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Nursing 304 > Elder Meds Part I > Flashcards

Elder Meds Part I Flashcards

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1
Q

What is “pharmacokinetics”?

A

“What the body does with the drug”

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2
Q

What is “pharmacodynamics”?

A

“What the drug does to the body”

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3
Q

What four things are part of pharmacokinetics?

A

Absorption
Distribution
Metabolism
Excretion

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4
Q

What are two things that medications can do to receptors?

A

Blocked

Stimulated

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5
Q

What are some age related changes that affect drug-receptor interaction?

A

Brain receptors become more sensitive, making psychoactive drugs very potent.

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6
Q

What are some age related changes that affect drug metabolism?

A

Liver mass shrinks.
Hepatic blood flow and enzyme activity decline.
Metabolism drops to 1/2 to 2/3 the rate of young adults.
Enzymes lose ability to process some drugs, thus prolonging drug half-life.

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7
Q

What are some age related changes that affect drug absorption?

A

Gastric emptying rate and gastrointestinal motility slow.

Absorption capacity of cells and active transport mechanism decline.

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8
Q

What are some age related changes that affect circulation (in relation to drugs)?

A

Vascular nerve control is less stable.
Antihypertensives, for example, may overshoot, dropping blood pressure too low.
Digoxin, for example, may slow the heart too much.

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9
Q

What are some age related changes that affect excretion (in relation to drugs)?

A

In kidneys, renal blood flow, glomerular filtration rate, renal tubular secretion and reabsorption, and number of functional nephrons decline.
Blood flow and waste removal slow.
Age-related changes lengthen half-life for renally excreted drugs.
Oral antibiotic drugs, among others, stay in the body longer.

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10
Q

What are some age related changes that affect distribution of drugs?

A

Lean body mass falls.
Adipose stores increase.
Total body water declines, raising the concentration of water-soluble drugs, such as digoxin, which can cause heart dysfunction.
Plasma protein diminishes, reducing sites available for protein-bound drugs and raising blood levels of free drug.

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11
Q

What are some drug interactions that slow absorption?

A

Use of combinations of drugs wherein one drug affects absorption of the other i.e. antacids/Ca/Mg/Al ions bind to object drug decreasing effect of same.
Free fraction effect
Decreased albumin production/aging liver

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12
Q

What is the free fraction effect?

A

Free fraction effect: drugs binding ++ to protein
Decreased Albumin production/aging liver=rise in free fraction in blood=increase in toxic side effects i.e. malnutrition, uremia; diabetes; acute nephrotic syndrome; surgery

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13
Q

What are the results of slowed liver metabolism?

A

Aging causes liver function to diminish i.e drug catabolization declines
Active drug or metabolites remain in body longer i.e. long acting benzodiazepines (Diazepam/Valium)
May result in excessive sedation

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14
Q

What rate does creatinine clearance decline with age?

A

10% every decade after 40 years

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15
Q

What level of creatinine clearance poses a risk of accumulation of drugs/metabolites that are nephrotoxic to kidney function?

A

Creatinine clearance 30 mL/min or below

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16
Q

What are some important considerations to avoid renal damage from antibiotics? (eg. vancomycin, gentamycin)

A

Initial renal function level and ongoing Peak and Trough level monitoring essential to prevent irreversible kidney damage /hearing loss/balance disturbances

17
Q

What is “rational” polypharmacy?

A

Rational->conscientious, minimal use of multiple drugs +diligent pt. follow-up

18
Q

What is “irrational” polypharmacy?

A

Irrational-> inappropriate use of multiple drugs-> risks outweigh benefits

19
Q

What are some roots of irrational polypharmacy?

A

Prescriber hesitates to d/c meds. pt. has been taking long time-> adds on more meds

Prescriber orders meds. to alleviate adverse reactions to other meds

Pt. influenced by anecdotal reports re benefits of certain meds

20
Q

How many patients use alternative pharmacotherapy i.e. herbal remedies unbeknownst to healthcare providers?

A

40% or more adults

21
Q

Why do people use alternative pharmacotherapy/herbal remedies without telling their doctor?

A

Why? Many people believe ‘natural’/alternative medications bought form a reputable source =safe

22
Q

What are some commonly used examples of alternative pharmacotherapy/herbal remedies?

A

Commonly used examples: gingseng, ginko biloba,garlic, St. John’s wort however, adverse interactions with some medications ie anticoagulant Warfarin; St. J’s wort/Digoxin level depletion etc.

23
Q

What is the Beers Criteria? (what is the intention, who is it for?)

A

Intended for:
use in all ambulatory, acute, institutionalized settings
Adults 65 yrs and older
Palliative and hospice settings excluded
Improve care of older adults by reducing exposure to PIM’s (potentially inappropriate medications)

24
Q

What are some examples of potentially inappropriate meds (PIMs) and drug-drug interactions in the elderly?

A 
Anticoagulants
Anticholinergics
Cardiac glycosides
Antihypertensive agents
Antimicrobials
Antipsychotics, anxiolytics, antidepressants, benzodiazepines
NSAID’s
Laxatives
Antacids
Long acting oral hypoglycemics
Opioid analgesics
25
Q

What is the nurse’s role when administering medications to the elderly?

A

Complete a thorough history including drug/alcohol consumption
Ensure medication reconciliation complete on admission, transfer, and discharge (herbs, OTC, vitamins)
Know the therapeutic aim of the drug and how it will be measured
When is the outcome to be reviewed?
What adverse effects might be expected and their significance?
How will the drug be monitored? Ie lab values
Teach about medication hazards
Institute non pharmacological approaches prn
Individualize patient education to patient/family (oral/written)

26
Q

What are the principles of geriatric prescribing?

A

Titrate dosage with pt. response i.e. “start low and go slow’
Simplify therapeutic regimen
Encourage regular pharmacy med reviews
Encourage use of one pharmacy only
Consider safest dispensing ie med machine, blister packs
Monitor compliance
Avoid pharmacology whenever possible try nonpharmacological approaches

Nursing 304 (12 decks)

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