During my clinical practice, I encountered a 62-year-old female patient who had been diagnosed with type 2 diabetes mellitus (T2DM) for 10 years. She was recently started on metformin 500 mg orally twice daily, but her blood glucose levels remained high despite the medication. The patient had a history of hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD).
Several factors could have influenced the patient’s pharmacokinetic and pharmacodynamic processes. One of the factors is age, which may have altered the patient’s drug response due to changes in renal and hepatic function that could affect drug metabolism and excretion. Additionally, T2DM is a progressive disease, and the patient’s condition may have altered the pharmacodynamic response to metformin. The patient’s hyperlipidemia and GERD could also influence the patient’s pharmacokinetic processes and drug absorption.
Personalized Plan of Care
Based on the patient’s history and influencing factors, a personalized plan of care for this patient could include close monitoring of blood glucose levels and titration of metformin dosage to optimize glycemic control. In addition, a comprehensive assessment of renal and hepatic function should be conducted regularly to determine any changes in drug metabolism and excretion that may require dosage adjustment. The patient should also be advised on lifestyle modifications, including diet and exercise, to manage T2DM and hyperlipidemia.
The patient’s GERD should be considered in selecting the appropriate drug therapy. For instance, the healthcare provider may consider prescribing an antacid or proton pump inhibitor to manage GERD. The healthcare provider should also monitor the patient for potential drug interactions and adverse reactions to metformin, considering that the patient has multiple comorbidities.
In conclusion, a personalized plan of care for patients should take into consideration pharmacokinetic and pharmacodynamic factors, including age, comorbidities, and genetic variations. By doing so, healthcare providers can tailor drug therapy to optimize outcomes while minimizing the risk of adverse drug reactions and drug interactions.
Lehne, R. A., Rosenthal, L. D., & Burchum, J. R. (2018). Pharmacology for nursing care (9th ed.). St. Louis, MO: Elsevier.
Wright, J. D., & Boudreau, R. A. (2021). Pharmacology for Nurses: A Pathophysiologic Approach. Philadelphia, PA: F.A. Davis Company.