Patients in the senior group usually present with memorable incidences in pharmacologic management due to age-related alterations in physiology, comorbidities, and polypharmacy. It becomes highlighted in the case study of Mrs. A, a 71-year-old widow with CHF and osteoarthritis, which shows the complexity of treating geriatric populations [ aged patients]. In this essay, we will critically analyze Mrs. A’s case by highlighting the drawbacks of the pharmacological administration, the pharmacokinetics changes in geriatric medicines, the position of renal and hepatic function in the drug treatment design, the undesired effects and drug interactions of her drug regimen and the difficulties of multidrug treatment. Moreover, we plan to acquaint assessment, managed care, and educational approach to the extent of influence on Mrs. A’s results.
Problematic Nature of Pharmacological Management
Mrs. A’s complex problem consists of morphed conditions, degenerative evident matters, and therapies that reflect several troublesome aspects. Firstly, she is troubled because the symptoms such as confusion, tiredness, production of harmful effects or interactions of medications, irritability, and symptoms of obsessive should be checked. The consortium of different drugs that she gets prescribed, including diuretic furosemide for the treatment of congestive heart failure (CHF), digoxin for cardiac assistance, and piroxicam for osteoarthritis, all have side effects that may perhaps contribute to or worsen the symptom picture. For instance, digoxin may cause mental disturbances and visual impairment. At the same time, piroxicam may have unwanted effects on the Central Nervous System (CNS) and may cause irritability and confusion (Krustev et al., 2022). On the contrary, polypharmacy, which is referred to as the combined use of multiple drugs, escalates the chances of unwanted effects and medication errors, thereby making Mrs. A taking care harder.
Additionally, her speech implies the possibility of cognitive impairment (otherwise known as dementia), which can further create a problem concerning pharmacological management. Figuring out to what extent to attribute side effects to medications and to what extent to highlight cognitive impairment that inherently exists in aging adults is an essential but demanding spiritual job done by specialists (Krustev et al., 2022). The adoption of unsuitable medicines or refusal to recognize the effects of medication on cognitive power implies such marked deterioration of Mrs. A’s functions, thus affecting her life quality and independence.
Pharmacokinetic Changes in the Geriatric Population
In the elderly, metabolism and drug delivery are likely to represent the significant changes that could significantly affect the way drugs are processed in the body. Initially, the theory proclaims that assimilation may vary depending on the perturbations in the gastrointestinal tract’s motility, the stomach’s pH, and the blood flow into the intestinal tract (Coetzee & Absalom, 2023). These modifications prolong the absorption time of orally taken medicines, and the consequence may mean loss of effectiveness of the drugs and slower onset of action.
In addition, the distribution process may be affected by changes in body composition, for instance, an increase in fat and a decrease in lean body mass that can affect the distribution of medicine in the human body. This consequence is evident in the increased plasma concentrations of lipid-soluble drugs and lower plasma concentrations of water-soluble drugs. In addition, when hepatic metabolism and renal clearance shift, they result in different clearances of drugs from the body (Coetzee & Absalom, 2023). Hepatic metabolism might get affected because of the low supply of blood and enzymes to the liver, thus also influencing the way drugs that are to undergo hepatic clearance are metabolized. Likewise, there may be reduced renal clearance with old age because of the decreased renal blood flow, the decreased glomerular filtration rate, and reduced tubular secretion. As a result, drugs that are usually cleared by the kidney may accumulate in the blood.
These pharmacokinetic changes in an older population are likely to lead to altered drug pharmacokinetics, which then brings the need to readjust the dosing and monitoring of these drugs to rule out adverse effects forever and to ensure therapeutic outcomes (Coetzee & Absalom, 2023). Pharmacokinetic considerations are the most desired components when doctors choose medicine for older adults because those components will help limit the problems of drugs and improve safe and effective pharmacotherapy.
Impact of Renal and Hepatic Function on Treatment Strategies
In older adults, kidney and liver function very often passes through significant alteration, which strongly affects the process of metabolism and excretion of medications. Most older adults have their renal function changed due to age-related structural and functional deterioration of kidneys where renal blood flow, glomerular filtration rate (GFR), and tubular secretion decrease (Blanco et al., 2019). Thus, such changes will result in longer drug half-lives, and the amount of drug present in the body will accumulate after prolonged use, as it is for medications like the cleared drugs digoxin and furosemide. This has, in turn, led to frequent dose adjustments to avoid over-toxicity of drugs in geriatric patients and improper kidney function.
Also, liver function in old age can be reduced as the liver mass decreases, blood flow reduces, and enzymatic activity becomes inefficient. This phenomenon can, therefore, affect the rate of metabolism of the drugs, which may be subjected to hepatic biotransformation, i.e., paracetamol and piroxicam (Blanco et al., 2019). This lowering of hepatic clearance can result in escalated plasma concentration of drugs and increase the probability of adverse effects, and patients with existing liver disorders in critical conditions most have these effects.
Potential Side Effects and Interactions in Mrs. A’s Drug Regimen
The seriousness of the drugs prescribed is capable of bringing out the side effects and interactions. Loop diuretic furosemide is associated with conditions such as low potassium and sodium levels, resulting in confusion and fatigue as symptoms. The side effects of digoxin, used in CHF, can manifest as confusion, visual problems, and irregularities of cardiac rhythm, particularly in older adults who suffer from age-related renal dysfunction (Schneider & Koretz, 2022). Piroxicam, an NSAID drug that has a high risk of gastrointestinal bleeding and renal impairment, may worsen the increase in the rate of renal insufficiency, which is already diagnosable among older adults. Ibuprofen, even when exceeding the therapeutic dose or when combined with other medications with acetaminophen, can cause liver damage. So, Mrs A. has an already compromised liver, and the risk of liver toxicity increases.
On the other hand, there is the case of piroxicam-paracetamol interaction, where both these drugs are possibly used together to cause hepatoxicity, and their potential side effects could work together to exacerbate each other’s effects (Schneider & Koretz, 2022). Consequently, the furosemide-piroxicam mix-tape raises the renal-injurious chance and kidney dysfunction. Among the characteristics of the elderly population, using several medications has a higher possibility of interaction with commonly used drugs metabolized by the liver.
Polypharmacy Issues and Management Strategies
The co-administration of polypharmacy will not only increase the risk but also be more pronounced among elders who already have several comorbidities. Mrs. A falls into that category. For instance, in this case, Mrs. A has six different drugs prescribed. Those drugs could interact with each other or with her body, possibly causing adverse effects or resulting in non-adherence to the medication regimen (Schneider & Koretz, 2022). Cognitive impairment may get worse with polypharmacy, which increases the chance of confusion. Particularly, the onset of dementing illnesses may depend on the use of too many types of drugs.
To deal with the complications featured in Mrs. A’s situation, one can involve different approaches for assessment and management. First and foremost, the comprehensive medication history should be annotated to discover ambiguities, duplications, and irrational usage (Schneider & Koretz, 2022). Such an overview is better done as a team with medical professionals at heart, including her doctor and pharmacist, who oversee the whole evaluation and optimize her drug plan. In stopping the secondary use of medications, the following factors must be considered: the distinction between those indispensable meds and those that cause more harm than good.
In his case, Mrs. A’s comprehensive geriatric assessment would uncover her cognitive function, functional status, and psychosocial factors that may have contributed to her symptoms. Such an assessment can be of great value in differentiating cognitive decline, the adverse effects of medication, and other factors that underlie her behavioral changes (Randhawa & Varghese, 2022). Multi-discipline team support that involves, e.g., nurses, social workers, and other specialists, is a critical intervention in ensuring that the provision of care is coordinated. In contrast, adequate interventions are implemented to meet Mrs. A’s needs.
Patient and family education are indeed two pivotal elements in the treatment and promotion of the recovery rates of elderly patients. While the personification of suffering is a popular trope in literature, Mrs. A and her daughter deserve to be educated about the significance of maintaining their medications on time, the possible side effects that the medications can cause, and how to deal with the disease’s symptoms. More attention should be paid to this issue of relaying any changes in Mrs. A’s daily life to whoever her treatment provider is.
Furthermore, the decision to opt for a less complex and better adherence treatment plan is also helpful alongside upgrading her medicine regimen. This could entail the minimization of the extent of the therapeutic entities, as well as their dosage frequency, whenever possible. As well as medication boxes and reminders, these devices can be helpful support tools to assist adherence and minimize the likelihood of errors. Scheduling frequent checkups to evaluate the effect of treatment and the appearance of any new symptoms or adverse reactions would be very appropriate. Modifications to the administration of medications should be made if needed. The quality of interaction and communication between the healthcare providers and the patient/family is then one of the crucial aspects of fighting diseases and illness and fast intervention.
In conclusion, the pharmacological management of patients with Mrs. A, especially in geriatrics, highlights the complexity of such cases during aging physiological changes, comorbidities, and polypharmacy. An effective management strategy deals with pharmacokinetic changes and renal and hepatic functions; potential side effects and drug interactions are also crucial factors to consider. Polypharmacy is another issue to face, making the whole task reasonably complicated. Ensuring that due to tailored assessment and management decisions per Mrs. A’s condition, collaboration among disciplines and the family/patient is critical for the best outcome and for improving her daily living.
References
Blanco, V. E., Hernandorena, C. V., Scibona, P., Belloso, W., & Musso, C. G. (2019). Acute Kidney Injury Pharmacokinetic Changes and Its Impact on Drug Prescription. Healthcare, 7(1). https://doi.org/10.3390/healthcare7010010
Coetzee, E., & Absalom, A. (2023). Pharmacokinetic and Pharmacodynamic Changes in the Elderly. Anesthesiology Clinics. https://doi.org/10.1016/j.anclin.2023.02.006
Krustev, T., Milushewa, P., & Tachkov, K. (2022). Impact of Polypharmacy, Drug-Related Problems, and Potentially Inappropriate Medications in Geriatric Patients and Its Implications for Bulgaria—Narrative Review and Meta-Analysis. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.743138
Randhawa, S. S., & Varghese, D. (2022). Geriatric Evaluation and Treatment of Age-Related Cognitive Decline. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK580536/
Schneider, E., & Koretz, B. K. (2022). Polypharmacy, An Issue of Clinics in Geriatric Medicine, E-Book. Elsevier Health Sciences.
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