Age-related pharmacokinetic and pharmacodynamics changes

Age-related pharmacokinetic and pharmacodynamics changes

Instructions/Descriptions

Age-related pharmacokinetic and pharmacodynamics changes

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When prescribing for any adult, regardless of age, what principles of good prescribing practice do we need to consider and why? Take a few moments to reflect and make some notes.

Complex health needs Case study

This case study investigates the management of a 68-year-old woman with complex health needs, who has been referred for assessment and management of her conditions.

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Martha has a history of vascular disease, having undergone a coronary bypass at the age of 53. Her past medical history includes type 2 diabetes (diagnosed 10 years ago), hyperlipidaemia, hypertension and atrial fibrillation. She is also a known asthma sufferer, with a history of multiple accident and emergency (A&E) admissions and therapy with prednisolone. Previously reported arthritic knee pain resulted in her reluctant retirement three years ago from her job as a PE teacher. She often feels breathless and has a moderate amount of ankle swelling, which she says is almost always present regardless of the time of day. Martha has also suffered from moderately lengthy depressive episodes in the past few years, since her husband died suddenly and her only daughter migrated to Australia. She has now presented for assessment and management.

The rest of this chapter will therefore consider the management of Martha’s drug regime for physical illness as well as for her mental health problems. These mental health issues can be significant as age increases and life-changing events become more frequent and often much more difficult to handle.

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Martha now lives alone and has just moved into sheltered accommodation. She has just changed her GP after 35 years and has visited the GP practice only once. Martha’s daughter has noted that her mother seems to have become more agitated recently when she calls her, and that she is reporting palpitations, large fluctuations in her blood sugar readings and some shortness of breath on exertion. Martha also suffered a particularly painful fall. Her daughter begins to wonder what is happening with Martha’s medication, as she seems to be taking a lot of drugs now, some of which appear to be new. Martha also regularly uses herbal medicine and her daughter has noted that this includes St John’s Wort.

Previously, Martha has been treated with a selection of drugs, which included amitriptyline, at times alongside drugs to manage agitation such as temazepam and nitrazepam. Other regular medication includes metformin, aspirin, digoxin, simvastatin, amlodipine, furosemide and telmisartan, with tramadol and diclofenac for arthritic pain and GTN spray and salbutamol inhaler as required (PRN) medications. Martha denies taking alcohol, has never smoked, and has no known allergies.

Age-related pharmacokinetic and pharmacodynamics changes

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