Case study

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.