gero lec 3 Flashcards
Aging Changes Affecting: Absorption
^ gastric ph
decreased surface for absorption, blood flow to spleen and GI activity
Aging Changes Affecting: Distribution
^ body fat
decreased cardiac Output
Total body water
LEAN body mass
Serum albumin
Protein binding
Aging Changes Affecting: Metabolism
^ body fat
decreased hepatic mass
Hepatic blood flow
Enzyme activity
Enzyme inductability
Aging Changes Affecting: Excretion
decreased renal blood flow
GFR
Tubular secretory function
Kidney size
Normal aging response to geropharmacology
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
Normal aging response to Anticholinergic drugs. What are the side effects to anticholinergic drugs?
Can’t…
SEE – blurry vision
PEE – urinary retention
Can’t…
SPIT – dry mouth
SH…..POOP – constipation
Also, confusion and dizziness
Drug supplement interactions: echinacea
risk of bleeding, digoxin level altered
Drug supplement interactions: garlic
(Risk of bleeding; monitor glucose)
Drug supplement interactions: ginkgo
(Risk of bleeding; several meds contraindicated; monitor glucose and BP)
Drug supplement interactions: ginseng
(Risk of bleeding; several meds contraindicated)
Drug supplement interactions: Red yeast rice
(Risk of bleeding; monitor glucose)
Drug supplement interactions: St Johns wort
(several meds contraindicated, monitor lipids, use sunscreen and educate that it may lower progesterone and estrogen levels)
Drug-food interactions
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)
Drug-drug interactions
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)
what are the two types of medications that are specifically less effective with the older population?
anticholinergic & sedating medications
what causes higher likelihood of orthostatic hypotension?
decreased baroreceptor reflex responses
anticholinergic effects
cannot see, pee, spit, shit
dizziness and confusion
which drug class is less effective in older people?
A
beta agonists & antagonists
due to decreased responsiveness of the adrenergic system
Beer’s List: what is it?
a list of medications that have a higher than usual risk in older adults
ginkgo biloba use
improves memory
ginseng use
reduces stress
echinacea use
think “icky”
for flu and cold
garlic use
prevents stroke & arteriosclerosis
that is why you can’t take it with anticoags
glucosamine sulfate use
reduced joint pain
red yeast rice use
lowers LDL
St. John’s wort use
mostly used to treat depression (NOT bipolar disorder)
CoQ10 use
Antioxidant
nursing implications for garlic, ginkgo, and ginseng
stop 2 weeks before surgery
nursing implications for St. John’s wort
stop 5 days before surgery
pain assessment (OLDCARTS) what does it stand for?
Onset
Location
Duration
Characteristic
Aggravation
Relieving factors
Treatments
Severity
symptoms of neuroleptic malignant syndome (NMS)
hyperthermia, rigidity, altered mental status, tachycardia, and pallor
interventions for malignant syndrome
avoid direct sunlight
hydration
regular assessment of body temperature
what are the barriers to pain management among older adults?
HCP
patient (inability to assess pain in cognitively impaired) AND family
healthcare system (cost, time, cultural and political bias on opioid use)
true or false: many people believe that pain is a normal part of aging
true
what factors affect pain and its assessment among the older population
pain history
how it affects function
expressions of pain
social resources
how have they managed past pains
pain scales for the cognitively impaired, nonverbal adults
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)
which medication does CoQ10 affect?
anti-hyperlipidemic or anticoagulative drugs
what are the nursing actions for echinacea?
advise person not to take without provider approval
what are the main concerns for administrating medications by enteral tube?
occluded tube
reduced effects
drug toxicity
patient harm and death
what are the most common OTC meds for older adults? C.A.G.E
Cough medicine
Analgesics
GI
Eye drops
what are the most common Rx medications for older adults?
1) CV
2) diuretics
3) nonopioid analgesics
4) anticoagulants
5) antiepileptics
common psychotherapeutic medications
1) antidepressants
2) anxiolytic agents
3) mood stabilizers
4) antipsychotics
common SNRIs used by the older population
Bupropion and Trazodone
what is the action of Buproprion?
reduces nicotine dependency
what is the action of Trazodone?
sleep aid
common anxiolytics for the older adults
Benzodiazepine and Buspirone
true or false: bezodiazepines have a fast onset and long half life, and more likely can lead to toxicity
true
true or false: buspirone must be taken daily
true
true or false: buspirone takes a week to take into effect, that is why it is prescribed along with benzodiazepine (due to fast onset)
true
antipsychotic medication action
blocks dopamine
side effects of antipsychotic medications S.H.A.M.E
sedation
hypotension
anticholinergic effects
Malignant syndrome
EPS
EPS symptoms
movement disorders
dystonia
akathisia
Parkinsonian symptoms
Tardive dyskinesia
what do you need to look for with NMS?
potential for liver damage and heat stroke (due to hyperthermia and decreased thermoregulation)
pseudoparkinsoniansim signs/symptoms T.R.A.P
stooped posture
shuffling gait
rigidity
bradykinesia
tremors at rest (pill rolling)
akathisia signs/symptoms
restless
trouble standing still
paces the floor
in constant motion (moving back and forth)
acute dystonia signs/symptoms
facial grimacing
involuntary upward eye movement
spasms from the neck (larynx) up to the face
tardive dyskinesia signs/symptoms
protrusion and rolling of tongue
sucking and smacking movements of lips
facial dyskinesia
involuntary mvmnts of body and extremities
chewing motion
what are the indications for polypharmacy?
staying in LCT factilities
disabled older adults
multiple HCPs
which type of drug can effectively treat neuropathic pain as an adjuvant?
tricyclic antidepressants
Amitriptyline, Amoxapine
what are other types of adjuvant treatments for pain?
corticosteroids
topical agents
muscle relaxants
