Case Background
Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA), along with diagnoses of type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease. The current prescribed medications are:
- Warfarin 5 mg daily MWF and 2.5 mg daily T, Th, Sat, Sun
- Aspirin 81 mg daily
- Metformin 1000 mg po bid
- Glyburide 10 mg bid
- Atenolol 100 mg po daily
- Motrin 200 mg 1–3 tablets every 6 hours as needed for pain.
Impact of Age on Pharmacokinetics and Pharmacodynamics
Medications have various effects on individuals based on their inherent characteristics. However, age is one of the most significant influences, so this factor was chosen as the basis for solving the case study. An elderly patient’s response to medication depends mainly on the physiological and pathological changes that occur with aging.
Influence of Pharmacokinetic and Pharmacodynamic Changes on Drug Therapy
Pharmacokinetics
The physiological processes of aging in the body lead to modifications in the pharmacokinetics and pharmacodynamics of pharmaceuticals (Drenth‐van Maanen, 2020). It is vital to start with pharmacokinetics and how its modifications affect the treatment. In older adults, virtually all pharmacokinetic processes are slowed down for most medications. Due to these shifts, there is an upsurge in the amount of free drugs in the bloodstream. For these reasons, elderly patients usually require fewer medicines to achieve the desired healing effect. Moreover, pharmacokinetic changes include decreased renal and hepatic clearance and raised elimination half-life, which must be considered in prescriptions.
Pharmacodynamics
Concerning pharmacodynamics, the effect of drugs on the body has significant features in older age. As the conditions of drug delivery to the tissues deteriorate, the number of specific receptors decreases, but their sensitivity to drug effects rises and is perverted (Rosenthal & Burchum, 2021). It explains the diversity and difficulty in predicting the response of the aging organism to drugs. Based on such peculiarities, it becomes necessary to modify the drug therapy.
For example, drugs acting on the CNS may have unexpectedly more potent effects at average concentrations in the blood, and sedatives and hypnotics have a longer duration of action (Drenth‐van Maanen, 2020). In older adults, they are more likely to depress respiratory function and may cause lethargy and coma. Older people have an increased sensitivity to neuroleptics, tranquilizers, and antidepressants, which can give a prolonged sedative effect with confusion and extrapyramidal symptoms (Rosenthal & Burchum, 2021). Moreover, changes in the cardiovascular system in the elderly lead to increased sensitivity to vasodilators and hypotensive agents.
Enhancing the Patient’s Drug Therapy Plan: Strategies and Considerations
Every doctor prescribing drug therapy to elderly and senile patients should ensure the indications are correctly defined. It is paramount to pay attention to the fact that the doses of drugs correspond to the patient’s characteristics. Furthermore, the doctor’s instructions must be fully understood, and his instructions must be applied appropriately. Starting drug therapy for elderly and senile patients, the doctor should have a clear picture of the influence of aging on the effectiveness of pharmacotherapy, the principles of dosage in geriatrics, and side effects (Drenth‐van Maanen, 2020). It is vital to evaluate the increase in the resistance of the aging body to the undesirable effects of medications.
Modification of Current Treatment or Exploration of Alternative Options
The treatment provided in the case must be adjusted to the patient’s peculiarities. Of particular concern is the drug Motrin, in particular, its combination with warfarin. Warfarin aims to prevent the formation of new blood clots and to stop the enlargement of existing blood clots (Thürmann, 2020). However, this medication is an anticoagulant, and its combination with Motrin can lead to severe bleeding. Therefore, it is advisable to replace Motrin with Tylenol as a pain reliever that is not a non-steroidal anti-inflammatory drug. In this case, the recommended drug dosage is about two tabs of PO 325 mg six to eight hours before meals (Thürmann, 2020). This treatment plan adjustment will help reduce the risks while maintaining the desired effect.
Another change in the treatment plan includes the use of statins. It is essential to treat hyperlipidemia because statins are a proven medication to improve prognosis. They can likewise affect the prevention of ischemic attacks. Moreover, since glyburide interacts with other drugs, such as warfarin, aspirin, atenolol, and metformin, the patient should be advised to check glucose levels regularly to prevent hypoglycemia (Thürmann, 2020). Age should be taken into account before changing treatment plans and dosages. The patient’s characteristics should be reviewed to adjust recommendations and provide a treatment plan.
References
Drenth‐van Maanen, A. C., Wilting, I., & Jansen, P. A. (2020). Prescribing medicines to older people—How to consider the impact of ageing on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921-1930. Web.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier.
Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anesthesiology, 33(1), 109-113.