Description of the Patient Case from Experience or Clinical Practice
During a recent clinical encounter, I was supervising a 65-year-old male patient diagnosed with hypertension and type 2 diabetes. The prescribed regimen included metformin and lisinopril to treat his condition. According to Bakhshaei et al. (2022), “…metformin is the first-line pharmacotherapy for type 2 diabetes, which also has lipid-modifying and cardioprotective advantages…” (p. 1).
Factors Influencing Pharmacokinetic and Pharmacodynamic Processes
Aging is often the biggest driver of physiological changes, such as declining kidney function and altered metabolism in the liver (Ebert et al, 2020). Metformin is mainly excreted through the kidneys, a decrease in drug clearance may occur due to the age-related decline in kidney function. This increases the risk of metformin accumulation and associated side effects. Comorbidities of the patient affected the motility and absorption of the gastrointestinal tract.
Personalized Plan of Care Based on Influencing Factors and Patient History
In this scenario, an individualized approach would include steps such as close monitoring of renal function through regular creatinine clearance assessments. Based on these results, the dose of the drug may need to be adjusted to prevent the accumulation of metformin and to mitigate possible side effects. Even though metformin has been a successful type 2 diabetes drug in Europe for over fifty years, there is still ongoing debate about its mode of action (Glossmann & Lutz, 2019).
The plan must clearly align with the patient’s unique characteristics (Rosenthal & Burchum, 2021). Regularly reassessing and maintaining flexibility in the plan is crucial to accommodate changing factors, as they wield a significant influence on both pharmacokinetics and pharmacodynamics. If the patient were younger, the personalized care plan would generally stay the same, with appropriate adjustments made to account for age-related considerations. However, if the person had comorbidities such as kidney failure, the plan would require further changes. In case of impaired renal function, the use of metformin can be reconsidered due to the increased risk of developing lactic acidosis. Alternative antidiabetic agents with non-renal routes of elimination may be considered.
Reference
Bakhshaei, S., Bakhshaei, B., Korani, S. S., Alamouti-Fard, E., Allamiaghmiouni, L., & Neshat, S. (2022). Impact of metformin on hypertension; current knowledge. Journal of Renal Endocrinology, 8, e25067. Web.
Ebert, T., Pawelzik, S., Witasp, A., Arefin, S., Hobson, S., Kublickiene, K., Shiels, P. G., Bäck, M., & Stenvinkel, P. (2020). Inflammation and premature aging in chronic kidney disease. Toxins, 12(4), 227. Web.
Glossmann, H. H. & Lutz, O. M. D. (2019). Pharmacology of metformin – An update. European Journal of Pharmacology, 865. Web.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) Elsevier.