Derek is an 84-year-old male admitted to the ER with delirium, altered level of consciousness, no signs of bruising, bleeding, or other injury. His wife reported that they have been married for 60 years and that he does not drink nor smoke. She also reported that he has no known allergies and takes the following medications: Digoxin 0.25 mg QD. Metoprolol XL 25mg QD. Warfarin 3 mg QD. APAP 650 mg TID. Omeprazole 20mg QD. Multivitamin QD

She also reported that he does not self-monitor his BP or heart rate at home and has the following chronic conditions. CKD x 4 years. GERD x 18 years. A Fib diagnosed 60 days ago. Osteoarthritis x 6 years. HTN x 9 years. Assessments and blood work was done and revealed the following:

Vital signs as follows: Blood Pressure 103/57, Heart Rate 53, Height 5’5”, and Weight 115 lbs.

Lab values as follows: Sodium 138, Chloride 99, Creatinine 1.2, BUN 33, INR 3.8, CO2 27, Digoxin 2.4, Potassium 4.0, and Glucose 109.

Develop a 3-page paper that addresses the following:

· Discuss how age might influence the pharmacokinetic and pharmacodynamic processes in the patient from the above case study.

· Explain 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 in details why you would make these recommended improvements.