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gero lec 3 Flashcards

1
Q

Aging Changes Affecting: Absorption

A

^ gastric ph
decreased surface for absorption, blood flow to spleen and GI activity

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2
Q

Aging Changes Affecting: Distribution

A

^ body fat
decreased cardiac Output
Total body water
LEAN body mass
Serum albumin
Protein binding

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3
Q

Aging Changes Affecting: Metabolism

A

^ body fat
decreased hepatic mass
Hepatic blood flow
Enzyme activity
Enzyme inductability

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4
Q

Aging Changes Affecting: Excretion

A

decreased renal blood flow
GFR
Tubular secretory function
Kidney size

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5
Q

Normal aging response to geropharmacology

A

Decreased baroreceptor response (higher risk orthostatic hypotension)
Decreased myocardial sensitivity to catecholamines (norepi, epi)
Decreased response of α-adrenergic system Reduced effects due to alterations in adrenergic system activity

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6
Q

Normal aging response to Anticholinergic drugs. What are the side effects to anticholinergic drugs?

A

Can’t…
SEE – blurry vision
PEE – urinary retention
Can’t…
SPIT – dry mouth
SH…..POOP – constipation

Also, confusion and dizziness

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7
Q

Drug supplement interactions: echinacea

A

risk of bleeding, digoxin level altered

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8
Q

Drug supplement interactions: garlic

A

(Risk of bleeding; monitor glucose)

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9
Q

Drug supplement interactions: ginkgo

A

(Risk of bleeding; several meds contraindicated; monitor glucose and BP)

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10
Q

Drug supplement interactions: ginseng

A

(Risk of bleeding; several meds contraindicated)

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11
Q

Drug supplement interactions: Red yeast rice

A

(Risk of bleeding; monitor glucose)

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12
Q

Drug supplement interactions: St Johns wort

A

(several meds contraindicated, monitor lipids, use sunscreen and educate that it may lower progesterone and estrogen levels)

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13
Q

Drug-food interactions

A

May affect absorption
Calcium binds to some meds (reduce absorption)
Grapefruit (increase or decrease bioavailability)
Green Leafy veggies (Contain Vit K, antidote to warfarin, keep intake consistent)
High K+ diet (K+ sparing diuretics, risk of hyperkalemia, keep intake consistent)

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14
Q

Drug-drug interactions

A

 with polypharmacy
Competition for receptor sites ( in bioavailabilty)
Antispasmotics slow GI motility (Competition for plasma proteins to bind to)
Altered distribution (Competition for plasma proteins to bind to)
Altered metabolism
 in pH
Alterations in renal tubules > prolonging half life of some meds
Similar SEs or MOAs (Simultaneous sedative effects)

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15
Q

what are the two types of medications that are specifically less effective with the older population?

A

anticholinergic & sedating medications

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16
Q

what causes higher likelihood of orthostatic hypotension?

A

decreased baroreceptor reflex responses

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17
Q

anticholinergic effects

A

cannot see, pee, spit, shit

dizziness and confusion

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18
Q

which drug class is less effective in older people?

A

A
beta agonists & antagonists

due to decreased responsiveness of the adrenergic system

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19
Q

Beer’s List: what is it?

A

a list of medications that have a higher than usual risk in older adults

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20
Q

ginkgo biloba use

A

improves memory

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21
Q

ginseng use

A

reduces stress

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22
Q

echinacea use

A

think “icky”
for flu and cold

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23
Q

garlic use

A

prevents stroke & arteriosclerosis

that is why you can’t take it with anticoags

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24
Q

glucosamine sulfate use

A

reduced joint pain

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25
Q

red yeast rice use

A

lowers LDL

26
Q

St. John’s wort use

A

mostly used to treat depression (NOT bipolar disorder)

27
Q

CoQ10 use

A

Antioxidant

28
Q

nursing implications for garlic, ginkgo, and ginseng

A

stop 2 weeks before surgery

29
Q

nursing implications for St. John’s wort

A

stop 5 days before surgery

30
Q

pain assessment (OLDCARTS) what does it stand for?

A

Onset
Location
Duration
Characteristic
Aggravation
Relieving factors
Treatments
Severity

31
Q

symptoms of neuroleptic malignant syndome (NMS)

A

hyperthermia, rigidity, altered mental status, tachycardia, and pallor

32
Q

interventions for malignant syndrome

A

avoid direct sunlight
hydration
regular assessment of body temperature

33
Q

what are the barriers to pain management among older adults?

A

HCP
patient (inability to assess pain in cognitively impaired) AND family
healthcare system (cost, time, cultural and political bias on opioid use)

34
Q

true or false: many people believe that pain is a normal part of aging

A

true

35
Q

what factors affect pain and its assessment among the older population

A

pain history
how it affects function
expressions of pain
social resources
how have they managed past pains

36
Q

pain scales for the cognitively impaired, nonverbal adults

A

Pain Assessment in Advanced Dementia Scale (for those who cannot reliably express their pain)
Pain Assessment Checklist for Seniors with Limited Ability to Communicate (observe facial expression, verbalizations, vocalizations, body movements)

37
Q

which medication does CoQ10 affect?

A

anti-hyperlipidemic or anticoagulative drugs

38
Q

what are the nursing actions for echinacea?

A

advise person not to take without provider approval

39
Q

what are the main concerns for administrating medications by enteral tube?

A

occluded tube
reduced effects
drug toxicity
patient harm and death

40
Q

what are the most common OTC meds for older adults? C.A.G.E

A

Cough medicine
Analgesics
GI
Eye drops

41
Q

what are the most common Rx medications for older adults?

A

1) CV
2) diuretics
3) nonopioid analgesics
4) anticoagulants
5) antiepileptics

42
Q

common psychotherapeutic medications

A

1) antidepressants
2) anxiolytic agents
3) mood stabilizers
4) antipsychotics

43
Q

common SNRIs used by the older population

A

Bupropion and Trazodone

44
Q

what is the action of Buproprion?

A

reduces nicotine dependency

45
Q

what is the action of Trazodone?

A

sleep aid

46
Q

common anxiolytics for the older adults

A

Benzodiazepine and Buspirone

47
Q

true or false: bezodiazepines have a fast onset and long half life, and more likely can lead to toxicity

A

true

48
Q

true or false: buspirone must be taken daily

A

true

49
Q

true or false: buspirone takes a week to take into effect, that is why it is prescribed along with benzodiazepine (due to fast onset)

A

true

50
Q

antipsychotic medication action

A

blocks dopamine

51
Q

side effects of antipsychotic medications S.H.A.M.E

A

sedation
hypotension
anticholinergic effects
Malignant syndrome
EPS

52
Q

EPS symptoms

A

movement disorders

dystonia
akathisia
Parkinsonian symptoms
Tardive dyskinesia

53
Q

what do you need to look for with NMS?

A

potential for liver damage and heat stroke (due to hyperthermia and decreased thermoregulation)

54
Q

pseudoparkinsoniansim signs/symptoms T.R.A.P

A

stooped posture
shuffling gait
rigidity
bradykinesia
tremors at rest (pill rolling)

55
Q

akathisia signs/symptoms

A

restless
trouble standing still
paces the floor
in constant motion (moving back and forth)

56
Q

acute dystonia signs/symptoms

A

facial grimacing

involuntary upward eye movement
spasms from the neck (larynx) up to the face

57
Q

tardive dyskinesia signs/symptoms

A

protrusion and rolling of tongue
sucking and smacking movements of lips
facial dyskinesia
involuntary mvmnts of body and extremities
chewing motion

58
Q

what are the indications for polypharmacy?

A

staying in LCT factilities
disabled older adults
multiple HCPs

59
Q

which type of drug can effectively treat neuropathic pain as an adjuvant?

A

tricyclic antidepressants

Amitriptyline, Amoxapine

60
Q

what are other types of adjuvant treatments for pain?

A

corticosteroids
topical agents
muscle relaxants

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