LM is an 86-year-old female admitted to the emergency department with delirium. Her spouse is with her and verifies that LM adheres to the medications she is currently prescribed. She does not self-monitor her BP or heart rate at home.

LM is an 86-year-old female admitted to the emergency department with delirium. Her spouse is with her and verifies that LM adheres to the medications she is currently prescribed. She does not self-monitor her BP or heart rate at home.

PMH:

A Fib diagnosed 1 month ago

HTN x 10 years

CKD x 5 years

Osteoarthritis x 7 years

GERD x 20 years

Medications:

Digoxin 0.25 mg QD

Metoprolol XL 25mg QD

Warfarin 3 mg QD

APAP 650 mg TID

Omeprazole 20mg QD

Multivitamin QD

Allergies: NKDA

Social History:

Married to husband for 57 years

No smoking, alcohol, limited daily exercise (short walks each morning)

Family History:

None reported

Vitals:                                     Labs:

Wt 113 lbs Ht 5’4”                   Na+ 138          K+ 4.0

BP 101/58, HR 52                   Cl- 99              CO2 27

BUN 33           Cr 1.2

Gluc 109         INR 3.8

Dig 2.4

PE:

Elderly female with altered level of consciousness, no signs of bruising, bleeding, or other injury.

Write a 2-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.

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