Outline how changes in renal and hepatic function may affect treatment strategies

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Mrs. A is a 71 year old widow with CHF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother’s ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:

· Furosemide 40 mg daily in the morning

· Digoxin 250 micrograms daily

· Paracetamol 500 mg, 1-2 tablets 4-hourly PRN

· Piroxicam 20 mg at night

· Mylanta suspension, 20 ml PRN

· Coloxyl 120 mg, 1-2 tablets at night

Assignment Questions

1. Critically discuss this case study in terms of the problematic nature of this patient’s pharmacological management.

2. Outline some pharmacokinetic changes in the geriatric population that may affect drug disposition.

3. Outline how changes in renal and hepatic function may affect treatment strategies.

4. In the drug regimen presented above – discuss potential side effects and potential interactions, if any?

5. Your response should include a discussion of the problems of polypharmacy as it is related to this case study and the assessment/management and educational strategies which could have been implemented to improve the outcome of Mrs. A.


· Prepare and submit a 3-4 page paper [total] in length (not including APA format).

· Answer all the questions above.

· Support your position with examples.

· Please review the rubric to ensure that your assignment meets criteria.

· Submit the following documents to the Submit Assignments/Assessments area:



Polypharmacy, or the use of more than five drugs at the same time, is common among the elderly. The majority of individuals over the age of 65 have several diseases and must see multiple specialists to manage their prescriptions. Polypharmacy has been connected to many senior patient falls and medication non-adherence. When a patient, especially one who is elderly, is taking more than five prescriptions each day, it might be difficult to keep track of the different times, or the patient may forget to take the drug and take it again (Brown, 2016).

To assist a patient with their polypharmacy, a health care provider must address all drugs at each appointment (Brown, 2016). Reviewing the medication list and drug history every six months is another method I may assist my patient. Look for medications that the patient is taking that the indication for is no longer needed during the medication review at each appointment or every six months (Woo et al, 2015). For example, pain medicine from a previous surgery or supplements that are no longer required. Duplicate drug therapies are another thing to look for during the review. When possible, support and educate patients about lifestyle modifications or non-drug therapy, and avoid prescribing needless prescriptions as a health care professional. It’s also important to distinguish between a symptom of the aging process, which could be a concern, and a disease process that requires treatment (Woo et al, 2015).


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