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Pharmacotherapeutics for the Advanced Practice Nurse > Drug Therapy in Geriatric Patients > Flashcards

Drug Therapy in Geriatric Patients Flashcards

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1
Q

Older patients are _____ to drugs and they show ___ individual variation

A

more sensitive

wider

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2
Q

Older adults experience more ADRs and

A

drug-drug interaction

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3
Q

Principal factors underlying ADRs and drug-drug interaction in older adults:

A
  • altered pharmacokinetics secondary to organ system degeneration
  • multiple and severe illness
  • multi drug therapy
  • poor adherence
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4
Q

For incurable chronic illness, the objective is to

A

reduce symptoms and quality of life

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5
Q

Decline in absorption, distribution, metabolism, and excretion of drugs ______ drug sensitivity

A

increases

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6
Q

The _____ of absorption may be slowed (delayed gastric emptying and reduced splanchnic blood flow) and drug responses may be _____

A

rate

delayed

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7
Q

Gastric acidity is ____ in older adults and my alter the absorption of certain drugs

A

reduced

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8
Q

Some drugs require high acidity to dissolve, and their absorption may be ____

A

reduced

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9
Q

Factors that alter drug distribution in older adults:

A
  • increased percentage of body fat
  • decreased percentage of lean body mass
  • decreased total body water
  • reduced concentration of serum albumin
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10
Q

Increase in body fat provides storage depot for ______

A

lipid soluble drugs like propranolol which reduces plasma levels and response

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11
Q

Due to decline in lean body mass and total body water, ______ become distributed in smaller volume than younger adults. The concentration is increased and causing more intense effects.

A

water soluble drugs (ethanol)

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12
Q

_____ levels can be significantly reduced in older adults who are malnourished

A

albumin

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13
Q

Reduced albumin levels ___ sites for protein binding of drugs causing levels of free drug to rise

A

decrease

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14
Q

Rates of hepatic drug metabolism tend to ____ with age

A

decline

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15
Q

Reasons for decline of hepatic drug metabolism:

A

reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes

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16
Q

Drug half-lives may be ____ thereby prolonging responses

A

increased

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17
Q

Beginning in early adulthood renal function and renal drug excretion undergo______

A

progressive decline

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18
Q

Most important cause of ADRs in older adults

A

drug accumulation secondary to reduced renal excretion

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19
Q

Decline in renal function is a result of:

A

reductions in renal blood glow, GFR, active tubular secretion and number of nephrons

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20
Q

When patients are taking drugs that eliminated by the kidneys, what should be assessed?

A

renal function

21
Q

Proper index of renal function

A

creatinine clearance

22
Q

Why test creatinine clearance and not serum creatinine levels?

A

creatinine levels do not adequately reflect kidney function in older adults because the source of serum creatinine-lean muscle mass- declines in parallel with the decline in kidney function

23
Q

creatinine levels may be ___ even though renal function is greatly____

A

normal

reduced

24
Q

Alterations in receptor properties may underlie altered sensitivity to some drugs

A

but info is limited

25
Q

Beta adrenergic blocking agents are less effective in older adults because of:

A
  • a reduction in number of beta receptors

- a reduction in the affinity of beta receptors for beta rector blocking agents

26
Q

Warfarin and certain CNS depressants produced effects more intense in older adults because of:

A

increase in receptor number

receptor affinity

27
Q

ADRs are ____ times more common in older adults

A

seven

28
Q

Older adults are uncomfortable revealing____ and ____

A

alcohol and recreational drug use

29
Q

Most ADR deaths are

A

dose related

30
Q

Factors that predispose older adults to ADRs:

A
  • drug accumulation secondary to reduced renal function
  • polypharmacy
  • greater severity of illness
  • presence of comorbidities
  • use of drugs that have a low therapeutic index (digoxin)
  • increased individual variation secondary to altered pharmacokinetics
  • inadequate supervision of long-term therapy
  • poor patient adherence
31
Q

This list identifies drugs with a high likelihood of causing adverse effects in older adults

A

Beers list

32
Q

Like the Beers list, this list has an advantage of also considering the cost of drug therapy

A

STOPP

33
Q

The set of lists that can be used to promote the selection of appropriate treatment in addition to the avoidance of inappropriate treatment

A

START/STOPP

34
Q

Nonadherence can result in

A

therapeutic failure from under dosing or erratic dose or toxicity from overdosing

35
Q

Most common nonadherence

A

under dosing with therapeutic failure

36
Q

Examples of unintentional nonadherence:

A

forgetfulness
failure to comprehend instructions
inability to pay
use of complex regimens

37
Q

Reasons for intentional nonadherence

A

patients conviction that the drug was not needed in the dosage prescribed, unpleasant side effects, price

38
Q

Promoting adherence for unintentional nonadherence:

A
  • simplify regimen with smallest number of drugs and doses per day
  • explain treatment plan with clear, concise, verbal and written instructions
  • choose appropriate dosage form (liquid for difficulty swallowing)
  • larger print on drug containers and easy to open containers for patients with arthritis
  • suggest use of calendar, diary, pill counter
  • ask if patient has access to pharmacy and can afford meds
  • enlist help
  • monitor for therapeutic responses, ADRs, and plasma drug levels
39
Q

Promoting adherence for intentional nonadherence:

A

intensive education

40
Q

End of life goals

A

shift from disease prevention and management to provision of comfort measures

41
Q

Meds that were once considered important in care like for cholesterol management may:

A

no longer be relevant and can be discontinued

42
Q

End of life drug of choice for constipation

A

first line choices are osmotic laxatives (lactulose, polyethylene glycol)
stool softener are second line if abdominal cramping is a concern
bisacodyl suppositories or enemas for patients that cannot swallow

43
Q

End of life drug of choice for delirium

A

haloperidol or olanzapine

Benzos like midazolam for acute episodes

44
Q

End of life drug of choice for dyspnea

A

oxygen if hypoxemia present
opioids, first line drug of choice
glucocorticoids
bronchodilators if associated with bronchospasm

45
Q

End of life drug of choice for fatigue

A

dexamphetamine

methylphenidate

46
Q

End of life drug of choice for N/V

A

ondansetron, aprepitant, dexamethasone
metoclopramide for gastroparesis and liver failure
haloperidol for unknown causes, bowel obstruction or renal failure
glucocorticoids secondary to brain tumors and bowl obstructions

47
Q

End of life drug of choice for pain

A

fentanyl for patient with renal/hepatic dysfunction

methadone for patients with renal dysfunction without hepatic dysfunction

48
Q

End of life drug of choice for respiratory secretions

A

anticholinergics- glycopyrrolate

Pharmacotherapeutics for the Advanced Practice Nurse (12 decks)

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