How you might improve the patient’s drug therapy plan

    EF is a 74-year-old African American male who is seeing his PCP because he noticed when he woke up that his “heart was not beating right; it feels like it is going to slow.” He denies chest pain, SOB, N/V. He notes feeling dizzy earlier in the day. Six weeks earlier his PCP started him on Diltiazem CD to further lower his BP to goal. His Metoprolol was lowered at that time as well from 75 mg to 50 mg BID. His PCP recommends he be admitted to the hospital. Upon presentation to the hospital: PMH: HTN x 7 years Type 2 DM CAD s/p angioplasty 2 years ago MI 3 years ago EF = 60% PVD s/p left femoral to posterior bypass Hx of A Fib x 4 years Medications: Digoxin 0.25mg once daily KCl 40mEq once daily Vitamin C 500mg once daily Diltiazem CD 180mg once daily ASA EC 325mg once daily Vitamin E 400 IU once daily Metoprolol tartrate 50mg twice daily Warfarin 5mg once daily Ibuprofen 200mg - 2 tabs prn headache Lisinopril 20mg once daily Famotidine 20mg once daily at bedtime MVI once daily Imdur 30mg once daily Lantus 26U once daily at bedtime Ca++/Vit D 500mg/200 IU twice daily HCTZ 12.5mg once daily Humalog 8U three times daily with meals Vitals: BP: 110/50 HR: 38 bpm RR: 14/min Rest of physical exam unremarkable Labs: Gluc 102 Na 135 K 6.9 BUN 35 Scr 1.9 WBC 5,800/mm3 Hct 35% INR 2.3 Dig 2.78 Write a 2- to 3-page paper that addresses the following: • Explain how the factor [genetics, gender, ethnicity, age, or behavior factors} you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study above. • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.