4. Medication

Question 1

Age-related changes

that affect the action of medications

Answer 1

• decline in renal function (eGFR) to metabolize drugs
• hepatic blood flow declines
• decreased muscle mass and water content. -impacts substance distribution
• low serum albumin (protein)= decrease likelihood of protein binding = meds compete for binding sites = effects
• altered receptor sensitivity=some drugs can be too weak or too strong

Question 2

Risk Factors

that affect med taking behaviour

Answer 2

Culture

Motivation

Physical inability (to swallow, remove caps, inject)

Lack of knowledge about purpose, directions, correct amount, timing…

Visual acuity and coordination

Question 3

Polypharmacy

Answer 3

• the 6th drug will either make you better or 25% chance of making you worse
• more meds than clinically indicated
• not about the number of meds
• all meds have side effects
• older adults experience stronger effects
• always weigh risks vs benefits

Question 4

Functional consequences

Answer 4

• polypharmacy may alter therapeutic effects
• adverse effects
• anticholinergic adverse effects
• altered mental status
• antipsychotics in dementia pts cause dyskinesia and drug-induced Parkinson’s

Question 5

Risk factors for adverse effects

Answer 5

• higher number of meds
• malnourishment or dehydration
• multiple comorbidities
• an illness that interferes with cardiac, renal, or hepatic function
• cog. impairment
• hx of med allergies or adverse effects
• recent change in health
• high risk drugs: anticoagulants, antiplatelets, antidiabetic, NSAIDs, CNS drugs

Question 6

Anti-Cholinergic effects

Answer 6

• are drugs that block the action of acetylcholine
• acetylcholine is a neurotransmitter that transfers signals. between certain cells to affect how your body functions
• can contribute to cog impairment
• safer alternatives exist so try to advocate for those

Question 7

Anti-psychotic

Answer 7

• they disrupt reality to treat hallucinations and to control disruptive behaviours
• can cause increased risk of falling and orthostatic hypotension

Question 8

Tardive Dyskinesia

Answer 8

• rhythmic involuntary movements of the trunk, limbs, jaw, lips, mouth, or tongue
• worm-like tongue movements
• side to side jaw, lip-smacking, blinking
• can begin 3-6 months after starting antipsychotic meds and. persist even after med is discontinued

Question 9

Drug-induced Parkinsonism

Answer 9

• parkinson-like symptoms such as shaking, involuntary movement
• usually misdiagnosed as Parkinson’s and pt is stated on a different med
• manifestations can be reversed if discontinued

Question 10

Assessment goals

Answer 10

• determine effectiveness of existing regimen
• identify factors that interfere with the regimen
• lookup risks for adverse effects or altered therapeutic actions
• detect adverse effects
• identify teaching needs

Question 11

What meds are nurses allowed to assess?

Answer 11

• OTC
• prescription, all routes, taken regularly
• PRN
• vit, min, sup
• herbal remedies
• alcohol, substances
• smoking, inhaling

Question 12

Intervention

Answer 12

1. Medication reconciliation
   - identify meds at any transition in care
   - view all meds
   - address ability to get prescriptions filled
   - address issues that affect adherence
   - allow questions

this ensures accurate med info to minimize med error during transitions

and identifies potential meds to be changed or discontinued

2. BEERS
   - a list of meds known to increase the risk of delirium and other adverse effects in older adults
   - should not be given to older adults unless the benefits outweigh the risks THEN should be used for shortest possible duration

other:

• recommend pts to keep a list of what meds they are currently on
• ensure pts understand PRN
• encourage pillboxes
• encourage non-pharm interventions to manage behaviour
• decrease the number of meds
• financial barrier: generic vs brand