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PHARMACOLOGY > Drug Therapy in Older Adults > Flashcards

Drug Therapy in Older Adults Flashcards

1
Q

By ____, persons over the __ years of age will outnumber those under 18 years of age in the United States.

A

2033; 65

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2
Q

By ____, persons over the __ years of age will outnumber those under 18 years of age in the United States.

A

2033; 65

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3
Q

Typically, persons with ______ chronic conditions take _____ prescription drugs.

A

two or more; five or more

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4
Q

Typically, persons with ______ chronic conditions take _____ prescription drugs.

A

two or more; five or more

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5
Q

Drug dosages are often adjusted according to the older adult’s _____, _____, and _____.

A

weight, laboratory results, and comorbid health problems

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5
Q

Drug dosages are often adjusted according to the older adult’s _____, _____, and _____.

A

weight, laboratory results, and comorbid health problems

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6
Q

______ may develop in the older adult for drug doses within the therapeutic range for the younger adult.

A

Drug toxicity

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7
Q

______ may develop in the older adult for drug doses within the therapeutic range for the younger adult.

A

Drug toxicity

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8
Q

Drugs for older adults should initially be prescribed at ___ dosages with a gradual increase in dosage based on therapeutic response.

A

low

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9
Q

Physiologic changes associated with aging can influence absorption, distribution, metabolism, and excretion of drugs as well as pharmacodynamic responses at receptors and target organs. These physiologic changes include the following:

A reduction in _______ and _______, resulting in _______, which alters the volume of distribution of drugs.

A

total body water and lean body mass; increased body fat

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10
Q

Physiologic changes associated with aging can influence absorption, distribution, metabolism, and excretion of drugs as well as pharmacodynamic responses at receptors and target organs. These physiologic changes include the following:

A reduction in _______ and _______, resulting in reduced hepatic clearance of drugs.

A

liver size and blood flow

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11
Q

A decline in the physiologic processes that maintain equilibrium in the older adult may mean a higher incidence of adverse effects. Examples of this include:

_________ in response to drugs that reduce blood pressure

A

Postural hypotension

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11
Q

Physiologic changes associated with aging can influence absorption, distribution, metabolism, and excretion of drugs as well as pharmacodynamic responses at receptors and target organs. These physiologic changes include the following:

A reduction in ________ and ________, leading to a reduced ___ and reduced _________ excreted by the kidneys.

A

kidney mass and lower kidney blood flow; GFR; clearance of drugs

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12
Q

A decline in the physiologic processes that maintain equilibrium in the older adult may mean a higher incidence of adverse effects. Examples of this include:

_________ and _________ in response to diuretics

A

Volume depletion and electrolyte imbalance

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13
Q

A decline in the physiologic processes that maintain equilibrium in the older adult may mean a higher incidence of adverse effects. Examples of this include:

__________ with anticoagulant and antiplatelet drugs

A

Excessive bleeding

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14
Q

A decline in the physiologic processes that maintain equilibrium in the older adult may mean a higher incidence of adverse effects. Examples of this include:

__________ to antidiabetic drugs

A

Altered glycemic response

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15
Q

A decline in the physiologic processes that maintain equilibrium in the older adult may mean a higher incidence of adverse effects. Examples of this include:

_________ with nonsteroidal antiinflammatory drugs (NSAIDs)

A

Gastrointestinal irritation

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16
Q

PHARMACOKINETICS
Absorption

Adults experience several GI changes with aging that may influence absorption. These include a decrease in ___________, slowed ___________, reduced ___________, and a _% to __% decrease in ___________.

A

decrease in small-bowel surface area, slowed gastric emptying, reduced gastric blood flow, and a 5% to 10% decrease in gastric acid production

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17
Q

PHARMACOKINETICS
Absorption

Other common problems that occur in older adults that can significantly influence drug absorption include ___________ difficulties, poor ___________, and dependence on ___________.

A

swallowing difficulties, poor nutrition, and dependence on feeding tubes

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18
Q

PHARMACOKINETICS
Distribution

With aging, adults experience a decline in ___________ and a __% to __% increase in ____.

A

decline in muscle mass and a 20% to 40% increase in fat

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19
Q

PHARMACOKINETICS
Distribution

The increase in body fat means ________ have a greater volume of _______, increased drug ______, reduced ______, and a prolonged period of ______.

A

lipid-soluble drugs; greater volume of distribution, increased drug storage, reduced elimination, and a prolonged period of action.

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20
Q

PHARMACOKINETICS
Distribution

Older adults have a __% to __% reduction in total body water, which affects water-soluble drugs, and a __% reduction in albumin.

A

10% to 15%; 10%

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21
Q

PHARMACOKINETICS
Distribution

Reduced albumin levels can result in decreased _______ and increased _______ available to exert therapeutic effects, but it also increases the risk for drug toxicity.

A

decreased protein binding of drugs and increased free drug

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22
Q

PHARMACOKINETICS
Metabolism

Hepatic blood flow in the older adult may be decreased by __%; aging also results in a __% to __% decrease in liver size and a reduction in __________ activity, which is responsible for the breakdown of drugs.

A

40%; 15% to 30%; cytochrome P450 enzyme

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23
Q

PHARMACOKINETICS
Metabolism

A reduction in _________ can decrease first-pass metabolism and can prolong drug half-life, resulting in increased drug levels and potential drug toxicity.

A

hepatic metabolism

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24
Q

PHARMACOKINETICS
Metabolism

To assess liver function, _________ must be checked. Elevated levels of __________ (ALT or SGPT) and _________ (AST or SGOT) may indicate possible liver dysfunction.

A

liver enzymes; alanine aminotransferase; aspartate aminotransferase

25
Q

PHARMACOKINETICS
Metabolism

However, an older adult can have normal __________ (LFT) results and still have impaired hepatic enzyme activity.

A

liver function test

26
Q

PHARMACOKINETICS
Excretion

Excretion is altered by ________ changes in kidney function, such as decreased ________ and ________, which differ for each individual.

A

age-related; renal size and volume

27
Q

PHARMACOKINETICS
Excretion

It is generally accepted that the GFR declines by _mL/min after __ years of age (normal GFR is ___-___mL/min).

A

1mL/min after 40 years of age (normal GFR is 100-125mL/min)

28
Q

PHARMACOKINETICS
Excretion

Changes in kidney function affect many drugs, leading to a prolonged ______ and elevated ______.

A

prolonged half- life and elevated drug levels

29
Q

PHARMACOKINETICS
Excretion

Changes in kidney function require ________, especially if the drug has a narrow therapeutic range.

A

dosage adjustment

30
Q

Pharmacodynamic responses to drugs are altered with aging as a result of changes in the ___________, which affects the affinity of certain drugs. These changes are seen most clearly in the cardiovascular system and central nervous system.

A

number of receptor sites

31
Q

Pharmacodynamics

Older adults experience a loss of sensitivity in ______, affecting both ______ and ______; this results in a reduced response to beta blockers and beta2 agonists.

A

adrenergic receptors; agonists and antagonists

32
Q

Pharmacodynamics

There is a reduced ________ to the brain, and the ___ also becomes more permeable. This puts the older adult at risk for CNS drug side effects which include dizziness, seizures, confusion, sedation, and extrapyramidal effects.

A

blood flow; BBB

33
Q

refers to the use of more medications than is medically necessary.

A

Polypharmacy

34
Q

Risk factors associated with polypharmacy include which of the following?
-advanced age
-female sex
-male sex
-multiple health care providers
-use of herbal therapies and OTC drugs
-multiple chronic diseases
-number of hospitalizations and care transitions.

A

-advanced age
-female sex
-multiple health care providers
-use of herbal therapies and OTC drugs
-multiple chronic diseases
-number of hospitalizations and care transitions.

35
Q

To reduce the risk for and incidence of polypharmacy, ______ must be involved in the coordination of care for older adults.

A

nurses

36
Q

No drug is safe. Every year, more than ______ emergency department (ED) visits occur due to adverse drug events (ADEs), and more than ______ people are hospitalized due to ADEs.

A

775,000; 125,000

37
Q

Most visits and hospitalizations occur due to reactions to ______, drugs used to treat ______ and ______, ______ drugs, and drugs used for ______.

A

reactions to blood thinners, drugs used to treat diabetes and seizures, cardiac drugs, and drugs used for pain control.

37
Q

There are five types of ADEs:

A

(1) adverse drug reactions, (2) medication errors, (3) therapeutic failures, (4) adverse drug withdrawal events, and (5) overdoses.

38
Q

is a problem for all patient age groups, but it is especially troublesome in older adult patients.

A

Adherence to a drug regimen

39
Q

_________ may fail to ask questions during interactions with HCP, which leads to the drug regimen not being fully understood or precisely followed.

A

Older adults

40
Q

Failure to adhere to a drug regimen can lead to ___, resulting in hospital admission, readmission to health care institutions, and even death.

A

ADEs

41
Q

is the cornerstone of adherence, and this includes education of the patient, family, and formal and informal caregivers.

A

Education

42
Q

The _______________ made it possible for older adults to obtain prescription drug coverage through Medicare. However, not all older adults have insurance that includes prescription drug coverage, nor are they able to afford their drugs even with insurance.

A

Medicare Modernization Act of 2003

43
Q

Barriers to Effective Drug Use by Older Adults

Identify cause for the given nursing action.

Develop a chart indicating times to take drugs. Provide space to place a mark for each drug taken. Coordinate the drug regimen with activities of daily living (e.g., meals) and events. Use an organizer container (daily or weekly). Have the patient bring all drugs–including over-the-counter drugs and herbal, vitamin, and mineral supplements. - to all health appointments.

A

Taking too many drugs at different times

44
Q

Barriers to Effective Drug Use by Older Adults

Identify cause for the given nursing action.

Explain the purpose, drug action, and importance of the drug. Provide time for questions and reinforcement. Reinforce with written information.

A

Failure to understand the purpose or reason for a drug

45
Q

Barriers to Effective Drug Use by Older Adults

Identify cause for the given nursing action.

Encourage family members or friends to monitor the patient’s drug regimen.

A

Impaired memory

46
Q

Barriers to Effective Drug Use by Older Adults

Identify cause for the given nursing action.

Advise family members or friends to have drugs and water or other fluid accessible and to assist older adults as needed.

A

Decreased mobility and dexterity

47
Q

Barriers to Effective Drug Use by Older Adults

Identify cause for the given nursing action.

Suggest eye and ear examinations (glasses or hearing aids).

A

Visual and hearing disturbances

48
Q

Barriers to Effective Drug Use by Older Adults

Identify cause for the given nursing action.

Contact the social services department of your institution and compassionate care programs as appropriate.

A

High cost of prescriptions

49
Q

Barriers to Effective Drug Use by Older Adults

Identify cause for the given nursing action.

Suggest that the patient request non-childproof bottle caps.

A

Childproof drug bottles

50
Q

Barriers to Effective Drug Use by Older Adults

Identify cause for the given nursing action.

Educate the patient and family about side effects to report to the health care provider.

A

Side effects or adverse reactions from the drug

51
Q

Health Teaching with the Older Adult

Ensure that the patient is wearing _______ and has working _______ in place if needed.

A

eyeglasses; hearing aids

52
Q

Health Teaching with the Older Adult

Speak in a tone of voice that the patient can ____; sit ____ the patient, and limit ____.

A

hear; facing; distractions

53
Q

Health Teaching with the Older Adult

Treat the patient with _______; never _______; expect that the patient can _______.

A

respect; infantilize; learn

54
Q

Health Teaching with the Older Adult

Use _______ and _______ against a _______ background; use a font with _______, or “_______”, which makes letters close together easier to read.

A

large print and dark type against a light background; serifs, or “feet and tails”

55
Q

Health Teaching with the Older Adult

Review all _______ at each patient visit; ask the patient to bring all drugs to each appointment, and advise use of only ___ pharmacy.

A

drugs; one

56
Q

Health Teaching with the Older Adult

Advise the patient to complete the _______ (medical information for emergency personnel to use in the provision of care) and keep it on the ___________ where safety personnel will know to look for it.

A

vial of life; refrigerator door

57
Q

Health Teaching with the Older Adult

Instruct the patient to keep a list of all ________, bring it to all health appointments , and carry it when out of the house.

A

drugs taken

58
Q

Health Teaching with the Older Adult

Encourage a __________ when possible.

A

simple dosing schedule

59
Q

Health Teaching with the Older Adult

Suspect ___________ if new confusion or disorientation occurs.

A

recently prescribed drug(s)

60
Q

Health Teaching with the Older Adult

Encourage the patient to _______ if a drug is not improving the condition for which it was prescribed.

A

report

61
Q

Health Teaching with the Older Adult

Consider use of ________ such as pill organizers or planners, alarms, blinking lights, or prerecorded messages.

A

memory aids

PHARMACOLOGY (11 decks)

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