Case Study Analysis Solved Example

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To Prepare

Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.

Review the case study assigned by your Instructor for this Assignment.

Select one 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.

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.

…

Solution

Individual patient factors such as gender, age, and genetics may influence pharmacokinetic and pharmacodynamic processes leading to undesired clinical effects. The changes in pharmacokinetic and pharmacodynamic processes affect drug therapies for cardiovascular disorders making it imperative to tailor drug therapies to suit the patient factors and overall health needs of the patient. The purpose of this case analysis examines how age might influence the pharmacokinetic and pharmacodynamic processes of the patient, how the changes impact the patient’s drug therapy and also offers improvements to the patient’s drug therapy plan.

Summary

Patient AO is diagnosed with hypertension and hyperlipidemia. The patient has a history of obesity and reports a recent 9 pounds gain. The current patient’s medication is Atenolol, Doxazosin, Hydralazine, Sertraline, and Simvastatin. The patient is 65 years old, male.

Individual Patient Factor- Age

Aging is one of the individual patient factors that affect the pharmacokinetics and pharmacodynamics of drugs and has implications on the drug therapies of cardiovascular diseases. According to Ayan et al. (2016), aging leads to progressive impairment of the absorption and secretion of multiple drugs, which are vital aspects of pharmacokinetics. The impairments can be attributed to changes that affect the functioning of the critical organ such as the liver and renal function. Secondly, age-related changes in homeostatic mechanisms, physiologic substrate, and receptors and cell signaling affect the actions of medications on the body; pharmacodynamics (Brenes-Salazar et al., 2015).

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Age-related changes on the liver, leading to a decreased liver mass and hepatic liver flow, resulting in a slower metabolism. For the patient, medications such as simvastatin, clearance depend on the metabolism (Ayan et al., 2016). Hence, the patient only benefits from lower daily dosages of the drug. Besides, aging affects renal blood flow and a reduced muscle mass, which reduces serum creatinine levels with excretion reduced by up to 50%, renal clearance of medications such as Doxazosin, necessitating lower daily dosages. Besides, increases the pharmacodynamic sensitivity of older adults to anticoagulants such as heparin and hypertensive channel calcium blockers (Rehman, Sanchez & Shah, 2020).

On the other hand, with beta-blockers such as atenolol, administered to the patient, a decreased pharmacodynamic sensitivity can be observed, necessitating higher dosages to attain lower HR (Brenes-Salazar et al., 2015). However, atenolol is among beta-blockers associated with weight gain as it decreases the metabolic rate as well as the total energy expenditure. Given that the patient has onset obesity, the risk for weight gain is alleviated.

Recommendations

To improve the patient’s drug therapy plan, adjustments should be made on the prescriptions of the medications in a manner that factors in the age of the patient as well as other health needs associated with obesity, hypertension, and hyperlipidemia. First, the patient’s Simvastatin medication should be reduced to 40mg daily since older adults have a decreased phase I metabolism. Lower dosages would lessen the side effects of the patient while also addressing hyperlipidemia.

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To increase the efficacy of atenolol and account for the patient’s age, the medication should be modified to 25mg per day. However, hypersensitivity should be monitored. For elderly patients with hypertension, the use of Doxazosin should be avoided due to the risk of orthostatic hypotension. However, to the patient, the Doxazosin helps with both hypertension and hyperlipidemia besides being free of adverse metabolic effects. Hence, it is imperative to maintain the dosage at 8mg. The weight gain can also be associated with sertraline use. The recommended approach is the gradual stopping of sertraline medication. In this, the patient will be informed of discontinuation symptoms that will occur as the dosage is reduced over a period of 4 weeks. Moreover, hydralazine can remain constant but monitored closely.

References

Ayan, M., Pothineni, N. V., Siraj, A., & Mehta, J. L. (2016). Cardiac drug therapy—considerations in the elderly. Journal of geriatric cardiology: JGC, 13(12), 992.

Bhardwaj, S., Selvarajah, S., & Schneider, E. B. (2013). Muscular effects of statins in the elderly female: a review. Clinical interventions in aging, 8, 47.

Brenes-Salazar, J. A., Alshawabkeh, L., Schmader, K. E., Hanlon, J. T., & Forman, D. E. (2015). Clinical pharmacology is relevant to older adults with cardiovascular disease. Journal of Geriatric Cardiology: JGC, 12(3), 192.

Sharpton, R. A., Laucka, P. J., McKeller, R. N., Dangler, M. A., Horne, J. S., & Dangler, J. Y. (2017). The Impact of Obesity on the Efficacy of Simvastatin for Lowering Low-Density Lipoprotein Cholesterol in a Veteran Population. Federal Practitioner, 34(3), 41.

Question – Case Study Analysis Solved Example

To Prepare

Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
Review the case study assigned by your Instructor for this Assignment.
Select one 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.
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.

Write a 2- to 3-page paper that addresses the following:

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.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

My case study;

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily

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Case Study Analysis Solved Example

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