ch 6: geriatric considerations Flashcards
what does the saying “start low and go slow” used for?
to reduce the chance of toxicity for an older adult
what physiologic changes happen to an older adult?
- decrease of total lean body mass and body water
- decrease function of kidneys
- decrease excretion of drugs
- decreased liver function
what are some adverse effects that an older adult may have?
- hypotension in response to drugs that reduce blood pressure
- electrolyte imbalance in response to diuretics
- excessive bleeding with anticoagulant and anti platelet
- altered glycemic response to anti-diabetic drugs
- GI inflammation in response to non steroidal anti inflammatory drugs
what GI changes determine the ability to absorb drugs?
- decrease in small bowel surface area
- slowed gastric emptying
- reduced gastric blood flow
- 5-10% decrease in gastric acid production
- difficulty swallowing
- poor nutrition
- dependence on feeding tubes
what effects of aging determines that ability of distribution?
- decrease muscle mass
- increase body fat
- reduced elimination
- prolonged period of action
- decrease total body water
- reduced albumin
by what percentage does metabolism decrease by? live size?
- 40%
- 15-30%
can an older adult have a normal liver test but still have impaired liver function?
yes
what are the drug classes that require drug dosage adjustment in chronic kidney disease?
BANDD CAMP
what does BANDD CAMP stand for?
- beta blockers
- ACEs/ARBs
- NSAIDs/opioids
- diuretics
- diabetic medications
- cholesterol medications
- antimicrobials
- miscellaneous
- psychotropics
what is polypharmacy?
the use of more medications than needed
how do you determine dosage for an older adult?
- GFR
- cockroft-gault formula
what are the barriers to effective drug use by older adults?
- taking too many drugs at different times
- failure to understand the purpose or reason for each drug
- impaired memory
- decreased mobility
- visual and hearing disturbances
- high cost of prescriptions
- childproof drug bottles
- side effects or adverse reactions from the drugs
what the gastric blood flow like for an older adult? what does this result in?
- slower
- decreased absorption rate
if an older adult has a question about and oral medication’s metabolism, what is the best thing to teach about?
a. first pass effect
b. enzyme function
c. GFR
d. motility
a. first pass effect
an older adult has just started on hydrochlorothiazide and is advised to eat foods that are high in potassium. what is the nurse’s best recommendation of food to consume?
a. cabbage and corn
b. bread and cheese
c. avocados and mushrooms
d. brown rice and fish
c. avocados and mushrooms
