Pharmacology 3rd Edition by Michael Adams , Carol Urban

Exercise 1

Remember the patient "John Kessler" at the beginning of the chapter? Now read the remainder of the case study. Based on the in formation presented within this chapter, respond to the critical thinking questions that follow.

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-ray this morning revealed bilateral pneumonia. John is receiving multiple medications through both the intravenous and inhalation routes.
What factors may influence drug metabolism or excretion in this patient?