A study by Scondotto et al 2018 discussed how there are various homeostatic

A study by scondotto et al 2018 discussed how there

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A study by Scondotto et al. (2018) discussed how there are various homeostatic changes that occur in the human body, such as a reduction in the homeostatic ability as the individual’s age increases. As a person ages, pharmacokinetic changes include a reduced renal and hepatic
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clearance and an increase in volume of distribution of lipid soluble drugs (which increases the half-life of some drugs) (Scondotto et al., 2018). Pharmacodynamic changes involve altered (usually increased) sensitivity to several classes of drugs such as anticoagulants, cardiovascular and psychotropic drugs (Arcangelo & Peterson, 2017). Impact on Patient’s Drug Therapy Managing AFib requires three key components that include preventing TIA with anticoagulants, restoring and maintaining a normal sinus rhythm, and controlling the ventricular rate (Arcangelo & Peterson, 2017). According to The Joint Commission core measures for stroke should include beta-blockers, aspirin, ACE inhibitors, and lipid therapy such as statins medications (Masica, Richter, Convey, & Haydar, 2009). Improvements on the Patient’s Drug Therapy Plan The patient’s medical conditions of hypertension, type 2 diabetes, atrial fibrillation, and ischemic heart disease all put the patient at an increased risk of developing congestive heart failure. With this knowledge, I would make several changes in the current medication regimen. First, I would maintain the patient’s atenolol dose but add in a loop diuretic. The recommended medication would be hydrochlorothiazide, 25mg PO daily. Given the patient’s type 2 diabetes and hypertension, I would add in an ACE inhibitor, Lisinopril 2.5mg PO daily. This would add kidney protection as well as giving the patient adequate hypertension control. The patient is also identified as having hyperlipidemia but is not presently taking a statin medication. As the patient is identified as having ischemic heart disease, per the core measures identified by the Joint Commission, the patient should be taking aspirin, a beta blocker, an ACE inhibitor or ARB, and a statin medication (Masica, Richter, Convey, & Haydar, 2009). The Lisinopril added to the medications provides the ACE inhibitor. Adding in simvastatin 10mg PO daily would provide statin coverage and reduce the patient’s risk associated with their hyperlipidemia. I would also choose to remove the Motrin from the patient’s medication regime as this medication can stress the kidneys and also acts as an additional blood thinner. Given that the patient is already on warfarin and aspirin, this would not be a good choice for pain control.
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