Geriatric Considerations Study Notes

Reduction in Total Body Water and Lean Body Mass
- This change can influence drug distribution and hydration status, important for drug dosing.
Reduction in Kidney Mass and Function
- Impacts the excretion phase of pharmacokinetics, increasing the risk of drug accumulation and toxicity.
Reduction in Liver Mass and Blood Flow
- Affects drug metabolism. Reduced hepatic function can lead to prolonged drug effects and increased side effects.
Volume Depletion & Electrolyte Imbalance with Diuretics
- Increased vulnerability to dehydration and electrolyte disorders, necessitating careful monitoring for patients on diuretics.
Postural Hypotension with Antihypertensives
- Increased risk of falls and associated injuries. Caution required while adjusting antihypertensive medications.
Excess Bleeding with Anticoagulants or Antiplatelets
- Heightened sensitivity to bleeding; frequent monitoring and patient education on signs of bleeding are necessary.
GI Irritation with NSAIDs
- Increased risk of gastrointestinal side effects; alternative pain management strategies should be explored.

Absorption
- Slowing of the GI tract can affect the rate and extent of drug absorption.
Distribution
- Decreased available protein (such as albumin) may lead to altered drug distribution, impacting drug binding and bioavailability.
Metabolism
- Decreased liver function results in diminished drug metabolism, potentially leading to increased plasma levels of medications.
Excretion
- Decreased kidney function complicates the excretion phase, necessitating renal dosing adjustments for many medications.

Age-related Changes
- General loss of sensitivity in adrenergic receptors leading to reduced cardiovascular reflexes.
- Blunting of compensatory reflexes affects the body's ability to respond to changes; e.g., postural hypotension.
- Loss of dopaminergic and cholinergic neurons in the brain can lead to cognitive deficits and decreased response to certain medications.
- Reduced blood flow to the brain further complicates responsiveness and drug efficacy.

Risk Factors
- Multiple chronic illnesses and prescriptions from various providers increase the risk.
Management Strategies
- Utilize the Beers Criteria to identify potentially inappropriate drug use.
- Implement renal dosing adjustments based on kidney function assessments.
- Monitor for drug-drug interactions carefully.
- Provide safety information to patients and caregivers.

Types of Adverse Events
- Adverse reactions from medications often lead to complications.
- Medication errors can occur frequently due to complex regimens.
- Therapeutic failures must be evaluated to adjust treatment plans accordingly.
- Adverse drug withdrawal events can occur when medications are suddenly discontinued.
- Overdoses may occur without proper education on medication management.

Challenges
- Patients may not fully understand their drug regimen, leading to nonadherence.
- Nonadherence can result in either underdosing or overdosing, negatively impacting health outcomes.
- Comprehensive medication education is crucial to ensure adherence.
- Lack of prescription drug coverage can hinder access to necessary medications.

Strategies for Effective Communication
- Ensure patients’ senses are as sharp as possible (e.g., clean eyeglasses, functional hearing aids).
- Speak in tones that the client can hear, facing the client to facilitate better communication.
- Limit distractions during discussions to enhance focus.
- Treat the client with respect and maintain a positive expectation of their capacity to learn.
- Use large print and bright colors in teaching aids to improve visibility and understanding.
Medication Management Guidance
- Review all medications during each visit to ensure understanding and compliance.
- Advise clients to complete a “vial of life” with vital medical information to keep visible for emergencies.
- Encourage clients to bring a list of all medications to appointments for thorough review.
- Promote the use of a simplified dosing schedule to enhance medication adherence.
- Dosing times can be adjusted to suit the patient's routine, using tools like medication logs or pill boxes to assist with management.
Monitoring New Medications
- With any onset of confusion or disorientation, it is vital to suspect newly prescribed medications as potential causes.
- Clients should be encouraged to report any lack of improvement from medications prescribed for specific conditions.

Physiologic Changes and Drug Activity
- Which of the following does not affect drug activity?
  A. Increased fat-to-water ratio.
  B. Decreased liver enzyme production.
  C. Loss of nephrons.
  D. Increased gastrointestinal blood flow.
Adverse Reactions and Drug Interactions
- Which of the following does not frequently cause adverse reactions?
  A. Numerous drugs due to multiple chronic illnesses.
  B. Orders from several health care providers.
  C. Increased incidence of allergic responses.
  D. Self-medication with OTC preparations.
Risk of Numerous Medications
- What is known as taking many medications together?
  A. Tachyphylaxis.
  B. Drug interaction.
  C. Polypharmacy.
  D. Tolerance.
Physiologic Changes Effecting Drug Administration
- Which change affects drug administration?
  A. Lower (acidic) gastric secretions.
  B. Increased first-pass effect through the liver.
  C. Increased glomerular filtration rate.
  D. Lower cardiac output.
Renal Function Assessment
- Which lab values should be monitored?
  A. Liver enzymes.
  B. Serum electrolytes.
  C. Complete blood count.
  D. Blood urea nitrogen and creatinine.