This is a case study. The main textbook for this course is : 

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

I need additional scholarly and current references as well.  Below you will find the case study and required questions to be answered about this case study. Thank you!

• Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
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• Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
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• Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
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• Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. 
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• Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
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Write a 2- to 3-page paper that addresses the following:

• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
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• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
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• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Would you discontinue any medications, change the dosage, and/or add medications to the patient’s regimen? DISCUSS EACH MEDICATION.

CASE STUDY:

Case study assigned

LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.

PMH:

• HTN
• Alzheimer’s disease
• Hypothyroidism
• Osteoarthritis
• Diabetes

MEDICATIONS:

• Amlodipine 10 mg QD
• Donepezil 10 mg QHS
• Levothyroxine 88 mcg QAM
• Celecoxib 200 mg QD
• Furosemide 40 mg QAM
• Metformin 500mg, 1 BID
• Glyburide 5mg, 1 BID

ALLERGIES: NKA

SOCIAL HISTORY:

Widowed with 2 adult children living in town, retired photographer and owner of an art supply store

VITALS:                                             LABS:

Weight: 129 lbs                               TSH 2.45, Free T4 0.98

Height: 64 inches                            Na 135, K+ 3.4, Cl 99, CO2 25,

BP: Supine = 177/82                       Glucose 101

HR: 78 bpm                                      WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1, Plt 255

                                                           BUN 42, Cr 1.6, UA Clear

                                                           eGFR: 45 ml/min

PE:

• HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI
• CV: RRR
• Respiratory: Clear to auscultation bilaterally
• Abdomen: Soft, non-tender, no masses or guarding
• G/U: Skin intact, assisted with toileting and personal hygiene by staff
• Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
• Neuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months

PAIN ASSESSMENT:

Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severe