McCuistion Chapter 7: DRUG THERAPY IN OLDER ADULTS

Geriatric Considerations:

Reduction in total body water and lean body mass

Reduction in kidney mass

Reduction in liver mass and blood flow

Blood sugars are difficult to maintain

Volume depletion and electrolyte imbalance with diuretics

GI Irritation with NSAIDS (Ibuprofen)

Geriatric Pharmacokinetics:

Absorption- gut slows down

Distribution- muscle mass decreases, increased fat, body water decrease

Metabolism- taste buds decrease

Excretion- glomerular filtration rate slows

Geriatric Pharmacodynamics

-loss of sensitivity in adrenergic receptors

-blunting of compensatory reflexes

-loss of dopaminergic and cholinergic receptors, neurons, and neural connections in brain

-reduced blood flow to brain

Beers Criteria

A list of medications that are generally considered inappropriate when given to elderly people

Polypharmacy refers to

Taking many different medications from various pharmacies. More than 5 medications and include OTC meds.

How do we assess kidney function?

monitor BUN and creatinine

Where are medications excreted?

kidneys

Where is medication metabolized?

Liver

How do we assess liver function?

AST/ALT tests (aspartate aminotransferase) (alanine aminotransferase)

What are adverse drug events?

adverse drug reactions, medication errors, therapeutic failures, adverse drug withdrawal events, overdoses.

Be careful when older adults are taking NSAIDS because...

NSAIDS (ibuprofen) is a blood thinning agent in which can harm gut and kidney health. Especially combined with another blood thinning drug.

Older populations have higher rates of drug overdoses due to ??

Metabolism slows down overtime, resulting in the older populations body slowly breaking down medications which could result in overdose

Implications of adverse drug events:

Adherence.

- patient may not fully understand how to take a drug

-can cause underdosing/overdosing

-medication education EXTREMELY important

- lack of prescription coverage

We as nurses should educate patients on?

About the medications that they are taking

Non enteric coated medications:

Can cut in half for cheap/ more medication readily available at low cost (what debi said in lecture dont know if we need this info)

Many patients know medications by:

There certain size or shape (some patients are particular with what there meds look like)

What should we assess before teaching a patient?

THAT THEY ARE READY TO LEARN

Preparing a patient to learn by:

having all senses as sharp as possible.

- Glasses on, magnifying glass, hearing aids in, speaking in a ton your patients can hear, facing the patient, limit distractions

Health teaching with older adults:

- using large print

- review drugs at each visit

- advise patient to complete vial of life

- encourage simple dosing schedule

How can we encourage a simple dosing schedule?

AM/PM pillbox, setting alarms

Clinical judgement: Concepts of Older Adults

proper communications, safety

Clinical judgement: Recognize cues

assess for sensory and cognitive barriers

assess lab results

discern if patient lives alone or needs assistance with medications

Clinical judgement: Analyze cues and prioritize hypothesis

Potential for decreased adherence ( they don't know what to do)

Clinical judgement: Generate Solutions (GOALS)

patient will list resources that can be used for more infor/support

Clinical judgement: Take action/interventions

watch patient for adverse reactions, recognize changes in unusual behaviors, increased confusion, and advise patient to request non childproof caps

When administering medications to the older adult population, the nurse is aware that the physiologic changes of aging that can affect drug activity include all of the following except:

A. Increased fat to water ratio

B. decreased liver enzyme production

C. loss of nephrons

D. increased gastrointestinal blood flow

D. increased gastrointestinal blood flow

which of the following does not cause frequent adverse reactions and drug interactions in older adults?

A. Consumption of numerous drugs owing to multiple chronic illnesses

B. Drugs ordered by several health care providers

C. increased incidence of allergic responses

D. self medication with OTC prescriptions

C. Increased incidence of allergic responses

Which of the following terms describes older adults' taking many medications together?

A. Tachyphylaxis

B. Drug interactions'

C. Polypharmacy

D. Tolerance

C. Polypharmacy

Which is a physiologic change seen in the older adult that has an effect on drug administration?

A. lower gastric secretions

B. Increased first pass effect through the liver

C. increased glomerular filtration rate

D. Lower cardiac output

D. Lower cardiac output

When assessing older adults renal function, which laboratory value will the nurse monitor?

A. Liver enzymes

B. Serum electrolytes

C. Complete blood count

D. Blood urea nitrogen and creatinine

D. Blood urea nitrogen and creatinine

What is a "vial of life"?

list of current medications