Ethico-Legal Considerations in the Care of Older Adult / Medications/ Ethical Principles Flashcards
any noxious, unintended, and undesired effects of a drug which occurs at doses in human for prophylaxis, diagnosis or therapy.
* Difficulties in the activities of daily living
* Cognitive changes
* Falls
* Anorexia, nausea
* Weight changes
Adverse Drug Reaction (ADR)
It may be related to prescribing, dispensing, administering or monitoring of drug. Root cause: Attributed to human knowldge based deficiencies and a lack of sophisticated systems to support and monitoring drug therapy
MEDICATION ERROR
any injury that results in medications used, and this includes both ADRs and medication errors that lead to an ADR.
Adverse Drug Event (ADE)
“Any symptom in an elderly patient should be considered a _________until proven otherwise.”
Drug Side Effects
Most likely group to visit ED for adverse reactions to drugs among adults?
Those 65 and older. Males (61.5% of visits) and females (60.9% of visits)
what the body does to the drug
Pharmacokinetics
what the drug does to the body
Pharmacodynamics
What is the 2012 Beers Criteria?
Commonly used consensus criteria related to inappropriate medications.
Guideline of drugs to avoid in older adults.
Use of antihistamines in older adults?
Avoid 1st generation antihistamin that have anticholinergic properties
Anti-parkinsons agents to avoid in older adults because of anticholinergic effects
benztropine and trihexyphenidyl
Increase potential for toxicity
Theophylline and Caffeine
Drug-Food Interaction
Decrease anti-parkinsonian effect
Levadopa and Clonidine
Drug-Food Interaction
Increase risk for bleeding
Warfarin and Aspirin
Drug-Drug Interaction
Most common psychiartric disorder in the elderly?
depression
Significant problem in older persons and is often associated with depression & dementia.
Anxiety
According to the Beer’s list, _ _ _ _ with long
half-lives should be avoided because of the likelihood of
accumulation of the patient drug and its active metabolite,
resulting in increase toxicity
benzodiazepines (persantine)
this antidepressant should be avoided in the older patient because of their anticholinergic and sedative side effects profile
tricyclic antidepressants
Appropriate indications for antipsychotic prescription include
Schizoprenia, Paranoid States, Symptoms of psychosis such as hallucination and delusions
3 D’s that may justify antipsychotic use:
Danger, Distress, Dysfunction
committing an unlawful or improper act
Malfeasance
performing an act improperly
Misfeasance
failure to take proper action
Nonfeasance
failure to abide by the standards of one’s
profession
Malpractice
disregard to protection the safety
of another person
Criminal Negligence
include compassion, equity, fairness, dignity, confidentiality, and mindfulness of a person’s autonomy within the realm of the person’s abilities and mental capacity.
ETHICS OF CARE
refers to loyalty and championing of the needs and interest of others, to educate and informed the patients about their rights and access benefits entitled for them.
ADVOCACY
Legislated the appropriate use of medications in institutionalized older persons. Use of chemical restraint, Use of unnecessary drugs.
Omnibus Budget Reconciliation Act (OBRA) 1987
emphasizes respect for human dignity that is demonstrated in daily work.
CONFIDENTIALITY
refers to using both fiscal reserves and caregiving resources wisely, potentially requiring a cost-benefit analysis to facilitate decision making.
FIDUCIARY RESPONSIBILITY
life referring to the value of life and the right to live.
SANCTITY OF LIFE
a perception based on personal
values and beliefs
QUALITY OF LIFE
is a feature of integrity concerned with the ability to be true to one’s self while respecting and supporting the values and views of another.
RECIPPROCITY
between family members and caregivers represent the elderly or assist them in decision-making.
Actual Conflict of Interest issues
which include those which are not actual conflicts in the
course of care but may later become conflicts when the elder patient’s interest diverge from those who provide the care.
Perceived Conflicts of Interest
