lect 3: chapter 9 Flashcards
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?
beta agonists & antagonists
due to decreased responsiveness of the adrenergic system
Beer’s List
a list of medications that have a higher than usual risk in older adults
what physiologic problems do older adults have regarding medications?
- increased gastric pH
- decreased GI motility and absorption
- decreased metabolism
ginkgo biloba
improves memory
ginseng
reduces stress
echinacea
cold and flu therapy
garlic
prevents stroke & arteriosclerosis
that is why you can’t take it with anticoags
glucosamine sulfate
reduced joint pain
red yeast rice
lowers LDL
St. John’s wort
mostly used to treat depression (NOT bipolar disorder)
CoQ10
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)
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)
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 nursing actions for garlic?
monitor glucose levels
what are the nursing actions for ginkgo?
monitor glucose levels and BP
what are the nursing actions for red yeast rice?
- warn patient of increased risk for bleeding
- monitor glucose levels
what are the nursing actions for St. John’s Wort?
- monitor lipid levels
- use sunscreen
- educate that it may lower estrogen/ progesterone levels
what are the main concerns for administrating medications by enteral tube?
- occluded tube
- reduced effects
- drug toxicity
what are the most common OTC meds for older adults?
- GI
- analgesics
- cough medicine
- eye drops
- vitamins
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
bezodiazepines have a fast onset and long half life, and more likely can lead to toxicity
true
buspirone must be taken daily
true
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
- sedation
- hypotension
- anticholinergic effects
- EPS
- Malignant Syndrome
EPS
extrapyramidal 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
- stooped posture
- shuffling gait
- rigidity
- bradykinesia
- tremors at rest (pill rolling)
akathisia
- restless
- trouble standing still
- paces the floor
- in constant motion (moving back and forth)
acute dystonia
facial grimacing
involuntary upward eye movement
spasms from the neck (larynx) up to the face
tardive dyskinesia
- 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
