Describe How Changes in the Processes Might Impact the Patient’s Recommended Drug Therapy
The patient’s current prescription drugs are daily doses of Atenolol, Doxazosin, Hydralazine, Sertraline, and Simvastatin. The patient’s age is a factor in the absorption, distribution, metabolism, and excretion of these drugs. The patient is on atenolol, a beta-blocker prescribed for r hypertension. The sensitivity to beta-blockers is higher increases with age, leading to increased risk of drug side effects. Therefore, a much lower dose should be used for older adults. The increased sensitivity results in increased absorption, thus increased plasma concentration and leading to increased risk of stroke and heart failure, the significant side effects. The high concentration results in increased kidney functioning to excrete the drug through urine, thus resulting in frequent urination and thirst. The drug, therefore, covers up diabetic symptoms in elderly individuals, which may lead to a late diabetes diagnosis. For this reason, the drug is discouraged in older adults (Wang, Xiang, Chen & Ji, 2019).
The second drug is doxazosin, an alpha-blocker prescribed for hypertension. Older adults are more sensitive to alpha-blockers, leading to increased absorption and high plasma concentration, therefore consequent severe side effects. The concentration is increased by impaired kidney functioning due to old age, which results in decreased drug excretion. The side effects include fainting, dizziness, and kidney failure (Abdi & Campbell, 2018). Co-administration of beta-blockers and alpha-blockers leads to extremely low blood pressure, which caused malfunctioning of blood vessels, due to muscle weakness associated with old age. It consequently impairs drug distribution via blood circulation. This is because they both act as muscle relaxers.
The third prescription is sertraline, prescribed for hyperlipidemia.it side effects include gastrointestinal complications like diarrhea, stomach upset, and intestinal bleeding. Due to the decrease in mucous lining along the digestive system associated with old age, these symptoms are severe in older adults. This consequently results in fast movement of food and impaired absorption of drugs, thus decreasing plasma concentration and drug effectiveness. Co-administration with beta and alpha-blockers increases the bleeding due to consequent muscle relaxation. This hinders transportation of drug to target tissues for metabolism (Chen et al., 2016).
The other prescription is simvastatin, a statin prescribed for high cholesterol levels. It impairs the processing of cholesterol by the liver, thus reducing general liver functioning. Old age is associated with muscle wear out hence consequent organ failure. Therefore, the drug causes faster liver failure in older individuals, leading to the permanent synthesis of body cholesterol. One of its side effects among the elderly is muscle problems. Therefore, if administered with beta and alpha-blockers, it alters the action of muscle relaxation, thus hindering drug distribution through blood circulation (Rosenthal & Burchum, 2018).
Explain How You Might Improve the Patient’s Drug Therapy Plan
First, since co-administration of beta-blockers and alpha-blockers causes’ excessive low blood pressure, and the two types of drugs lead to risk of cardiovascular complications like stroke, the AHA, only recommends prescription of Thiazide Diuretics as a first-line therapy in the treatment of hypertension in the elderly population. This is because they have been established prevent other cardiovascular conditions like stroke, coronary artery disease and chronic heart failure. I would, therefore, discontinue Atenolol and Doxazosin, and prescribe Thiazide Diuretics; a dose of 12.5 mg of hydrochlorothiazide instead. The low dose helps prevent toxicity caused by high plasma concentration due to old age associated renal function impairment. It is supplemented by non-pharmacological approaches. Hydralazine should also be terminated as well since it should ideally be given with a beta-blocker. Simvastatin dose should be continued as it is the AHA prescribed the first-line drug for hyperlipidemia. However, the dose should be lowered to 40 g to decrease the risk of diabetes, which is one of the side effects of the drug. The reason is that although the patient does not have diabetes, his age puts him at risk of diabetes. Bariatric surgery such as gastric bypass and laparoscopic adjustable gastric banding will be prescribed for treatment, rather than obesity drugs, to prevent drug interaction.
I will also recommend Non- pharmacologic Treatment. AHA recommends that hypertension treatment in the elderly should entail both pharmacological and non-pharmacological approaches to avoid drug interaction, associated with the use of multiple d
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