Explain how you might improve the patient’s drug therapy plan

Below is the case study for this week’s Assignment.
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.
A Fib diagnosed 1 month ago
HTN x 10 years
CKD x 5 years
Osteoarthritis x 7 years
GERD x 20 years
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
Elderly female with altered level of consciousness, no signs of bruising, bleeding, or other injury.
By Day 7 of Week 2
Select one the following factors: genetics, gender, ethnicity, age, or behavior factors. Note, if you choose behavior, you need to include weight, exercise, alcohol use, illicit drug use and smoking habits. Do NOT include information on drug adherence.
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. Stick to ONE factor. Describe the effect of the ONE factor on PK/PD in general
Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. Research the effect of the ONE factor you selected on EACH drug in the drug list provided as part of the patient case. You must use primary research articles and a drug reference for information. How will the changes in PK/PD affect the bioavailability of each drug?
Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Address each drug in the patient’s list. Continue/stop current drugs. Start new drugs. Be specific. For example:
decrease atenonol to 50mg daily because bioavailibilty…
stop hydralazine. Start ABC at XXmg because bioavailibilty…

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