Ch 8 Flashcards
Pharmacokinetics
how the drug is absorbed,
distributed, metabolized and excreted
Pharacodynamics
how the body is affected by the drug at the
cellular level and in relation to the target organ).
Absorbtion
refers to the passage of a medication from its site of introduction,
usually the gastrointestinal tract, into the general circulation.
Absorption of oral meds can be affected by
can be affected by
diminished gastric acid, increased gastric pH, delayed gastric
emptying and the presence of other substances (e.g., food,
nutrients, medication additives).
Elimination/serum half-life
is the time required to decrease the drug concentration by one half
of its original value.
It takes ______ half times to reach steadystate
concentrations after a drug is initiated or to completely
eliminate a drug from the body after a drug is discontinued.
5
The clearance rate
measures the volume of blood from
which the drug is eliminated per unit of time
Can herbs be taken along with medications without worry of any potential intereaction
No
How could oldr adult bod ycomposition affect the effects of medications?
decreased
body water and lean tissue and increased body fat)
can affect substances according to their degree of fat or water
solubility. Consequently, medications that are distributed
primarily in body water or lean body mass may reach higher
serum concentrations in older adults and their effects may be
more intense. Similarly, the serum concentration of highly
fat-soluble substances can increase, so the immediate therapeutic
effects are diminished, but the overall effects are prolonged
or erratic.
Polypharamacy
typically
refers to the use of more medications than are clinically indicated.
(Many drugs)
Not about the number, about the appropriateness & combination of meds
Medication nonadherence
refers to medication-taking patterns
that differ from the prescribed pattern, including missed
doses, failure to fill prescriptions, or medications taken too
frequently or at inappropriate times.
prescribing cascade
an adverse drug reaction
is misinterpreted as a new medical condition, a drug is
prescribed for this condition, another adverse drug effect occurs,
the patient is again treated for the perceived additional
medical condition, and the sequence perpetuates new adverse
events.
Ac
before meal
Pc
After meal
Hs
At bedtime
Qd
Every day
PO
Per oral
Absorption medication affect by
Reduced gastric acid, increased gastric pH, delayed gastric emptying, and the presence of other substances
Age-related physiological changes that affect the action of medications in older adults
Decline in renal function (eGFR) - older adults have slower GFR
Hepatic blood flow declines
Decreases muscle mass and water content
Low serum albumin (protein)
Altered receptor sensitivity
What affects medication-taking behaviour
Motivation
Knowledge abt med
Cultural and psychosocial influences
Physical ability to remove the substance from the container and administer it
Ability to swallow oral preparations
Additional skills related to administering nasally, transdermally, SC and other routes
Considerations of polypharmacy
All meds have side-effects
Older adults are more likely to experience stronger side-effects
Always consider wether the benefit outweighs the risk
Side-effects and medication
Every med has side-effects, they are just not necessarily common
Narcotics do what
Slow respiratory rate
Functional consequences associated with medications in older adults
Disease or polypharmacy may alter the
therapeutic effects of a medication
Adverse effects
Anticholinergic Adverse Effects
Altered mental status
Antipsychotics in people with dementia
Tardive Dyskinesia and Drug-Induced
Parkinsonism
Factors that increase older adults risk for adverse events
Higher number of medications
* Malnourishment or dehydration
* Multiple comorbidities
* An illness that interferes with cardiac, renal or
hepatic function
* Cognitive impairment
* History of medication allergies or adverse effects
* Fever that can alter the action of certain
medications
* Recent change in health
* Certain medications: anticoagulants/
antiplatelets, antidiabetics, NSAIDs, CNS drugs
Antipsychotics should not be given to
Dementia
Anticholinergics
Drugs blocking action of AcH, inhibiting the parasympathetic NS
Higher specificity to older adults (Often not reccomended if better option available)
Morbidity
Illness
cardiac, renal or
hepatic function in
Main metabolizing organs
Exzmples of anticholinergics
OTC cough, cold flu and sleep problems
Treatment for older adults (antihistamines, antidepressants antipsychotics CV agents, antiparkinsonians)
Safer alternatives usually exist and should be advocated for
Anti-psychotics
Increasingly used in LTC facilites
US restricted by FDA to prescribe ONLY for psychotic symptoms
Tardive dyskenisia
- Rhythmic involuntary movements of the trunk, extremities, jaw, lips, mouth or
tongue.
Can begin 3-6 months after initiation of antipsychotic use and persist after medication is discontinued
Drug induced parkinsonism
Parkinson-like symptoms such as shaking,
involuntary or poorly controlled movement.
* Condition can be easily misdiagnosed as
Parkinsonism and patients are started on
new medications
BEERS
A list of medications known to increase
the risk of delirium and other adverse
reactions in older adult
should not be
prescribed for older adults unless there is
a greater benefit
-risk ratio for a particular
situation, and then should only be used
for the shortest possible duration.
When are meds safest and most therapeutic
Prescribed and regularly reviewed
Goals of assment
Determine effectiveness of existing
regimen
Identify any factors that interfere with the
current regimen
Notice risk for adverse effects
Detect adverse medication effects
Identify teaching needs regarding medications
Scope of Medication
Assessment
Prescription and OTC medications (all routes)
taken regularly
Medications taken “as needed” or PRN
Vitamins, minerals, and dietary supplements
Herb and Folk remedies and complementary/
alternative modalities
Alcohol, substances
Smoking/inhaling
Medication reconciliation
Identifying medications at any transition in
care
View all the medications
Address ability to get prescriptions filled
Address issues that affect adherence
Allow the client to ask questions
Nursing intervention
Recommend all odler adulrs have a list of what the are currently taking
Snesure clients and caregivers understand the appropriate use of “as needed” (PRNP meds)
Encourage use of decices and systems to improve medication adherances
What info should we know when gathering med history from patient
Current medications (including herbal, OTCs, and PRNS)
Dose/freq
Why?
Working?
Side effects/concerns
Qs pertinent to med administration
Age, weight, BMI
All medical diagnoses
Prevailing symptoms and reason for hospitalization/care, ongoing lab draws
Known drug allergies? (describe)
Previous drug reactions? (describe)
Any difficulty swallowing pills? Other concerns?
Smoker?
Provider managing medications _
What must be know ABOUT the medication before adminsitering
What drug is ordered?
Drug name (generic and trade) and classification
Intended or proposed use
Effects on the body
Contraindications
Special considerations
Side effects
Why the medication has been prescribed
How the med is to be administered including dosage ranges
10 Rights
Drug
Client
Dose
Route
Time of delivery and frequency
Documentation
History and assessment
Drug approach and right to refuse
Drug- drug interaction and evaluation
Right education and information
3 checks of drug admin occur
When preparing it
When removing the drug
Immediately before administering
What is the first check of the med
Comparing the physians order to the MAR
ac
Before meal
pc
After meal
gtt
Drop
Hs
At bedtime
Standing order
To be completed on a regular basis
Nursing actions when preparing to administer drug
Wash hands, assemble supplies
Calculate dose (safe range?)
Brief patient assessment
- Administer drug accurately
10 rights, 3 checks
aseptic or sterile techniques
talk to patient
Enteric coating
Coating diesinged to hold the tablet together when it is in the stomach and break down in none acidic conditions in the intestines
SR vs IR
Sustained/timed release vs immediate release
SR means a drug can be taken less frequently and is administered slower and steadier
Why would a drug be enteric coated
Protect stomach from drug
Protect drug from the stomach
Relase drug after the stomach
First pass effect
a phenomenon in which a drug gets metabolized at a specific location in the body that results in a reduced concentration of the active drug upon reaching its site of action or the systemic circulation.
Disadvtages of oral route
First pass effect
Slower release
Pt must be able to swallow
Reccomendations ofr adinstering meds by NG
Use liquids where possible
Tablets to be crushed or dissolved
Topical drugs include
Drugs applied to the skin
Drugs applied into body cavities
Inhaled drugs
Topical meds side affects?
Low side effects because amounts reaching general circulation are minimal
Parental route
Needle into the skin layers sc tissue, muscles or veins
SC
IM
IV
`
Preventing med errors
Neveruse trailing 0s (2.0)
Always use leading )s (0.25)
What should patients know about medication usage
What it’s for
If it interacts with anything else
How to monitor oneself
How are drugs categorized
Based on their target body tissue use and/or their action
Significant info to know about a drug
Indication ( What it’s for)
Most COMMON side effect + any lethal side effect
Mot important nursing implications (administration or monitoring need-to-do)
Most needed patient education
If an older adult is having any unusual sign of confusion or diorientation, where should our first culprit be
Adverse drug affect
Important fact about older adults recieveing medications
Older adults face an increased risk of adverse medication effects.
What age related change relates to slower drug clearance
Reducae heaptic blood flow
Does diet affect an older adults ability to receive medication
Not usually
What are medication on the BEERS criterea for?
catalogues medications that cause side effects in older adults due to the
physiologic changes of agin
