NURS 6521 wk 1 Diabetes Care in the Elderly
Ms. X is an 86-year-old white obese female who presented to the ED with altered mental status and weakness last week. Ms. X has a history of hypertension, UTIs, and type two diabetes mellitus (DM). Ms. X lives next door to her daughter but otherwise is very independent and active. Upon arrival to the ED, her blood glucose level was in the 30’s. The ED physician ordered a D10 drip, and the patient was sent to the medical intensive care unit for monitoring. Before presenting to the ED, Ms. X was seen at her primary care provider’s office and was prescribed Bactrim for a probable UTI (no urine specimen was obtained) and continued to take her prescribed medications which included Glipizide. NURS 6521 wk 1 Diabetes Care in the Elderly
Pharmacokinetics is how a drug moves through the bodily systems, is processed, absorbed, and excreted. Pharmacokinetics also entails the study of the onset and duration of a drug in the body and enables the provider to find the therapeutic window, the targeted therapeutic response without toxic side effects (Arcangelo, Peterson, Wilbur, & Reinhold, 2017)
Pharmacodynamics is what the administered drug does to the body, studying the biochemical, physiologic, and molecular effects of a drug within the body. Pharmacodynamics can be influenced by disease, aging, and polypharmacy (Farinde, 2016).NURS 6521 wk 1 Diabetes Care in the Elderly
Ms. X took two prescribed drugs that interfered with each other, Bactrim and Glipizide. Bactrim, an antimicrobial, prescribed for a suspected UTI, and Glipizide was a daily maintenance medication used to control her DM. Ms. X had several factors that influenced the pharmacokinetics and pharmacodynamics. First, Ms. X is 86. Elderly patients have reduced renal and hepatic function causing a diminished metabolism often causing an elevated drug level leading to toxicity. Patients over the age of 65 are seven times more likely to be hospitalized due to unintentional overdosing (Woo & Robinson, 2016).
Second, Ms. X took a potentially harmful combination of drugs. Glipizide is a sulfonylurea. An adverse effect of this drug is hypoglycemia, specifically in the elderly with renal impairment or hepatic dysfunction. Glipizide has a long half-life and is not recommended in older adults as it could build up to toxic levels. A new concern is the risk of hypoglycemia when sulfonylurea drugs are mixed with the concurrent use of antibiotics (Woo, Kim, Sung, Cho, & Park, 2012). Bactrim should be used cautiously in elderly patients, particularly in those with decreased renal function. Combining Glipizide and Bactrim can cause increased levels of Glipizide in the body due to the competition of the drugs to be bound to proteins (RXList, n.d.).
The mixture of a DM, reduced renal and hepatic function, and the combination of a sulfonylurea and an antibiotic created the perfect storm for Ms. X to have a hypoglycemic episode. Hypoglycemia is the most common medication complication seen in elderly patients and can be an even bigger problem than cardiovascular disease in some sub-groups in the elderly (Nainggolan, 2013).NURS 6521 wk 1 Diabetes Care in the Elderly
DM is becoming one of the most chronic diseases in the world with the growing elderly population. An appropriate plan of care for patients like Ms. X should include frequent assessments, especially with medication evaluations and possible drug interactions. Treatment plans should remain simple, with few drugs as possible and if drugs are required, utilize the smallest dose possible to start and increase only if needed and at a slow rate. All patients should have a thorough physical assessment as well as baseline liver and kidney function tests performed before any drug regimen is started (Yakaryilmaz & Ozturk, 2017). Ms. X needs to have her medications re-evaluated and changed to those that are compatible with impaired organ function. She and her daughter need to be educated on possible drug interactions as well as lifestyle changes that can be made to help reduce the number of drugs needed on a daily basis. NURS 6521 wk 1 Diabetes Care in the Elderly