Assignment: Pharmacology Case Study Essay
Assignment Pharmacology Case Study Essay
The case study is of patient AO with a history of obesity and recent weight gain of 9 pounds. The patient has a diagnosis of hypertension and hyperlipidemia. The currently prescribed drugs include, Atenolol 12.5 mg daily, Doxazosin 8 mg daily, Hydralazine 10 mg QID, Sertraline 25 mg daily and Simvastatin 80 mg daily. This paper will discuss how age might influence the patient’s pharmacokinetic and pharmacodynamic processes and how changes in the processes might affect the patient’s recommended drug therapy.
How Age Influence the Pharmacokinetic and Pharmacodynamic Processes
Old age is associated with impairment in the function of various regulatory processes that facilitate the integration of functions between cells and organs. Pharmacokinetic changes that occur with age include decreased absorption of oral drugs and time of onset of action is delayed with advanced age due to decreased gastric secretion, gastrointestinal motility, gastrointestinal flow and increased pH (Schlender et al., 2016). Moreover, there is a decrease in renal and hepatic clearance and an increase in distribution of lipid-soluble drugs resulting in a prolonged elimination half-life in people with advanced age (Schlender et al., 2016). As a result, dosage should be decreased for drugs eliminated through the hepatic system in elderly patients. Pharmacodynamic changes include increased sensitivity to various classes of drugs such as cardiovascular, anticoagulant and psychotropic drugs.
Atenolol is a Beta-1 selective blocker indicated in the management of hypertension. The drug should be used with caution in geriatric patients to prevent toxicity as a result of high concentrations of Atenolol in the blood (Sarfraz et al., 2015). Besides, the dose of Atenolol should be prescribed with caution in an elderly patient by starting with a low dose due to decreased renal, hepatic and cardiac function in old age (Mukker, Singh & Derendorf, 2016). Doxazosin is an alpha blocker used in the treatment of hypertension and also in benign prostatic hyperplasia. The drug should be avoided in individuals above the age of 60 years in treatment of hypertension. Doxazosin use is associated with a high risk of orthostatic hypotension (Mukker, Singh, & Derendorf, 2016). If Doxazosin has to be used in geriatric patients, the initial dose should have a low dosage and it is recommended that the dosage is gradually adjusted.
Sertraline is an antidepressant in the class of Selective Serotonin Reuptake Inhibitors (SSRIs). Old age influences Sertraline pharmacodynamic processes. Geriatric patients may develop hyponatremia and hence a patient’s sodium levels should be closely monitored (Bhat, Thanusubramanian & Balaji, 2017). Furthermore, advanced age is associated with decreased clearance and a prolonged half-life of Sertraline and long-term administration of the drug in geriatric patients would result in late achievement of steady state concentrations.
How Changes in the Pharmacokinetic and Pharmacodynamic Processes Might Impact the Patient’s Recommended Drug Therapy
Atenolol is highly dependent on hepatic metabolism and a decrease in hepatic clearance can result in an increased drug concentration and eventually toxicity. The drug regimen with Atenolol may need to be altered by stopping the drug if the patient has hepatic impairment. In addition, Atenolol is excreted via the kidneys and severe impairment of renal function in the patient may result in eliminating the drug from the treatment plan (Goeres, Williams, Eckstrom & Lee, 2014). Doxazosin is extensively metabolized in the liver and a condition affecting the liver such as liver impairment may result in the dosage of Doxazosin being reduced or the drug being eliminated from the treatment plan.
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Hydralazine is primarily metabolized in the liver and the drug’s metabolism may be affected by liver impairment. As a result, if the patient develops liver impairment, the dose may have to be reduced or the drug withdrawn (Goeres et al., 2014). Sertraline is
metabolized by cytochrome P450 hepatic enzymes. It is recommended that the dose of Sertraline be decreased by 50% in patients with mild hepatic impairment. In patients with moderate to severe hepatic impairment, the drug is not recommended. Consequently, Sertraline dose may have to be reduced by half if the patient develops mild hepatic impairment or stopped if there is moderate to severe hepatic impairment. Simvastatin is converted to its active metabolite by hepatic enzymes thus its dose may require to be altered in a patient with liver impairment.
How I Might Improve the Patient’s Drug Therapy Plan
The patient is experiencing weight gain despite being in a moderate intensity statin therapy with Simvastatin 80 mg to manage hyperlipidemia. I will improve the hyperlipidemia treatment poll by changing to Atorvastatin 40 mg daily dose. Atorvastatin will also help in lowering the risk of stroke, diabetes type 2 and coronary heart disease in the patient since he has a history of hypertension (Wilmot et al., 2015). Beta blockers are associated with elevated lipid levels and Atenolol could be contributing to the patient’s weight gain (Goeres et al., 2014). I would remove Atenolol from the therapy plan and substitute it with Amlodipine 5 mg daily dose. Atenolol has drug interactions with Hydralazine that require close monitoring and may be contributing to ineffective control of high blood pressure (Goeres et al., 2014). Consequently, I will substitute Atenolol with Amlodipine.
Amlodipine will facilitate lowering blood pressure as well as the risk of fatal and non-fatal myocardial infarctions, strokes and cardiovascular events. Moreover, the drug is associated with improving the lipid profile and may contribute in lowering the low-density lipid cholesterol levels and promoting weight loss (Goeres et al., 2014). Lastly, I will remove Sertraline from the treatment plan since the patient has no history of depression or anxiety disorder. Besides, Sertraline is associated with fluid retention, and increased appetite, resulting in weight gain (Bhat, Thanusubramanian & Balaji, 2017). Stopping the drug might help in preventing weight gain in the patient.
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:
o Atenolol 12.5 mg daily
o Doxazosin 8 mg daily
o Hydralazine 10 mg qid
o Sertraline 25 mg daily
• Explain how the factor you selected migExplain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.ht 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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