An 86-year-old patient is seen in clinic for a scheduled ...

[naturalchemist]

An 86-year-old patient is seen in clinic for a scheduled follow-up after starting a new oral medication 1 month prior. The patient reports no change in symptoms, and a laboratory test reveals a subtherapeutic serum drug level.
 
  The NP caring for this patient should: a. consider ordering more frequent dosing of the drug.
  b. titrate the patient's dose upward and recheck in 1 month.
  c. ask the patient about any increased frequency of bowel movements.
  d. determine the number of pills left in the patient's prescription bottle.

Question 2

A thin 90-year-old patient who will begin taking warfarin has experienced a recent weight loss of 15 pounds. The NP caring for this patient should:
 
  a. obtain a baseline liver function test (LFT) before starting the drug.
  b. write the initial prescription at the lowest possible dose.
  c. encourage the patient to consume a diet high in fat and protein.
  d. counsel the patient to take the drug with food to enhance absorption.

[CharlieArnold]

Answer to Question 1

D
Because of cost concerns, poor understanding of a drug's actions, or confusion about how to take a medication, many elderly patients do not comply with drug regimens and may not take drugs as prescribed. Before increasing the frequency or amount of a drug, it is important to assess first whether or not the patient has been taking the drug as ordered. Counting the number of pills in the bottle will help the provider assess whether the patient is taking the drug as ordered. Changes in gastric motility do not generally have major effects on the effectiveness or serum drug levels of medications.

Answer to Question 2

B
A common age change that affects the distribution of drugs in older adults is a decrease in serum albumin. Significant changes that may affect drug therapy may be seen in malnourished elderly patients. Warfarin has a high binding affinity with albumin. Significant decreases in albumin may result in a greater free concentration of highly protein-bound drugs. It is important to order the lowest possible dose and titrate upward as needed. A baseline LFT is not indicated. A diet high in fat and protein is not indicated.

[naturalchemist]

TYSM

[ryhom]

Gracias!