Chapter 6 Geriatric Considerations Flashcards
Drug dosage for older adult depends on
Weight, laboratory results (liver enzymes and glomerular filtration), and combined health problems.
Start low and go slow
Reduction in total body water and lean mass
Increasing fat and alters the voilume of distribution of drugs
Reduction in kidney mass and lower kidney blood flow
Leading to reduced glomerular filtration rate and reduced clearance of drugs excreeed by the kidney
Reduction in liver size and blood flow
Reduced hepatic clearance of drugs
Decline of equilibrium causes higher incidences with
Postural hypotension in response to blood pressure meds
Volume depleteion and electrolyte imbalance
Excessive bleeding with anticoagulants
Altered glycemic response to antidiabetic drugs
GI irritation with NSAIDs
Absorption
Decrease in small bowel surface, slowed gastric emptying, reduced blood flow, and 5% to 10% decrease in gastric acid production.
Distribution
Decline in muscle mass and increase in fat. Lipid soluble drugs have a greater volume of distribution, increased storage, reduced elimination, and a prolonged period of action.
Metabolism
Hepatic portal flow is decreased, decrease in liver size and reduction in P450 enzymes. Prolong drug half life and increased drug levels
Excretion
Decreased renal size and volume
Determine creatinine clearance
Drug classes that require adjustment with kidney disease
Beta blockers, ACEIS’s, NSAIDs, opioids Diuretics Diabetic medications Cholesterol medication Miscellaneous Psychotropics
BANDD CAMP
Poly pharmacy
Use of more medications than is medically necessary
Barriers to affective drug use by older adults
Taking too many drugs at different times Failure to understand the purpose Impaired memory Decreased mobility and dexterity Visual and hearing impairment High cost Childproof drug bottles Side effects or adverse reaction
