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Posted: September 7th, 2023
The Impact of Age on Pharmacokinetics and Pharmacodynamics for LM
LM is an 89-year-old female resident experiencing multiple falls and increased pain with ambulation. Her advanced age is an important factor to consider, as the aging process can significantly impact pharmacokinetics and pharmacodynamics.
Pharmacokinetic changes occur as people age. LM has likely experienced a decrease in lean body mass and weight, which can increase drug concentrations in the blood by decreasing the volume of distribution. Her liver and kidney function may also be declining with age, reducing the clearance of drugs from her system and prolonging their half-lives. This puts LM at greater risk for drug accumulation and toxicity. Age-related changes in gastric emptying and intestinal absorption could also affect peak drug levels and bioavailability in LM.
Pharmacodynamic changes with aging also impact drug therapy. LM's receptors may have reduced sensitivity, decreasing her response to certain medications. As an elderly patient with multiple comorbidities, LM is more susceptible to adverse drug reactions and drug-drug interactions due to changes in overall health status and an increased risk of polypharmacy.
These pharmacokinetic and pharmacodynamic alterations in the elderly should prompt modifications to LM's current drug regimen. Her nonsteroidal anti-inflammatory celecoxib could be contributing to falls risk and gastrointestinal intolerance due to changes in absorption and receptor sensitivity with age (Blaschke & Hansten, 2012). A topical analgesic may provide pain relief with less systemic exposure. Her diuretic furosemide may require dose reduction to prevent dehydration from impaired kidney function (Rowland, 2015). More frequent monitoring of renal and liver function tests is also prudent.
In summary, LM's advanced age necessitates careful consideration of altered pharmacokinetics and pharmacodynamics when evaluating her medication regimen. Modifying or substituting certain high-risk drugs could help optimize therapy and minimize adverse outcomes, improving her safety and quality of life in the long-term care facility. Regular medication reviews accounting for age-related changes are important for elderly patients like LM.
References:
Blaschke, T. F., & Hansten, P. D. (2012). Drug therapy in the elderly: Principles and practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Rowland, M. (2015). Pharmacokinetics and pharmacodynamics in the elderly. Clinical Pharmacokinetics, 54(12), 1313-1331.
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