John Kessler has been ill for a long time and his prognosis is poor. He is 84 years old with multiple debilitating and chronic conditions. He has had uncontrolled diabetes for more than 20 years, and...

John Kessler has been ill for a long time and his prognosis is poor. He is 84 years old with multiple debilitating and chronic conditions. He has had uncontrolled diabetes for more than 20 years, and has experienced many complications due to this condition. Three years ago, he developed chronic renal failure and requires dialysis three times a week. To further complicate his condition, John has continued to consume alcohol every day, and smokes one pack of cigarettes per day. He has a long history of both alcohol and tobacco use. Five days ago, his daughter noticed that he was becoming increasingly weak and lethargic. Last night when his temperature reached 38.8°C (102°F) and he became confused, his daughter took him to the emergency department, and he was admitted to the medical unit. A chest x-rays this morning revealed bilateral pneumonia. John is receiving multiple medications through both the intravenous and inhalation routes.

1. What factors may influence drug metabolism or excretion in this patient?

2. Discuss why drug elimination for this patient may complicate the pharmacotherapy.

3. How will the IV or inhalation drug therapy affect the absorption of his medications?

4. John will receive a loading dose of IV antibiotic and then be placed on maintenance doses every 6 hours. What is the purpose of this regimen? Why would this patient be a candidate for a loading dose?