Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Patient Case

A 62-year old female patient was seen in my clinic. She had been diagnosed for the past 10 years with T2DM. Recently, she was prescribed metformin (500 mg twice daily) but her blood glucose level remained high. She had a previous history of gastroesophageal acid reflux (GERD), hypertension and hyperlipidemia.

Influencing Factors

Several factors could have influenced the patient’s pharmacokinetic and pharmacodynamic processes. One of the factors is age, which may have altered the patient’s drug response due to changes in renal and hepatic function that could affect drug metabolism and excretion. Additionally, T2DM is a progressive disease, and the patient’s condition may have altered the pharmacodynamic response to metformin. The patient’s hyperlipidemia and GERD could also influence the patient’s pharmacokinetic processes and drug absorption.

Personalized Plan of care

Based on the patient’s history and influencing factors, a personalized plan of care for this patient could include close monitoring of blood glucose levels and titration of metformin dosage to optimize glycemic control. Regularly assess renal and hepatic functions to identify any potential changes in the drug’s metabolism or excretion. To manage T2DM, and hyperlipidemia, the patient must also receive advice on lifestyle changes, such as diet and physical activity.

The patient’s GERD should be considered in selecting the appropriate drug therapy. To manage GERD, a healthcare provider could prescribe an antacid and/or proton-pump inhibitor. A healthcare provider may also need to monitor the patient’s metformin for possible drug interactions or adverse reactions, given that they have multiple comorbidities.

Finally, it is important to note that a plan of personalized care should consider pharmacokinetic and psychodynamic factors. These include age, co-morbidities and genetic variations. This allows healthcare providers to tailor the drug therapy in order to maximize outcomes and minimize adverse reactions.

Referrals

Lehne, R. A., Rosenthal, L. D., & Burchum, J. R. (2018). Pharmacy for Nursing Care, 9th Edition. St. Louis, MO: Elsevier.

Wright, J. D., & Boudreau, R. A. (2021). The Pharmacology of Nurses, A Pathophysiologic Perspective. Philadelphia, PA: F.A. Davis Company.