LM is an 86-year-old female admitted to the emergency


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LM is an 86-year-old female admitted to the emergency department with delirium. Her spouse is with her and verifies that LM adheres to the medications she is currently prescribed. She does not self-monitor her BP or heart rate at home.


· A Fib diagnosed 1 month ago

· HTN x 10 years

· CKD x 5 years

· Osteoarthritis x 7 years

· GERD x 20 years


· Digoxin 0.25 mg QD

· Metoprolol XL 25mg QD

· Warfarin 3 mg QD

· APAP 650 mg TID

· Omeprazole 20mg QD

· Multivitamin QD

Allergies: NKDA

Social History:

· Married to husband for 57 years

· No smoking, alcohol, limited daily exercise (short walks each morning)


Write a 2-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.

· 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 improvemen

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