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Case 5: Polypharmacy of the ElderlyPharmacologyRachel PetersonIdentify each of the medical diagnoses for Mr. Kaufman. Mr. Kaufman has the following diagnosis: coronary artery disease (CAD), type 2 diabetes, peripheral neuropathy, renal insufficiency. In the past, he has also been treated for osteoarthritis, prostate cancer, and diverticulitis/diverticulosis. Are there also normal changes in renal function that occur with aging? Age-related changes in renal function vary significantly. Some older adults experience little change, whereas other experience life-threatening change. On average, glomerular filtration rate declines by approximately 8-10 mL/min/1.73 m2 /decade after the age of 30-35. The progressive decline in renal function can lead to inability to excrete concentrated or dilute urine, a delayed response to sodium deprivation or a sodium load, and delayed response to an acid load. Renal function is also affected by dehydration, diuretic use, and medications, especially antibiotics. Define Polypharmacy. Do you think that Mr. K’s medications represent polypharmacy? Why is Polypharmacy a concern in the elderly? Polypharmacy is a nutrition-related consequence consisting of taking five or more medications or over-the-counter medications daily. Yes, Mr. Kaufman’s medications represent polypharmacy because he is currently taking 11 medications daily. Polypharmacy is of great concern in the elderly because they are often times in charge of their own medications while simultaneously experiencing a decline in memory. Often times, the elderly are not even sure of why they are taking a certain medication, what it does to their body, how it interacts with other meds, or how it interacts with the food they consume. Polypharmacy can also cause poor side effects in the elderly, like dry mouth. Elderly are at an increased risk for developing drug-drug interactions as well as drug-nutrient interactions. Describe the potential nutritional complications secondary to pharmacotherapy. Pharmacotherapy can compromise the nutritional status of an individual. Loss of appetite, nausea, diarrhea, weight changes, digestive system complications and malnutrition all potential nutritional complications secondary to pharmacotherapy. A well-organized team of experts who frequently monitors/evaluates the patients may be able to provide effective treatments while maintaining healthy nutritional status. Such a team of experts consist of physicians, pharmacists, dietitians and nurses will be able to determine the required drugs and doses, while managing healthy nutritional status by adjusting diet or dietary supplements.Describe the potential effect of nutrition on the action of the medications. Certain vitamins and minerals are absorbed inefficiently due to the action of certain medications. The excretion and disposition of the medications in the body can also affect nutrition of an individual without them being aware.Mr. K is 5’5” tall and weighs 196 pounds. Calculate his BMI. How would you interpret this value? Should any adjustments be made in the interpretation to account for his age? Mr. K’s BMI is 32.7. This figure classifies him into the Obese Class I category of Body Mass Index. Typically, BMI increases with age, and as a general rule it is better to be a little overweight than underweight when it comes to the elderly population and resisting disease states. In this case though, Mr. K is a little too overweight, and he could potentially enhance his overall health if he could lose a little excess body weight. Calculate Mr. K’s percent UBW. Interpret the significance of this assessment. Assuming that 210 pounds is Mr. K’s normal body weight, his percent UBW is 93.3%. On the positive side, Mr. K’s body weight is lower than it was when he initially moved in with his daughter. On the other hand, he is still considered obese. This classification of obesity is more than likely affecting his disease states. In an older individual, what specific changes occur in body composition and energy requirements that may need to be taken into consideration when completing a nutritional assessment? There are several changes in body composition and energy requirements that accompany aging. Fat mass increases and muscle mass decreases with age. Changes in body composition also affect the resting metabolic rate which in return, affects the overall energy needs of an older adult. As an individual reaches an older age, their energy requirements will increase regardless of their overall sedentary lifestyle. Mr. K’s daughter expressed concern regarding his fluid intake. Is this a common problem in again? Explain. Yes, this is a common problem in aging. As individuals age, their thirst mechanism decreases, and they no longer feel thirsty like they once did in their younger years. The elderly often times face dry mouth, decreased taste sensation, and decreased saliva production. All of these factors make eating and drinking less pleasurable and more difficult. Often times, this can lead to dehydration, altered electrolyte levels, and malnutrition. Do you think Mr. K needs to take a multivitamin? In general, do needs for vitamins and minerals change with aging? What reference would you use to determine recommended amounts of the micronutrients? I do not think that Mr. K needs to take a multivitamin. He already takes plenty of medications, and he eats an overall nutritious diet. He consistently eats three meals per day containing fruits and vegetables, low-fat/low-sugar snacks, and appropriate amounts of protein. He could try to incorporate foods that he is lacking in vitamins and minerals. If abnormal lab values were to result after this discontinuance of his multivitamin, the idea should be reconsidered. According to the text, the understanding of vitamin and mineral requirements, absorption, use, and excretion with aging has increased, but much remains unknown. Mr. K was diagnosed with mild metabolic alkalosis and dehydration. What is metabolic alkalosis? Read his history and physical. What signs and symptoms does the pt present with that might be consistent with metabolic alkalosis and dehydration? Explain. Metabolic alkalosis results from the administration or accumulation of HCO3- or its precursors, excessive loss of acid, or loss of extracellular fluid containing more chloride than HCO3-. Alkalosis can also occur from severe hypokalemia. The condition also negatively affects the kidneys. According to Mr. K’s labs taken at the hospital, his potassium levels were low which is common with metabolic alkalosis. In the patient’s medical history, it stated that he experienced renal insufficiency. This also indicates that the metabolic alkalosis diagnosis is accurate. What medications are the most likely to have contributed to the abnormal lab values and thus this diagnosis? Why? There are several medications that could have potentially contributed to the abnormal lab values for Mr. K. For starters, the medication Prilosec, which treats heartburn and GERD, is known to produce false test results. Next, furosemide has the ability to affect blood glucose levels and reduce potassium levels. On the other hand, Diovan can potentially increase potassium levels. Neruotonin can interfere with urine protein tests. Lastly, aspirin can cause overall abnormal lab results especially in urine glucose tests. ................
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