Introduction
The patient from the assigned case has a history of a heart attack at the age of 54. Therefore, they might belong to the elderly age group in addition to an already complicated cardiovascular health history. The patient is also diagnosed with harmful health conditions such as hypertension and hyperlipidemia. Lastly, they gained extra 10 pounds of weight during the COVID-19 outbreak, which could also have a negative effect on their heart and blood vessels. While heart attack, hypertension, hyperlipidemia, and weight gain are concerning conditions by themselves, the age factor and its possible influence on prescribed medications demand a special investigation. The impact of age on pharmacokinetics and pharmacodynamics might create the need to change the medication regimen.
Age Influence on Pharmacokinetics and Pharmacodynamics
The exact age of the patient from the assigned case is unknown. However, an already complicated health history allows to assume that the patient’s cardiovascular system is closer to older adults’ condition. As a result, the patient’s age might be affecting the current medication plan. Peeters et al. (2019) provided the following examples of age-related changes in drugs:
- Pharmacokinetics: distribution volume and half-lives. Older people usually have less muscle tissue, more fat tissue, and less body water percentage. As a result, the drugs accumulate in their bodies more easily, which can affect drug effectiveness and side effects;
- Pharmacodynamics: the patient from the assigned case has hypertension, which could result from age affecting their blood vessels. In addition, aging reduces cardiac contractility, which can lead to heart failure.
In addition, Peeters et al. (2019) claimed that elderly patients often use several medications to treat chronic diseases, which leads to more drug-drug interactions and adverse effects. Therefore, it would be reasonable to lower the total number of medications so that an elderly patient could take only the drugs necessary for their condition. The dosage of certain medicines can be reduced as well in order to avoid unnecessary accumulation in the patient’s body and ease the drug’s excretion.
Possible Impact on Drug Therapy
The recommended drug therapy for the patient from the assigned case consists of the following medications:
- Atorvastatin: 80 mg daily;
- Lisinopril: 40 mg daily;
- Metoprolol succinate XL: 50 mg daily;
- Repatha: 140 mg/ml SC 2 weeks;
- Aspirin: 81 mg;
- Loratadine: 10 mg daily;
- Melatonin: 10 mg qhs;
- Omeprazole: prn
The pharmacokinetics and pharmacodynamics specific to the elderly might cause polypharmacy and unnecessary accumulation of drugs. For example, an excessive accumulation of statins such as atorvastatin can cause dangerous conditions such as type 2 diabetes mellitus, hepatotoxicity, or renal toxicity (Ward et al., 2019). Moreover, negative drug-to-drug interactions can occur between the medications from the list — for instance, aspirin can potentially nullify the benefits of lisinopril (Drug Interactions between Aspir 81 and lisinopril, n.d.). Therefore, the existing therapy plan needs to be edited in order to lower the risks of drug accumulation and negative drug-to-drug interaction.
Changes to Medication Regimen
Based on examples from the previous section and effects of age on drug’s pharmacokinetics and pharmacodynamics, it seems appropriate to make the following changes to medication regimen:
- Atorvastatin: the current dose of 80 mg daily is a maximum for adults with hyperlipidemia (Atorvastatin Dosage, 2021). Therefore, the dosage for an older person from the assigned case could be lowered to 40 mg daily. This change would still allow to reduce low-density lipoprotein and avoid unnecessary accumulation in the body;
- Lisinopril: the dose of 40 mg per day can be considered maximal (Mayo Clinic, 2021). Consequently, the dosage can be lowered to 20 mg and increased if the necessity arises;
- Metoprolol succinate XL: the 50 mg daily dose is average for patients with high blood pressure (Toprol XL, 2020). The patient from the assigned case has hypertension, so metoprolol dosage can remain unchanged;
- Repatha: 140 mg/ml SC 2 weeks — this is an average dosage for patients with hyperlipidemia (Repatha, 2021). Therefore, it can be left unchanged for the two weeks;
- Aspirin: 81 mg. According to the U.S. Preventive Services Task Force, daily aspirin therapy is recommended for several groups of the population. Among them are people aged between 50-59, who do not have a risk of bleeding and have an increased risk of heart attack (as cited in Mayo Clinic, 2019). The patient from the assigned case fits all three groups; however, due to possible adverse interactions with lisinopril, aspirin should be taken in a minimal therapeutic dosage;
- Loratadine: 10 mg daily. Loratadine is an anti-allergic medication, and the patient from the case is not said to have allergies. Therefore, it can be removed entirely from the regimen in order to avoid the risk of drug-to-drug interaction;
- Melatonin: 10 mg qhs. According to Sun et al. (2016), melatonin has an antihypertensive effect and can be considered an inexpensive and well-tolerated drug. Due to that fact, melatonin can be kept in medication regimen;
- Omeprazole: prn. The patient is not said to have gastric or duodenal ulcers or any problems with excessive acid in the stomach, which are the primary use for omeprazole (Mayo Clinic, 2021). Therefore, omeprazole can be excluded from the regimen or taken only “pro re nata.”
The revised therapy plan has all the necessary medications to treat hypertension and hyperlipidemia. At the same time, it mitigates the risks of polypharmacy and excessive drug accumulation caused by pharmacokinetics and pharmacodynamics usual for elderly patients.
References
Atorvastatin Dosage. (2021). Drugs.com. Web.
Drug Interactions between Aspir 81 and lisinopril. (n.d.). Drugs.com. Web.
Mayo Clinic. (2019). Daily aspirin therapy: Understand the benefits and risks. Web.
Mayo Clinic. (2021). Lisinopril (Oral Route) Web.
Mayo Clinic. (2021). Omeprazole (Oral Route) Web.
Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension.Expert opinion on drug metabolism & toxicology, 15(4), 287-297. Web.
Repatha. (2021). RxList. Web.
Sun, H., Gusdon, A. M., & Qu, S. (2016). Effects of melatonin on cardiovascular diseases: progress in the past year. Current Opinion in Lipidology, 27(4), 408-413. Web.
Toprol XL. (2020). RxList. Web.
Ward, N. C., Watts, G. F., & Eckel, R. H. (2019). Statin toxicity: mechanistic insights and clinical implications. Circulation Research, 124(2), 328-350. Web.