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Pharmacology

Pharmacology

Description

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

Review the case study and Write a 3 pages paper explaining the following: 

Select 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

  • 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  pharmacokinetic and pharmacodynamic  processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
  • 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 you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

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