CH 15: Safe medication use

Question 1

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

Answer 1

polypharmacy

Question 2

risks and interventions with polypharmacy

Answer 2

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

Question 3

older adults reactions with pharmacodynamics

Answer 3

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

Question 4

risk for adverse reactions is higher due to:

Answer 4

age related differences

Question 5

early sign of adverse reaction in older adults

Answer 5

mental dysfunction
should not be treated with additional drugs

Question 6

factors affects drug absorption

Answer 6

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

Question 7

measure to enhance absorption

Answer 7

heat
massage

Question 8

factors affecting distribution

Answer 8

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

Question 9

side effects of distribution

Answer 9

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

Question 10

factors affecting metabolism

Answer 10

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

Question 11

factors affecting excretion

Answer 11

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

Question 12

what is the BEERs list
ex:

Answer 12

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

Question 13

nursing considerations for BEERs list drugs

Answer 13

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

Question 14

promotion of the safe use of drugs

Answer 14

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?

Question 15

what to teach the client about safe drug use

Answer 15

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

Question 16

important factors for safe oral med admin

Answer 16

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

Question 17

consideration for safe suppository med admin

Answer 17

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

Question 18

considerations fro safe injection med admin

Answer 18

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

Question 19

alternatives to drug admin

Answer 19

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

Question 20

special considerations for older adult clients

Answer 20

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

Question 21

older adult considerations for antacids

Answer 21

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

Question 22

nursing considerations for antacids

Answer 22

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

Question 23

older adult consideration for antibiotics

Answer 23

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

Question 24

nursing considerations for antibiotics

Answer 24

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

Question 25

older adult consideration for anticoagulants

Answer 25

Higher risk of bleeding with older adults
Used for prevention

Question 26

nursing considerations for anticoagulants

Answer 26

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

Question 27

nursing considerations for anticonvulsants

Answer 27

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

Question 28

older adult consideration for anticonvulsants

Answer 28

Higher risk of toxicity
Carbamazepine, lamotrigine, valproate, and gabapentin safe to use
Can be used to treat other disorders

Question 29

older adult considerations for antidiabetic

Answer 29

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

Question 30

nursing considerations for antidiabetics

Answer 30

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

Question 31

older adult considerations for antihypertensive drugs

Answer 31

Be cautious with
Beta blockers
ACE inhibitors
Diuretics
Calcium channel blockers
Alpha blockers

Question 32

nursing considerations for antihypertensives drugs

Answer 32

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

Question 33

older adults considerations for NSAIDs

Answer 33

Only COX-2 inhibitor is celecoxib
Only use when necessary
Avoid sulfa

Question 34

nursing considerations for NSAIDs

Answer 34

Narrowed therapeutic window  higher risk of toxicity
Blood work
Give with food or milk
Be alert to interactions

Question 35

older adult considerations for cholesterol lowering drugs

Answer 35

be mindful of liver, muscles, kidneys

Question 36

nursing considerations for cholesterol lowering drugs

Answer 36

Dietary and lifestyle modifications
LFTs and other labs
Monitor for interactions

Question 37

older adult considerations for cognitive enhancing drugs

Answer 37

slow cognitive decline with mild dementia

Question 38

nursing considerations for cognitive enhancing drugs

Answer 38

Evaluate mental status, cognition, and ADLs before starting therapy
Assess cardiac function with cholinesterase inhibitors
Avoid abrupt discontinuation
Be alert to interactions

Question 39

older adult considerations for digoxin

Answer 39

Older adults should not exceed 0.125 mg
Use in caution with renal impairment

Question 40

nursing considerations for digoxin

Answer 40

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

Question 41

nursing considerations for diuretics

Answer 41

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

Question 42

nursing considerations for laxatives

Answer 42

Assist in prevention
Assess for underlying reason for constipation
Be aware of side effects and interactions
Good fluid intake

Question 43

older adult considerations for antianxiety drugs

Answer 43

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

Question 44

nursing considerations for antianxiety drugs

Answer 44

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

Question 45

older adult considerations for antidepressants

Answer 45

SSRIs are well tolerated for older adults
TCAs produced more side effects for older adults

Question 46

nursing considerations for antidepressants

Answer 46

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

Question 47

older adult considerations for antipsychotics

Answer 47

Atypicals cause postural hypotension, sedation, and falls
Treatment with atypicals  increased cerebrovascular adverse events and mortality
Nonpharm measures before meds

Question 48

nursing considerations for antipsychotics

Answer 48

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

Question 49

older adult considerations for sedatives/hypnotics

Answer 49

Do not give chloral hydrate, diphenhydramine, flurazepam, hydroxyzine, quazepam, and triazolam to older adults

Question 50

nursing considerations for sedatives/hypnotics

Answer 50

Evaluate contributing factors of insomnia
Nonpharm measures first
High risk for falls
Be alert for interactions