantly impact the pharmacokinetics of drugs. CYP enzymes are responsible for the metabolism of many drugs, including amlodipine, celecoxib, and glyburide, which LM is currently taking. Individuals with genetic polymorphisms in CYP enzymes may have altered drug metabolism, which can result in changes in drug efficacy or toxicity. For example, individuals with genetic variations in CYP2C9, the enzyme responsible for the metabolism of celecoxib and glyburide, may experience increased toxicity from these drugs.

Age and Pharmacokinetics:
As individuals age, their body composition changes, and organ function declines, which can impact the pharmacokinetics of drugs. Older adults may have decreased renal and hepatic function, leading to decreased drug clearance and increased drug exposure. Additionally, older adults may have altered absorption, distribution, and metabolism of drugs due to changes in gastrointestinal motility, blood flow, and protein binding. These changes can increase the risk of adverse drug reactions and drug interactions.

Impact of Pharmacokinetic Changes on Drug Therapy:
The pharmacokinetic changes associated with aging and genetic factors can significantly impact drug therapy in older adults. For LM, the decline in renal function and genetic polymorphisms in CYP enzymes may increase the risk of drug toxicity from amlodipine, celecoxib, and glyburide