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Case
Recently, there has been a growing interest in personalized medicine due to the genetic, age and other factors differences among patients. There is a need to consider some risk factors that can worsen the condition of a patient especially during the intervention phase (Weerink et al. 2017). Mr. L, a 75-year-old African American man was admitted to the hospital after he complained of numbness in the limbs and face especially one side, problems in vision, severe headaches, lack of coordination, and difficulty in communication. Additionally, the patient expressed some behaviors such as being startled easily and avoiding eye contact. Besides, he had increased heart rate, shaking and sweating, numbness and cold flushes. He was diagnosed with stroke and depression
Pharmacokinetics
The patient was subjected to selective serotonin reuptake inhibitors (SSRIs) which seemed to be weakening the bones of the patient. After some time he was subjected to ensam antidepressant drugs that were administered through transdermal routes. The absorption of these drugs was affected because of the reduced tissue blood perfusion. This is common among the elderly (Shimizu et al. 2016). Drug distribution was not profoundly affected since the drugs administered were not hydrophilic. The liver is responsible for drug metabolism, and since aging is related to low liver mass, the response to the medicine was not highly positive as compared to when younger people are administered the drug. Elimination and drug interaction was not affected by age.
Pharmacodynamics
Pharmacodynamics depends on the drug concentration at the receptor, the receptor response, post-receptor events within the cells as well as the homeostatic mechanisms (Hochhaus et al. 2016). Aging affected all these pharmacodynamics. Plasma concentration in the body of this man led to a high risk of adverse effects such as headaches, insomnia, and rash.
A Personalized Plan of Care
In treating depression and anxiety, I would use selective serotonin reuptake inhibitors (SSRIs). These drugs work by escalating brain chemicals that fight depression. To avoid thinning of bones which might cause fractures among the elderly, I would start the medication at low doses and increase them slowly for the elderly. I would also consider injection rather than transdermal routes.
References
Hochhaus, G., Khan, P., Mobley, C., & Issar, M. (2016). Pharmacokinetics and pharmacodynamics of drugs delivered to the lungs. In Pharmaceutical Inhalation Aerosol Technology, Second Edition (pp. 222-257). CRC Press.
Shimizu, R., Hotta, K., Yamamoto, S., Matsumoto, T., Kamiya, K., Kato, M., … & Tanaka, S. (2016). Low-intensity resistance training with blood flow restriction improves vascular endothelial function and peripheral blood circulation in healthy older adults. European journal of applied physiology, 116(4), 749-757.
Weerink, M. A., Struys, M. M., Hannivoort, L. N., Barends, C. R., Absalom, A. R., & Colin, P. (2017). Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clinical pharmacokinetics, 56(8), 893-913.
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