Case Study Unit 1 Kalena Lopez Lloyd
pdf
keyboard_arrow_up
School
Herzing University *
*We aren’t endorsed by this school
Course
636
Subject
Health Science
Date
Feb 20, 2024
Type
Pages
5
Uploaded by Kalena101
1 Case Study: Polypharmacy Kalena Lopez Lloyd Herzing University NU636-8F: Advanced Pharmacology Dr. Frank Uche Akpati
2 Case Study: Polypharmacy According to Varghese et al. (2022), polypharmacy can be defined as utilizing five or more medications simultaneously. The use of polypharmacy raises concern in the general population due to the risk of adverse drug reactions, drug interactions, and medication nonadherence. In the elderly population, polypharmacy is a particular concern due to multimorbidity, pharmacokinetic changes associated with aging, age-associated changes in pharmacodynamics, and risk for injury (Varghese et al., 2022). This short paper will discuss the case study involving the problematic nature of Mrs. A’s pharmacological management. Case Study Mrs. A is described as an older woman with chronic heart failure and osteoarthritis exhibiting unusual behavior. She has been showing signs of confusion, irritability, and fatigue. The case study mentioned Mrs. A starting to experience obsessive-compulsive behavior and vision changes. She is currently on four medications with two as-needed medications in addition. The medications are as follows: •
Furosemide 40 mg daily in the morning, •
Digoxin 250 micrograms daily, Paracetamol 500 mg, 1-2 tablets 4-hourly as needed •
Piroxicam 20 mg at night •
Mylanta suspension 20 mL as needed •
Coloxyl 120 mg, 1-2 tablets at night. In the elderly, some of the primary concerns when prescribing medications are the interactions between doses and the renal/ hepatic function of the involved client. Pharmacokinetic Changes in the Geriatric Population According to Chahine (2019), as cited in Naghnaghia et al. (2023):
3 Older people with renal impairment are at a high risk of using inappropriate prescriptions due to their multiple comorbidities, polypharmacy, and changes in the pharmacokinetics and pharmacodynamics of drugs excreted by the kidney due to a decreased filtration rate and renal metabolism (p. 2). While age-related decrease varies from person to person, after the age of 40, the glomerular filtration rates decrease by about 8 mL/min/1.73 m
2
/decade (0.1 mL/sec/m
2
/decade) (Ruscin & Linnebur, 2021). Another significant change that occurs with the aging process is decreased hepatic metabolism. According to Ruscin & Linnebur (2021), hepatic clearance decreases by about 30% to 40% requiring drug dosage reductions to avoid toxicity. Regular monitoring, lab testing, and dosage tailoring should be taken to ensure that clients are receiving safe doses of medication. Case Study Problem Mrs. A is a 71-year-old woman who, more than likely, has experienced decreased renal and hepatic function due to age. She also happens to be taking Digoxin –a drug known for causing toxicity if not monitored and adjusted closely. Some key symptoms of Digoxin toxicity include lethargy, confusion, anorexia, nausea, vomiting, abdominal pain, blurred vision, color disturbances, haloes, and scotomas (Pincus, 2016). While a client is on Digoxin, they should be regularly screened to avoid toxicity from occurring. In the event signs and symptoms emerge, such as in Mrs. A’s case, the client should seek immediate treatment and monitoring to prevent further complications. While taking any medication, it is essential to consider potential drug interactions and incompatibilities. According to the Heart and Stroke Foundation of Canada (n.d.), Digoxin has many drug incompatibilities, including erythromycin, tetracycline, calcium channel blockers,
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
4 over-the-counter antacids, and more. Mrs. A currently takes furosemide daily and Mylanta as needed. Furosemide is a potent diuretic that helps the client reduce excess water retention. Mylanta is an antacid that alters the stomach acid's pH to relieve clients of indigestion and heartburn symptoms. Both medications can interact with Digoxin causing an increased risk of toxicity. Mylanta particularly alters the rate of absorption of Digoxin, resulting in reduced blood concentration in the blood and impaired therapeutic effect (Salisbury & Terrell, 2022). In the event the client needs relief through the Mylanta medication, patients should take the medication no closer than two hours of Digoxin administration. Scheduling out medications can help maintain Digoxin’s dose integrity delivering the intended dose/effect to the client. Conclusion When prescribing medications to an elderly client, it is essential to consider both hepatic and renal function to ensure the client is safe and receiving optimum care during treatment. While under supervision, either in-patient or out-patient, the client should be educated thoroughly on the risks associated with polypharmacy. Clients should undergo complete and accurate medication reconciliations and history to avoid future polypharmacy. Clients should be empowered with the education surrounding medication administration and completability. Given her current condition and age-induced complications, Mrs. A should be appropriately and promptly screened and treated to avoid further harm.
5 References Heart and Stroke Foundation of Canada. (n.d.). Cardiac glycosides (digoxin). https://www.heartandstroke.ca/heart-disease/treatments/medications/digoxin Naghnaghia, S., Nazzal, Z., Abu Alya, L., Al-Ramahi, R., Hamdan, Z., & Samara, E. (2023). The association between renal impairment and polypharmacy among older Palestinian patients: a multi-center cross-sectional study. BMC primary care
, 24
(1), 1-8. https://doi.org/10.1186/s12875-023-02005-9 Pincus M. (2016). Management of digoxin toxicity. Australian prescriber
, 39
(1), 18–20. https://doi.org/10.18773/austprescr.2016.006 Ruscin, J., & Linnebur, S. (2021). Pharmacokinetics in older adults.
Merck Manual. https://www.merckmanuals.com/professional/geriatrics/drug-therapy-in-older-
adults/pharmacodynamics-in-older-adults Salisbury, B., & Terrell, J. (2022). Antacids. In StatPearls.
StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526049/ Varghese, D., Ishida, C., & Haseer Koya, H. (2022). Polypharmacy. In StatPearls
. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/30422548/