Reference no: EM133241513

LM is an 86-year-old female admitted to the emergency department with delirium. Her spouse is with her and verifies that LM adheres to the medications she is currently prescribed. She does not self-monitor her BP or heart rate at home. 

PMH: 

A Fib diagnosed 1 month ago 

HTN x 10 years 

CKD x 5 years 

Osteoarthritis x 7 years 

GERD x 20 years 

Medications:  

Digoxin 0.25 mg QD 

Metoprolol XL 25mg QD 

Warfarin 3 mg QD 

APAP 650 mg TID 

Omeprazole 20mg QD 

Multivitamin QD 

Allergies: NKDA 

Social History: 

Married to husband for 57 years 

No smoking, alcohol, limited daily exercise (short walks each morning) 

Family History: 

None reported 

Vitals:                                     Labs: 

Wt 113 lbs Ht 5'4"                   Na+ 138          K+ 4.0 

BP 101/58, HR 52                   Cl- 99              CO2 27 

                                                BUN 33           Cr 1.2 

                                                Gluc 109         INR 3.8 

                                                Dig 2.4 

PE: 

Elderly female with altered level of consciousness, no signs of bruising, bleeding, or other injury. 

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.