Drug Therapy In Older Clients Flashcards
Administration of many drugs together. This increases chances of toxicity and interactions =
Polypharmacy
Are herbal remedies considered drugs?
Yes
May cause confusion, falls, malnutrition, renal/ liver dysfunction, non-adherence =
Polypharmacy
People over the age of 65 buy what percentage of all prescriptions?
35%
People over the age of 65 buy what percentage of all OTC meds sold in America?
Over 40%
The average older adult living at home uses how many prescription + OTC drugs?
4-5 Prescription
2 OTC
Most commonly used OTC’s =
Analgesics, anti-inflammatory drugs, laxatives, and antacids
Diuretics, Potassium Salts, Histamine2-antagonists, Nitroglycerin, Insulins, Cardiac Glycosides, Beta-blockers, Anti-anxiety drugs, and Hypertensives =
Most commonly used prescribed meds
Should you encourage the use of the SAME pharmacy for all prescription needs?
Yeah
Do many people know what pills that they are taking are?
No
There’s a 100% chance of drug interaction when taking how many drugs?
8 or more
The more drug taken, the more-
The chance for side effects
The goal of drug therapy is to-
Maintain health with the fewest drugs possible
What is the purpose of Brown Bag Sessions?
To check appropriateness of meds for a patient
What may you discover during a brown bag session?
Inappropriate drugs, duplicated drugs, expired drugs, supplements or OTC’s not listed elsewhere
What’s a brown bag session?
When all meds are brought into doctor’s office during visits
What kinds of GI changes can affect drug therapy?
Increased pH, decreased peristalsis, motility, and first pass effect
What kinds of cardiac changes can affect drug therapy?
Decreased cardiac output leads to decreased circulation
What kinds of hepatic changes can affect drug therapy?
Decreased enzyme function and blood flow
What kinds of renal changes can affect drug therapy?
Decreased blood flow, decreased nephrons, decreased GFR
Absorption, distribution, metabolism, and excretion can all be slowed by-
The physiologic changes in an older adult
Oral meds may not respond as quickly in older adults due to-
GI changes
Decreased cardiac output leads to-
Reduced perfusion in the GI tract
Reduced perfusion in the GI tract leads to-
Delayed, less thorough, and less reliable removal of drugs from intestinal lumen.
Can reduced perfusion in the GI tract cause a reduced absorption of substances?
Yes
As you get older, your liver should remain functional, but your ability to metabolize a drug may decline. Does this make drug accumulation an important issue?
Yes
Does extended half-lives warrant close monitoring in older adults?
Yup
Renal changes, CV disease, dehydration, and kidney disease may increase a drug’s half-life by up to-
40%
Due to a drug remaining in the body longer, the risk of what increases?
Adverse Effects
As you get older, what changes in body composition occur?
Weight decreases, fat % increases
Do older people experience a decline in total body water?
Yes
Hepatic =
The liver
Absorption, distribution, metabolism, and excretion are all apart of-
Pharmacokinetics
What the body does to the drug =
PK (Pharmacokinetics)
What the drug does to the body =
PD (Pharmacodynamics)
Absorption, distribution, metabolism, and excretion are not all affected by physiological changes in the elderly.
True or false?
False
A fat-soluble drug has more distribution the more fat % there is, does this lead to an extended half life?
Yes
What does a declining amount of body water lead to?
Drug accumulation for highly water-soluble drugs
What can enhance drug absorption from the GI tract?
Physical activity
How does physical activity enhance drug absorption?
It increases blood flow
Can you expect a lengthened or shortened drug half-life for an elder patient with renal changes?
Lengthened
Views the client as a product of their culture =
Ethnopharmacy
Tries to bridge the gap between traditional healthcare practices and meds + their role in healthcare today
Ethnopharmacy
Is illness culturally defined?
Yup
What are the 5 major ethnic sub-groups?
White Americans
African Americans
Hispanic Americans
Asian Americans
Native Americans
How do White Americans typically define health?
Able to do ADL’s, physically/emotionally well, free from illness
What do White Americans typically see as causes for an illness?
Breaking religious rules, exposure to causative agents, God’s punishment, environmental changes, bodily abuse (smoking, drinking, etc.)
What percentage of people try to self-treat themselves?
77%
What percentage of people typically wait to see if a problem will go away on its own?
69%
Are White Americans typically confident in the healthcare decisions that they make?
Yes
Feel responsible to help friends + family make healthcare decisions =
Communal
How do African Americans typically define health?
Harmony of mind, body, and spirit
How do African Americans typically define illness?
Disharmony resulting from natural causes or divine punishment
Which sub-ethnic group has a fundamental belief in the power of the supernatural?
African American
Herbs, spices, roots.
Prayer, laying on of hands.
These are all done by what sub-ethnic group?
African American
Epsom salts, salt pork, and potato poultice are all examples of-
Home/ Folk Remedies
Which sub-ethnic group uses a lot of epsom salts, salt pork, and potato poultice?
African Americans
Why are African Americans more likely to seek other options than traditional western healthcare?
Discriminatory Practices, Unfair Treatment, Difficult Access
Which sub-ethnic group is the least likely to visit a healthcare provider?
Hispanic American
Which sub-ethnic group uses medicinal herbs + religious rituals?
Hispanic American
How do Hispanic Americans define health?
A balance between forces of “hot” and “cold”
Which sub-ethnic group supports the use or absence of “hot” and “cold” foods depending on condition?
Hispanic American
Which sub-ethnic group sees illness as a result from supernatural forces?
Hispanic American
Mal Ojo =
Evil Eye
Cause of illness or bad luck in Hispanic culture =
Envy
Mal Ojo is from which sub-ethnic group?
Hispanic American
Which sub-ethnic group uses candles, amulets, and herb teas for remedies?
Hispanic Americans
Curandero =
A type of health practitioner
The belief that the imbalance between yin and yang comes from which culture?
Asian American
In which sub-ethnic group do most therapies aim to “restore balance”?
Asian American
Acupuncture, Herbal Medicine, Massage, Tai Chi, “cupping” are all apart of which sub-ethnic group?
Asian American
How many tribes within America?
170
What is the most widely known traditional remedy used by Asian Americans?
Ginseng Root
Why is ginseng root important medically?
It has proven anti-oxidant, anti-tumor, and anti-viral effects
A type of acupressure treatment, sometimes used for pain relief and treatment of respiratory problems =
Cupping
What kind of treatment can you confuse for abuse?
Cupping
Medicine, magic, and religion are beliefs of most-
Native Americans
For Native Americans, what is important to health?
Relationship with nature, respect for one’s body, and the earth
Native Americans are like Hispanic Americans in that they both utilize-
Amulets, herbs, and medicine man
How should you know if a PT understands something, rather than asking if they understand?
Question the client about the subject to ensure they understand
Is a medical interpreter always preferred over having a PT’s family member/friend interpret for you?
Yup
What percentage of the population is functionally illiterate?
20%
Often difficult to assess, as it is sometimes well hidden=
Illiteracy
How many times do you check the five rights and how many times do you check the drug label?
Drug label = 3
5 rights = 4
