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CH 15: Safe medication use Flashcards

1
Q

the simultaneous use of multiple drugs to treat a single ailment or condition

A

polypharmacy

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2
Q

risks and interventions with polypharmacy

A

Occurs in more than 1/3 of older adults
Due to high prevalence of health conditions to use a large number and variety of meds
Median seven meds per client
Monitor for s/s of interactions

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3
Q

older adults reactions with pharmacodynamics

A

have increased myocardial sensitivity to anesthesia and increased CNS receptor sensitivity to narcotics, alcohol, and bromides

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4
Q

risk for adverse reactions is higher due to:

A

age related differences

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5
Q

early sign of adverse reaction in older adults

A

mental dysfunction
should not be treated with additional drugs

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6
Q

factors affects drug absorption

A

Route of admin, concentration and solubility, and diseases and symptoms influence absorption

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7
Q

measure to enhance absorption

A

heat
massage

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8
Q

factors affecting distribution

A

Changes in circulation, membrane permeability, body temp., and tissue structure can affect

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9
Q

side effects of distribution

A

decreased cardiac output leading to raises in plasma level of drugs
reduced serum albumin leading to unbound drug concentrations limiting drug effectiveness

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10
Q

factors affecting metabolism

A

Dehydration, hyperthermia, immobility, liver disease influences
Reduced secretion of enzymes for metabolism  decreased metabolism rate
Detoxification and conjugation of drugs is reduced  stays in blood stream longer
Decreased liver size and decreased hepatic blood flow  altered metabolism of antibiotics, cimetidine, chlordiazepoxide, digoxin, lithium, meperidine, nortriptyline, and quinidine

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11
Q

factors affecting excretion

A

Decreased renal function  decreased drug excretion  toxicity
Extended drug half-life can increase risk of toxicity

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12
Q

what is the BEERs list
ex:

A

List of unsafe drugs for older adults
Drugs inappropriate for use in general and presence of specific conditions
Used to reduce adverse effects and drug costs
Ex. Anticholinergics, TCAs, antipsychotics, barbiturates, benzos

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13
Q

nursing considerations for BEERs list drugs

A

Monitor lab values
Be aware of functional, cognitive, educational, sensory, and financial limitations with medication administration
Identify and eliminate risk factors for medication errors
Patient teaching

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14
Q

promotion of the safe use of drugs

A

Review necessity and effectiveness of the drug
Review renal and liver function prior to
Ask…
Why is the drug ordered?
Is the smallest possible dosage ordered?
Is the patient allergic to the drug?
Can this drug interact with other drugs, herbs, or nutritional supplements that are being used?
Are there any special instructions accompanying the drug’s administration?
Is the most effective route of administration being used?

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15
Q

what to teach the client about safe drug use

A

Keep a current list of all the meds, herbs, OTCs, supplements, nonprescription meds
Know the dosage, time, instructions, purpose, side effects, adverse effects, precautions, storage of drug
Recognize their drug dosage is different then others on the same drug
Can develop adverse effects after years of taking med
Reduce the meds you are using
Review drugs and its effectiveness
Try to manage symptoms without drugs
Do not take new drugs with provider knowledge

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16
Q

important factors for safe oral med admin

A

Most common
Dry mucous membranes can prevent swallowing
Proper oral hygiene, ample fluids, proper positioning, and examining the oral cavity after admin
Look for an alternative form if capsules/enteric coated meds can’t be tolerated
Combine meds with applesauce or juice

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17
Q

consideration for safe suppository med admin

A

Decreased circulation to lower bowel and vagina & decreased body temp.  prolonged melting of suppository

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18
Q

considerations fro safe injection med admin

A

May bleed more
Do not inject into an immobile limb (affects absorption)
Cautious of IVF to prevent overload and complications

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19
Q

alternatives to drug admin

A

Lifestyle changes
**Can be used before initiating drug therapy
Diet
Exercise
Stress management
Regular sleep patterns and rest
Proper elimination habits
Use of alternative and complementary therapies

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20
Q

special considerations for older adult clients

A

decreased tolerance to meds
decreased IV rate to avoid fluid overload
increased risk for:
-respiratory depression
-pneumonia
-disorientation
-skin breakdown
-problems with circulation, nutrition, constipation, fluid and electrolyte balance
decreased balance
increased falls
sudden increased confusion

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21
Q

older adult considerations for antacids

A

Chronic use requires further evaluation
Can cause fluid and electrolyte abnormalities
Use drugs only when needed

22
Q

nursing considerations for antacids

A

Ask specifically about the use of antacids
Evaluate underlying cause
Avoid administering other meds within 2 hours
Monitor bowel elimination
If on sodium restriction, avoid sodium bicarb
Be alert to interactions

23
Q

older adult consideration for antibiotics

A

Adverse reactions occur more frequently
Use selectively and cautiously to prevent resistance and adverse reactions
Fluoroquinolones increase hypo/hyperglycemic effects and prolonged QT intervals
Excessive use of ABX cause antibiotic-resistant bacteria

24
Q

nursing considerations for antibiotics

A

Ensure cultures are obtained first
Administer on a routine schedule
Observe for s/s of superinfection
Be alert to interactions

25
older adult consideration for anticoagulants
Higher risk of bleeding with older adults Used for prevention
26
nursing considerations for anticoagulants
Ensure PT/INR Age-adjusted dosages as indicated Administer at the same time each day Observe s/s of bleeding Be careful of Vit K intake Refrain from herbs Keep Vit K readily available in healthcare setting Avoid using aspirin concurrently Be aware of interactions
27
nursing considerations for anticonvulsants
Monitor side effects Adequate physical activity Lab monitoring Can worsen liver and kidney disease Should not be discontinued abruptly Avoid grapefruit products May cause photosensitivity Avoid with glaucoma, CAD, and prostate disease Be aware of interactions
28
older adult consideration for anticonvulsants
Higher risk of toxicity Carbamazepine, lamotrigine, valproate, and gabapentin safe to use Can be used to treat other disorders
29
older adult considerations for antidiabetic
Self-injection can be a challenge with arthritic hands, poor vision, and cognitive impairment Do not use chlorpropamide and glyburide  increased risk of hypoglycemia Hypoglycemia is more problematic than ketosis Classic s/s of hypoglycemia might not be present
30
nursing considerations for antidiabetics
Proper use and storage of meds Education on hypo/hyperglycemia Wear or carry identification Examine injection sites Report conditions that alter antidiabetic drugs Avoid drinking alcohol Be alert to interactions
31
older adult considerations for antihypertensive drugs
Be cautious with Beta blockers ACE inhibitors Diuretics Calcium channel blockers Alpha blockers
32
nursing considerations for antihypertensives drugs
Assess blood pressure carefully Nonpharm measures to reduce BP Change positions slowly Administer drugs at bedtime Labs Adhere to treatment Do not abruptly discontinue Be aware of interactions and side effects
33
older adults considerations for NSAIDs
Only COX-2 inhibitor is celecoxib Only use when necessary Avoid sulfa
34
nursing considerations for NSAIDs
Narrowed therapeutic window  higher risk of toxicity Blood work Give with food or milk Be alert to interactions
35
older adult considerations for cholesterol lowering drugs
be mindful of liver, muscles, kidneys
36
nursing considerations for cholesterol lowering drugs
Dietary and lifestyle modifications LFTs and other labs Monitor for interactions
37
older adult considerations for cognitive enhancing drugs
slow cognitive decline with mild dementia
38
nursing considerations for cognitive enhancing drugs
Evaluate mental status, cognition, and ADLs before starting therapy Assess cardiac function with cholinesterase inhibitors Avoid abrupt discontinuation Be alert to interactions
39
older adult considerations for digoxin
Older adults should not exceed 0.125 mg Use in caution with renal impairment
40
nursing considerations for digoxin
Instruct client to check pulse for rate, rhythm, and regularity before admin Extended half-life for dig  increased toxicity Avoid hypokalemia Older adults can have s/s of toxicity with normal labs Be alert to interactions and s/s of toxicity
41
nursing considerations for diuretics
High risk for F&E imbalances Morning admin Monitor I&O with adequate fluid intake Recognize and report s/s of F&E Prevent falls with postural hypotension Monitor hearing for loop Can worsen liver disease, renal disease, gout, and pancreatitis and raise blood glucose Lab monitoring Be alert to interactions
42
nursing considerations for laxatives
Assist in prevention Assess for underlying reason for constipation Be aware of side effects and interactions Good fluid intake
43
older adult considerations for antianxiety drugs
On Beers list of do not use Only used for well documented, persistent anxiety not due to preventable reasons; creates such distress or dysfunction that is makes the person a risk to themselves or others Benzos are commonly used Older adults experience more side effects
44
nursing considerations for antianxiety drugs
Nonpharm measures first Change positions slowly Monitor bowel elimination Caution in grapefruit consumption Several days of administration will reveal effects Avoid alcohol Be alert to interactions
45
older adult considerations for antidepressants
SSRIs are well tolerated for older adults TCAs produced more side effects for older adults
46
nursing considerations for antidepressants
Assess factors contributing to depression Use of other therapies with meds Use lowest effective dose Several weeks of therapy for effectiveness Monitor plasma level of drug Increased risk of falls due to side effects (prevention) Discontinue gradually Observe for worsening depression or suicidal thoughts Be alert to interactions
47
older adult considerations for antipsychotics
Atypicals cause postural hypotension, sedation, and falls Treatment with atypicals  increased cerebrovascular adverse events and mortality Nonpharm measures before meds
48
nursing considerations for antipsychotics
Physical and mental health evaluation Use other interventions to address symptoms Drugs have longer half-life in older adults; use low dosage Older adults are more sensitive to anticholinergic effects & EPS symptoms High fall risk (prevention) Gradual weaning Responses to drug may vary Be alert to interactions
49
older adult considerations for sedatives/hypnotics
Do not give chloral hydrate, diphenhydramine, flurazepam, hydroxyzine, quazepam, and triazolam to older adults
50
nursing considerations for sedatives/hypnotics
Evaluate contributing factors of insomnia Nonpharm measures first High risk for falls Be alert for interactions
51

Gero Exam 1 (9 decks)

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