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Gero Unit 2 > Gero ch.9 > Flashcards

Gero ch.9 Flashcards

1
Q

Absorption

A
  • This event is where the drug is into the bloodstream
  • influenced by changes in GI motility
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2
Q

what depends on several factors, such as the route of introduction (e.g., IV, oral, parenteral, transdermal, or rectal) and the bioavailability and dose of medication?

A

The amount of time between the administration of the drug and its absorption.

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3
Q

What happens when the drug is administered by the IV route and is quickly delivered when using parenteral and transdermal route, or when mucous membranes become utilized?

A

The drug is delivered immediately to the bloodstream.

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4
Q

Pharmacokinetics

A
  • movement of medication in the body from the point of administration to excretion
  • drugs are absorbed, distributed, and metabolized
  • implications for safe drug use in later life occurs
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5
Q

what type of drug is absorbed slowly, especially with enteric coatings compared with other routes of administration?

A

Orally administered drugs

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6
Q

What slows the action of acid-dependent medications?

A

The increased gastric pH of the aging stomach

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7
Q

What diminishes or negates the absorption and therefore the effectiveness of short-lived drugs?

A

Delayed emptying

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8
Q

Enteric-coated medications

A

designed to bypass the stomach and to be absorbed in the small intestine

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9
Q

What happens if absorption of the products become delayed?

A

gastric irritation or nausea may occur

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10
Q

What happens if there is an increased motility in the small intestine bc of shortened contact time resulting in decreased absorption and effectiveness?

A

the effect of the drug is diminished

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11
Q

What increases the contact time, the amount absorbed, and effect?

A

slowed intestinal motility, which is common in aging

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12
Q

Distribution

A

based on the availability of plasma protein in the form of lipoproteins, globulins, and especially albumin

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13
Q

What happens when drugs are absorbed?

A
  • they have to be transported to the receptor site on a targeted organ to have the desired effect
  • they bind with the protein and are distributed throughout the body
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14
Q

What is inactivated as it binds to a protein?

A

the predictable percentage of the absorbed drug

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15
Q

remaining free drug

A

available in the blood and has a therapeutic effect when an adequate concentration is reached in the plasma

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16
Q

What do most older adults have during distribution?

A

insignificant reduction of albumin

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17
Q

the presence of albumin becomes dramatically reduced in who?

A
  • those who are frail
  • those who have an inadequate diet
  • those who have reduced protein intake
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18
Q

Where are low serum albumin levels found?

A
  • adults who are needing long-term care
  • adults who have dementia
  • adults who are socially isolated
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19
Q

What may accumulate in the blood stream unpredictably?

A
  • toxic levels of available free drug
  • highly protein-bound medications (due to protein not being available) with narrow therapeutic windows
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20
Q

What are the potential alterations of medication distribution in late life?

A

Changes in body composition such as:

  • decreased lean body mass
  • increased body fat
  • decreased total body water
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21
Q

What does decreased body water lead to?

A

higher relative serum levels of water-soluble drugs (e.g., lithium, digoxin, ethanol, aminoglycosides)

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22
Q

What leads to toxicity during distribution?

A
  • dehydration and increased serum levels with extended diarrhea, vomiting, or other conditions
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23
Q

What doubles in older men and increases by one-half in older women?

A

adipose tissue

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24
Q

what drugs are stored in the fatty tissue, extending and possibly elevating an effect?

A

drugs that are highly lipid-soluble

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25
Q

How does accidental and potential fatal overdoses happen?

A

when the medication accumulates in excess

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26
Q

Metabolism

A
  • process by which the body modifies the chemical structure of the drug
  • compound is converted to a metabolite that is later more easily excreted
  • a drug will continue to exert a therapeutic effect as long as it remains either in its original state or as an “active” metabolite
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27
Q

Active metabolites

A

retains the ability to have a therapeutic effect, as well as the same or a greater chance of causing adverse effects

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28
Q

duration of drug action

A

defined by the metabolic rate and is measured in terms of half-life, or the length of time one-half of the drug remains active in the body

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29
Q

Why is it safer to consider 3 g of acetaminophen in 24 hrs?

A

because of the unpredictable nature of drug metabolism in the body

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30
Q

number of enzymes

A

plays an active part in drug metabolism with one of these

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31
Q

What affects the availability of enzymes and metabolism?

A
  • age
  • weight
  • sex
  • liver and kidney function
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32
Q

What is the primary site of drug metabolism?

A

liver

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33
Q

what does the reduction in liver function lead to?

A

a significant increase in the half-life of these drugs

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34
Q

What happens if the dose and timing are not adjusted?

A

drugs could accumulate and the administration of a single dose could have significantly more effects, and it can be found in a younger person

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35
Q

What is inappropriate to prescribe?

A

Valium, anyone older than 65 years

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36
Q

Excretion

A

drugs are being eliminated

37
Q

Where are drugs excreted at?

A
  • sweat
  • saliva
38
Q

what is the primary site of excretion?

A

through the kidneys

39
Q

Kidney function declines significantly with aging, this means:

A

the ability to excrete or eliminate drugs in a timely manner declines as well

40
Q

What further prolongs the half-life of drugs and the amount of time required to eliminate the drug, adding to the risk of accumulation and increasing the potential for toxicity or other adverse events?

A

Decreased glomerular filtration rate (GFR)

41
Q

What happens when the CrCl is reduced?

A

reductions in dosages for drugs excreted by the kidneys are needed

42
Q

reduction in dosages

A

may be necessary when the patient is very ill or dehydrated

43
Q

Pharmacodynamics

A

interaction between the drug and the body

44
Q

The older the person becomes…

A

the more likely there will be an altered or unreliable response of the body to the drug

45
Q

What happens during the aging process?

A

a decreased response to beta-adrenergic receptor stimulators and blockers; decreased baroreceptor sensitivity; and increased sensitivity to a number of medications all occur

46
Q

Chronopharmacology

A

relationship between the biological rhythms of the body and variations in pharmacokinetics and pharmacodynamics

47
Q

If the same dose is taken in divided amounts over the say as labeled

A

unwanted effects of the drug may suppress the hormonal activities stemming from the hypothalamus-pituitary-adrenal axis

48
Q

What influences absorption?

A
  • increased gastric pH
  • level of motility of the GI tract
  • the degree of blood flow

they all obtain biorhythmical variations

49
Q

distribution of protein-bound drugs

A

depends on the levels of albumin and glycoproteins produced by the liver

50
Q

What happens during the day?

A

albumin levels are high, but they are low in the early morning

51
Q

what else is rhythmical?

A

drug metabolism; b/c of changes in the liver over the course of the day

52
Q

Renal elimination

A
  • depends of kidney perfusion, glomerular filtration, and urine acidity
  • also shows rhythmical variation
53
Q

what varies rhythmicity to where it results in a cyclical response for beta blockers?

A
  • brain
  • heart
  • blood cells
54
Q

echinacea

A

enhances immunity

avoid use with anticoagulation drug b/c it increases the risk of bleeding

55
Q

garlic

A

inhibits platelet aggregation

avoid use with any anticoagulant or antiplatelet drug b/c it can increase the risk of bleeding.

It can also cause hypotension when taken with antihypertensive drugs.

56
Q

ginger

A

antiemetic

57
Q

gingko biloba

A

improves memory

Avoid use with any anticoagulant, antiplatelet, & antidiabetic drugs b/c it increases the risk of bleeding.

It also alters blood glucose levels, so patients that are diabetic should avoid this herb but if they are taking it, they must be aware of how to monitor blood glucose closely.

58
Q

ginseng

A

increases physical endurance

Avoid use with antidiabetic drugs, anticoagulants, antiplatelets, & MAOIs b/c it will increase the risk of bleeding.

It also can alter glucose levels

Use of MAOIs will cause mania, headaches, and tremors so the patient should be instructed to not take two medications all together

59
Q

valerian root

A

promotes sleep and reduces anxiety

60
Q

Green tea

A

Avoid with Warfarin sodium and stimulants b/c it has caffeine to where it increases the effects when taken with stimulants

use with warfarin can alter coagulation effects; so patients are instructed to not consume this herb on warfarin

61
Q

St. John’s Wort

A

Avoid use with everything

It interacts with a lot of medications and should not be used without talking to the doctor first

62
Q

Warfarin

A

Avoid foods with vitamin K because K decreased the effect of the drug

kale, spinach, greens, broccoli, green tea, collards, parsley or any other dark green veggies are examples of vitamin K

63
Q

Grapefruit juice

A

Interacts with multiple medications by altering metabolism and elimination

64
Q

polypharmacy

A
  • defined as the use of approximately five or more medications or the use of multiple medications for the same problem
  • may occur “accidentally”
65
Q

What if a patient has multiple chronic conditions?

A

simple polypharmacy may be necessary, even if the prescribing provider is following evidence-based guidelines

66
Q

How would polypharmacy occur “accidently?”

A

If an existing drug regimen is not considered when new medications are prescribed

67
Q

two major concerns of polypharmacy

A
  • increased risk of drug interactions
  • increased risk of adverse events
68
Q

Adverse drug reaction (ADR)

A

an unwanted pharmacological effect such as a minor rash or nausea

69
Q

Adverse drug event (ADE)

A

When a reaction reaches the level of harm, it is an adverse drug event (ADE) which may include withdrawal and therapeutic failures.

70
Q

What is one of the most common ADRs for the older adult?

A

delirium and confusion - increases risk for falls

71
Q

Misuse of drugs

A
  • can occur for any number of reasons, from inadequate skills of the nurse or the prescriber to inadequate funds to purchase prescribed medications
  • it happens when more drugs are taken
72
Q

What affects drug misuse?

A

memory failures

73
Q

problems with health literacy

A

limits the ability to take medications correctly

74
Q

limitations in vision

A

will interfere with reading instructions, especially of bottle labels

75
Q

psychoactive medications

A

Used to treat anxiety, depression, bipolar, and psychosis

Higher than usual risk for adverse reactions

Must be administered with caution and awareness of how the older adult will be able to tolerate

Implement nonpharmacological interventions with medications

76
Q

antidepressants

A

Used to treat depression

Always assess the patient’s mood status

Assess if progress is occurring while taking antidepressants

We are worried about suicide risk

77
Q

Antipsychotics

A

Haloperidol, chlorpromazaine

Should be used as a last result due to dangerous side effects

Should be used at lowest dose for shortest amount of time

78
Q

mood stabilizers

A
  • lithium
  • treatment for bipolar disorder
79
Q

If a patient is taking lithium

A

he/she will need frequent lab monitoring (narrow therapeutic window) and extensive patient education regarding diet

80
Q

Neuroleptic Malignant Syndrome (NMS)

A

A rare, life threatening adverse drug event to antipsychotics

81
Q

Extrapyramidal Syndrome (EPS)

A

Most common side effects of antipsychotics are movement disorders referred to as EPS reactions

Acute dystonia
Akathisia
Parkinsonian Symptoms
Tardive dyskinesia

82
Q

acute dystonia

A

an abnormal involuntary movement consisting of slow and continuous muscular contractions or spasms

83
Q

Akathisia

A

compulsion to be in motion and may occur at any time during therapy. The patient might feel restless, feel unable to be still, have an unrelentless desire to move, and feeling “like crawling out of my skin”.

The patient might be pacing, aimlessly walking, shifting weight from one leg to another, & fidgeting. Safety is our primary concern for this patient.

84
Q

Parkinsonian Symptoms

A

bilateral tremors, slow movements, rigidity of muscles, the patient might not be able to move, flat facial expression

85
Q

Tardive dyskinesia

A

irreversible movement disorder.

Patient will have wormlike movements of the tongue, facial grimacing and blinking. Slow involuntary twisting movements of the trunk, face, neck, and eyes.

86
Q

Nursing implications

A

The nurse and patient should decide when a PRN medication is needed

The nurse will need to complete an extensive medication reconciliation

Assess for key persons involved

Ensure a safe environment to enhance communication

Choose the right timing

Communicate effectively

Reinforce teaching

87
Q

Components of a medication assessment for Older Adults

A

Assess if the patient can afford their medications

Assess if the patient has means to get medications refilled

Assess how the patient remembers to take medications as scheduled

Does the patient get routine labs for medication levels?

Can the patient open bottles as needed?

Does anyone help with setting medications out or reminding the patient to take medications?

88
Q

Administration

A

Due to chronic conditions such as osteoarthritis the patient might not able to open medication bottles

Moisten mouth then place pill on the front of the tongue and swallow a fluid

Never crush an enteric coated medication

Use consistent devices for measurement

Transdermal patches should not be cut or altered (always wear gloves to remove and place a patch)

89
Q

Monitoring

A

Assess vital signs and for any changes noted in the patient’s functional abilities/cognitive functioning

TSH monitoring if someone is taking thyroid replacement therapy

INR monitoring for anyone taking warfarin

Hgb A1C monitoring for diabetic patients

Communicate acute changes with the PCP promptly

Be an educator and advocate for your patient

Gero Unit 2 (4 decks)

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