Case Study

Mrs. A is a 71 year old widow with CHF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother’s ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:

• Furosemide 40 mg daily in the morning
• Digoxin 250 micrograms daily
• Paracetamol 500 mg, 1-2 tablets 4-hourly PRN
• Piroxicam 20 mg at night
• Mylanta suspension, 20 ml PRN
• Coloxyl 120 mg, 1-2 tablets at night

Assignment Questions and Instructions

1. Critically discuss this case study in terms of the problematic nature of this patient’s pharmacological management.
2. Outline some pharmacokinetic changes in the geriatric population that may affect drug disposition.
3. Outline how changes in renal and hepatic function may affect treatment strategies.
4. In the drug regimen presented above – discuss potential side effects and potential interactions, if any?
5. Your response should include a discussion of the problems of polypharmacy as it is related to this case study and the assessment/management and educational strategies which could have been implemented to improve the outcome of Mrs. A.

Solution: NU636 Assignment Unit 1: Assignment Case Study: Polypharmacy

Problematic Nature of Pharmacological Management

The patient in this case study is a 71-year-old widow who, according to her daughter, has been experiencing a changed mental state and strange conduct as of late. She has a history of congestive heart failure and osteoarthritis. Her daughter is worried about the patient’s safety living alone, doubts her capacity to care for herself, and wants to look into moving her to an assisted living facility because of this persistent worry. Along with the changes in behavior and OCD tendencies, the patient has also been mentioning that they are more tired and irritable than before (Pazan & Wehling, 2021). She has some kind of visual disturbance that makes her think her lace curtains are always filthy, so she washes them more often than necessary. When compared to males, older women have a greater rate of muscle mass loss, making them more susceptible to negative medication effects (Pazan & Wehling, 2021). Her present self-managed prescription regimen raises concerns about potential pharmaceutical abuse, which might lead to drug toxicity or inadequate treatment of her underlying medical issues (Pazan & Wehling, 2021).

Pharmacokinetic Changes in Geriatric Populations

Drug pharmacokinetic disposition is affected by changes that take place in the adult body and important organ systems as a consequence of aging. Drug toxicity or subtherapeutic drug levels required to generate appropriate treatment effects might result from age-related changes in the stomach’s blood flow, motility, and emptying, as well as its pH (Maher et al., 2021). With the exception of total body fat, the three variables that determine the efficient distribution of medications—body mass, percentage of total body water, and serum proteins, or albumin—tend to decline with age (Maher et al., 2021). These changes influence the action of lipid- and water-soluble drugs, as well as protein-binding pharmaceuticals, on the aging body. Reduced hepatic and renal function has direct effects on drug metabolism and excretion, which might cause inadequate medication dispersion or add to drug toxicity. Due to this, when making changes to a patient’s regimen, the prescriber must carefully examine the effects of the medication on the…..Please click purchase button below to get full answer for $10

Related: (Solution) NU636 Unit 1: Discussion 2 Alternative Modalities