CH 15: Safe medication use Flashcards
the simultaneous use of multiple drugs to treat a single ailment or condition
polypharmacy
risks and interventions with polypharmacy
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
older adults reactions with pharmacodynamics
have increased myocardial sensitivity to anesthesia and increased CNS receptor sensitivity to narcotics, alcohol, and bromides
risk for adverse reactions is higher due to:
age related differences
early sign of adverse reaction in older adults
mental dysfunction
should not be treated with additional drugs
factors affects drug absorption
Route of admin, concentration and solubility, and diseases and symptoms influence absorption
measure to enhance absorption
heat
massage
factors affecting distribution
Changes in circulation, membrane permeability, body temp., and tissue structure can affect
side effects of distribution
decreased cardiac output leading to raises in plasma level of drugs
reduced serum albumin leading to unbound drug concentrations limiting drug effectiveness
factors affecting metabolism
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
factors affecting excretion
Decreased renal function decreased drug excretion toxicity
Extended drug half-life can increase risk of toxicity
what is the BEERs list
ex:
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
nursing considerations for BEERs list drugs
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
promotion of the safe use of drugs
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?
what to teach the client about safe drug use
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
important factors for safe oral med admin
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
consideration for safe suppository med admin
Decreased circulation to lower bowel and vagina & decreased body temp. prolonged melting of suppository
considerations fro safe injection med admin
May bleed more
Do not inject into an immobile limb (affects absorption)
Cautious of IVF to prevent overload and complications
alternatives to drug admin
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
special considerations for older adult clients
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
older adult considerations for antacids
Chronic use requires further evaluation
Can cause fluid and electrolyte abnormalities
Use drugs only when needed
nursing considerations for antacids
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
older adult consideration for antibiotics
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
nursing considerations for antibiotics
Ensure cultures are obtained first
Administer on a routine schedule
Observe for s/s of superinfection
Be alert to interactions
older adult consideration for anticoagulants
Higher risk of bleeding with older adults
Used for prevention
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
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
older adult consideration for anticonvulsants
Higher risk of toxicity
Carbamazepine, lamotrigine, valproate, and gabapentin safe to use
Can be used to treat other disorders
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
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
older adult considerations for antihypertensive drugs
Be cautious with
Beta blockers
ACE inhibitors
Diuretics
Calcium channel blockers
Alpha blockers
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
older adults considerations for NSAIDs
Only COX-2 inhibitor is celecoxib
Only use when necessary
Avoid sulfa
nursing considerations for NSAIDs
Narrowed therapeutic window higher risk of toxicity
Blood work
Give with food or milk
Be alert to interactions
older adult considerations for cholesterol lowering drugs
be mindful of liver, muscles, kidneys
nursing considerations for cholesterol lowering drugs
Dietary and lifestyle modifications
LFTs and other labs
Monitor for interactions
older adult considerations for cognitive enhancing drugs
slow cognitive decline with mild dementia
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
older adult considerations for digoxin
Older adults should not exceed 0.125 mg
Use in caution with renal impairment
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
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
nursing considerations for laxatives
Assist in prevention
Assess for underlying reason for constipation
Be aware of side effects and interactions
Good fluid intake
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
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
older adult considerations for antidepressants
SSRIs are well tolerated for older adults
TCAs produced more side effects for older adults
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
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
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
older adult considerations for sedatives/hypnotics
Do not give chloral hydrate, diphenhydramine, flurazepam, hydroxyzine, quazepam, and triazolam to older adults
nursing considerations for sedatives/hypnotics
Evaluate contributing factors of insomnia
Nonpharm measures first
High risk for falls
Be alert for interactions
