Case Study
BN is a 74-year-old African American
male who is seeing his PCP because he noticed when he woke up that his “heart
was not beating right; it feels like it is going to slow.” He denies chest
pain, SOB, N/V. He notes feeling dizzy earlier in the day. 6 weeks earlier his
PCP started him on Diltiazem CD to further lower his BP to goal. His Metoprolol
was lowered at that time as well from 75 mg to 50 mg BID. His PCP recommends he
be admitted to the hospital.
Upon presentation to the hospital:
PMH:
HTN x 7 years
Type II DM
CAD s/p angioplasty 2 years ago
MI 3 years ago
EF = 60%
PVD s/p left femoral to posterior
bypass
Hx of A Fib x 4 years
Medications:
Digoxin 0.25 mg QD KCl 40 mEq QD
Vitamin C 500 mg QD
Diltiazem CD 180 mg QD ASA EC 325 mg QD
Vitamin E 400 IU QD
Metoprolol 5- mg BID Warfarin 5 mg QD
Ibuprofen 200 mg 2 tabs prn headache
Lisinopril 20 mg QD Famotidine 20 mg
QHS Multivitamin QD
Imdur 30 mg QD Lantus 26u QHS Ca++/Vit
D 500mg/200 IU BID
HCTZ 12.5 mg QD Humalog 8u with meals
PE:
BP 110/50 Pulse 38 bpm Resp 14/min
Rest of physical exam unremarkable
Labs:
K+ 6.9 WBC 5,800/mm3
Na+ 135 Hct 35%
Cr 1.9 Dig 2.78
BUN 35 INR 2.3
Gluc 102
As an advanced practice nurse
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.