case study

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:



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



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



BP: 110/50

HR: 38 bpm

RR: 14/min

Rest of physical exam unremarkable



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.


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