BN is a 74-year-old African American male who is seeing his PCP because he noticed when he woke up that his “heart was not beating right; it feels like it is
going to slow.” He denies chest pain, SOB, N/V. He notes feeling dizzy earlier in the day. 6 weeks earlier his PCP started him on Diltiazem CD to further lower
his BP to goal. His Metoprolol was lowered at that time as well from 75 mg to 50 mg BID. His PCP recommends he be admitted to the hospital.
Upon presentation to the hospital:
PMH:
HTN x 7 years
Type II DM
CAD s/p angioplasty 2 years ago
MI 3 years ago
EF = 60%
PVD s/p left femoral to posterior bypass
Hx of A Fib x 4 years
Medications:
Digoxin 0.25 mg QD
KCl 40 mEq QD
Vitamin C 500 mg QD
Diltiazem CD 180 mg QD
ASA EC 325 mg QD
Vitamin E 400 IU QD
Metoprolol 50 mg BID
Warfarin 5 mg QD
Ibuprofen 200 mg 2 tabs prn headache
Lisinopril 20 mg QD
Imdur 30 mg QD
HCTZ 12.5 mg QD
Humalog 8u with meals
Lantus 26u QHS
Ca++/Vit D 500mg/200 IU BID
Famotidine 20 mg QHS
Multivitamin QD
PE:
BP 110/50
Pulse 38 bpm
Resp 14/min
Rest of the physical exam was unremarkable
Labs:
K+ 6.9
Na+ 135
Cr 1.9
BUN 35
Gluc 102
Dig 2.78
INR 2.3
WBC 5,800/mm3
Hct 35%
-Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
-Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
-Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.
