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Gerontological Nursing > Lecture #3 > Flashcards

Lecture #3 Flashcards

1
Q

Geropharm Background

A

65+ largest consumer of medications
12% of population
1/3 of medication consumers
1/2 of OTCs

94% take Rx meds
46% take OTCs
53% take supplements

most common Rx med in older adults:
CV
diuretics
non-opioid analgesics
anticoagulants
antiepileptics

most common OTCs meds in older adults:
GI
analgesics
cough products
eye washes
vitamins

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2
Q

study of the movement and actions of a drug in the body: absorption, distribution, metabolism, and excretion

A

pharmacokinetics

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3
Q

aging changes affecting: absorption

A

increased: gastric pH
decreased: surface for absorption, blood flow to SPLEEN, GI activity

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4
Q

aging changes affecting: distribution

A

increased: body fat
decreased: cardiac output, total body H2O, LEAN body mass, serum albumin, and protein binding

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5
Q

aging changes affecting: metabolism

A

increased: body FAT
decreased: hepatic mass, hepatic blood flow, enzyme activity, and enzyme inductability

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6
Q

aging changes affecting: excretion

A

decreased: renal blood flow, GFR, tubular secretory function, and kidney size
think = TOXICITY!!

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7
Q

physiological processes between drug and body
the older a person gets, the more likely they will have an alteration or unreliable response to drug
less reliable and more unpredictable

A

pharmacodynamics

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8
Q

What is decreased in normal aging?

A

baroreceptor response
myocardial sensitivity to catecholamines (nor-epi, epi)
response of a-adrenergic system

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9
Q

what are the increased sensitivity to anticholinergic effects?

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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10
Q

what are the increased sensitivity to diuretics?

A

reduce baroreceptor response – higher risk of orthostatic hypotension

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11
Q

what are the increased sensitivity to beta agonist and antagonists?

A

reduced effects due to alterations in adrenergic system activity

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12
Q

taking multiple medications at same time:
20% 65+ adults take 10+ meds
more meds take in LTC facilities
disabled have higher %

increased risk for drug interactions
increased risk of adverse events

A

polypharmacy

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13
Q

what are the drug-supplement interactions? echinacea

A

risk of bleeding; digoxin level altered)

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14
Q

what are the drug-supplement interactions? garlic

A

risk of bleeding; monitor glucose

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15
Q

what are the drug-supplement interactions? Ginkgo

A

risk of bleeding; several meds contraindicated; monitor glucose

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16
Q

what are the drug-supplement interactions? Ginseng

A

risk of bleeding; several meds contraindicated

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17
Q

what are the drug-supplement interactions? red yeast rice

A

risk of bleeding; monitor glucose

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18
Q

what are the drug-supplement interactions? St. john’s wart

A

several med contraindicated

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19
Q

What are some food-drug interactions?

A

Ca+ binds to some meds (reduces absorption)
grapefruit (increases or decreases bioavailability)
green leafy veggies (contain vitamin K, antidote to warfarin, keep intake consistent)
high K+ diet (K+ sparing diuretics, risk of hyperkalemia, keep intake consistent)
may affect absorption

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20
Q

what happens with drug-drug interactions?

A

increase with polypharmacy
competition for receptor sites (triangle in bioavailability)
antispasmodics slow GI motility (competition for plasma proteins to bind to)
altered metabolism
triangle in pH
alterations in renal tubules > prolonging half life of some meds
similar SEs or MOAs (simultaneous sedative effects)

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21
Q

what are some high risk for medication errors?

A

occluded tube
reduced drug effect
drug toxicity
patient harm
patient death

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22
Q

What do you need to know about adverse drug reactions? (ADRs)

A

not just a SE
one drug or from two (or more) drugs together)
reactions causing or potentially causing harm
sometimes predictable (can be proactive)
sometimes unpredictable (allergic reactions, bleeding risk)
often overlooked in older adults
prevention (lover dosages, “start low, go slow, but go”

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23
Q

drugs identified to have a higher than usual risk when used in older adults

overwhelming benefit vs. risk documentation when prescribing these drugs considered a standard of practice

use as guide, not absolute direction

“safety alert: do not use list”

A

Beer’s List

(not an absolute! can’t always be avoided. collaborate w/ provider to reduce or change to other options when possible)

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24
Q

what are the psychotherapeutics in late life?

A

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

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25
What are some antidepressants?
SSRIs SNRIs
26
SSRIs: what neurotransmitter?
Serotonin
27
Selective SEROTONIN reuptake inhibitor (SSRIs):
first line work well in older small doses effective often have sexual side effects --> switch to SNRIs
28
SNRIs: what neurotransmitter?
Serotonin Nor-epinephrine
29
SEROTONIN & NOR-EPI reuptake inhibitor (SNRIs)
second line less sexual side effects Bupropion (Wellbutrin): reduces nicotine dependency as well Trazodone: also used as a sleep aid
30
What is serotonin syndrome?
excessive amounts of serotonin can cause this. It is characterized by an altered mental status, high fever, sweating, and clonus. Clonus is an involuntary, rhythmic muscle contraction.
31
Benzodiazepines:
ends in "am" highly effective fast onset but long half life side effects: drowsiness, confusion, dizziness, impaired coordination (increasing risk for falls and accidents), depression, and increased anxiety
32
Buspirone (BuSpar)
taken daily no effect until about one wk
33
used to treat psychosis (sometimes as mood stabilizer) blocks dopamine
antipsychotics
34
what are some side effects of antipsychotics?
sedation hypotension anticholinergic effects extrapyramidal syndrome (ESP) = dystonia akathisia Parkinsonian symptoms tardive dyskinesia
35
what is malignant syndrome?
meds affect hypothalamus and thermoregulation increased temp: intolerant to warm temps assess temp regularly, keep hydrated, cool baths, fans potential for liver damage and heat stroke
36
what are some movement disorders?
pseudoparkinsonism acute dystonia akathisia tardive dyskinesia
37
what does pseudoparkinsonism look like?
stooped posture shuffling gait rigidity bradykinesia tremors at rest pill-rolling motion of the hand
38
what does acute dystonia look like?
facial grimacing involuntary upward eye movement muscle spasms of the tongue, face, neck, and back (back muscle spasms cause trunk to arch forward) laryngeal spasms
39
what does akathisia look like?
restless trouble standing still paces the floor feet in constant motion, rocking back and forth
40
what does tardive dyskinesia look like?
protrusion and rolling of the tongue sucking and smacking movements of the lips chewing motion facial dyskinesia involuntary movements of the body and extremities
41
promoting health aging implications for gerontological practice
monitor for potential drug reactions, s/s of ADR prompt recognition of changes in pt status pt and family education on purpose and side effects of all meds
42
How do you assess medication use?
Ask person to bring in all medications being taken, including OTCs, herbals, and dietary supplements Ask person how he or she actually takes medicine rather than depending on label Assess: readiness to learn, ability to comprehend, functional ability to make lifestyle changes for med management Educate & Promote adherence
43
50-60% of older adults use these (vitamins, non-herb, herb) often believe that they are natural and safe higher use when unsatisfied with medical care grossly under reported
herbs and supplements
44
what are the standards in manufacturing herbs and supplements?
overall considered dietary supplement: much less scrutiny the meds manufactures may not say that herbs and supplements: prevent disease, treat, or cure disease differences in manufacturing: Small business making H&S in small labs with no regulation. Some conduct scientific research to evaluate efficacy. Often with lots of fillers- soybeans, rice, yeast FDA approves only a few: Aloe, psyllium, capsicum, witch hazel, cascara, senna, and slippery elm. Those non-FDA approved may still have positive benefits
45
cold and flu therapy taken in tea from, but can be used as tincture Contraindications: allergy to daisy plant, HIV, autoimmune disease
Echinacea
46
to prevent stoke and arteriosclerosis mixed results from the research (reduced blood clots, reduce LDL & 2 meta-analysis show it lowers BP) contrindications: use with anticoagulants (remember many cardiac pts are anti-coagulated should be approved by healthcare provider
garlic
47
what are side effects for garlic?
flatulence bleeding risk nausea heart burn hypotension hypoglycemia
48
what are side effects for echinacea?
fever sore throat N/V/D abd pain
49
used to improve memory there is NO evidence showing it improves memory contraindications: use with anticoagulants, antihypertensives, antidepressants, pts w/ seizure disorder should be approved by healthcare provider (most will say avoid)
Ginkgo Biloba
50
what are side effects of ginkgo biloba?
bleeding risk GI upset headache heart palpitations dizziness weakness constipation. hypotension
51
reduces stress, lowers LDL, lowers glucose, immune stimulant, erectile dysfunction research is weak, overall contraindications: use with anti-diabetics, anti-coagulants, anti-hypertensives, immunosuppressants, stimulants, MAOIs should be approved by healthcare provider
Ginseng (root of plant)
52
what are the side effects for ginseng?
HTN (possible hypo) risk of bleeding edema diarrhea mania (in those w/ bipolar)
53
reduce joint pain improve function of knees with OA often used in conjunction with chondroitin evidence leans toward supporting efficacy overall, well tolerated contraindications: shellfish allergy and glaucoma (increases IOP) use w/ caution with anti-diabetics and HTN
glucosamine sulfate
54
what are side effects of glucosamine sulfate?
GI upset headache insomnia rash hypoglycemia
55
used to lower LDL evidence leans toward supporting efficacy contraindications: liver dysfunction or elevated LFTs use with other hepatotoxic meds
red yeast rice
56
what are side effects of red yeast rice?
muscle pain liver damage heartburn bloating flatulence dizziness
57
mostly used to treat depression evidence is mixed contraindications: use with triptans, MAOIs, digoxin, and anti-depressants (overall, avoid in OLDER adults) should be approved by healthcare provider
St. John's wort
58
What are side effects and severe reactions with St. John's Wart?
side effects: photosensitivity rash GI upset restlessness anxiety headache severe reactions: mania hypomania suicidal/homicidal ideations
59
powerful antioxidant to reduce risk of MI, improve HF and BP mixed evidence most common use: along with statins and statins reduce natural levels of this side effects: some GI upset (overall, tolerated well) increase effectiveness of anti-hypertensives (monitor BP) reduce effectiveness of anti-coagulants
Coenzyme Q 10 (CoQ10)
60
Herb and supplement interactions w/ standardized drugs
Many herb and supplement products interact with prescription or over-the-counter medications, foods, and/or other herbs and supplements The more herbs and other drugs that the client is taking, the more likely it is that an interaction will occur
61
misuse of herbal and dietary supplements:
Patients often do not reveal use of herbs and supplements to provider Failure to share important health information can severely jeopardize client Many products may have serious consequences of misuse based on actions or interactions with individual’s current health status You must ask the right questions!
62
Nursing implications with herbs and supplements:
Proper assessment of herbs and supplements Inform clients of benefits and harms Manufacturing No standardization Where to obtain quality agents Assess for SEs, interactions, urge to stop if any issues, and talk to HCP Recommending H&S is a prescriptive action Stay within your scope, even when making informal recommendations
63
perioperative implications with herbs/supplements?
Garlic – stop 2 wks before surgery Ginkgo – 2 wks Ginseng – 2 wks St Johns wort – 5 days
64
pain and comfort in older adults:
Pain management is a patient right “5th vital sign” A key nursing quality indicator in acute care and LTC setting Undertreated in older adults, especially in elders of color and cognitively impaired adults.
65
pain at the end of life:
Most common and most feared symptom of people at end of life Comprehensive and multifactorial assessment by interdisciplinary team is key to management
66
Temporary Postoperative, procedural, and traumatic pain Easily controlled by analgesic
acute pain
67
No time frame Persistent at varying levels of intensity More difficult to control
persistent pain
68
most common cause of non-cancer pain in older adults are...
Musculoskeletal: arthritis and degenerative spinal conditions Neuropathic: diabetes, peripheral vascular disease (PVD), herpes zoster, and stroke
69
What are consequences of untreated pain?
falls and other accidents functional impairment slowed rehabilitation mood changes increased health care cost caregiver strain sleep disturbances changes in nutritional status impaired cognition increased dependency and helplessness depression, anxiety, fear decline in social and recreational activities increased health care utilization and costs
70
Pain in cognitively impaired elders:
Consistently untreated or under-treated for pain Careful observation and caregiver reports need to be used if person cannot reliably communicate pain Non-verbal expressions of pain: Behavioral changes Changes in ADL’s Vocalizations Physical changes
71
pain scales and assessment:
Standard of care in pain assessment Multiple scales available for cognitively intact older adults Cognitively impaired non-verbal adults require close assessment of cues and behaviors to evaluate presence of pain PAINAD PACSLAC
72
what are non-opioid analgesics pharmacological interventions to promote comfort?
Acetaminophen Maximum dose 4000mg(4gm) in 24 hours from all sources Monitor renal and hepatic function NSAIDS Safety alert—Aspirin and NSAID use --> When taken together decrease cardio-protective affect of aspirin Associated with significant number of adverse drug events in older adults Cox-2 inhibitors also have serious side effects
73
what are opioid analgesics pharmacological interventions?
Demerol (meperidine) contraindicated in older adults Begin with short acting low dose medications and titrate to response and side effects Age-related changes may produce a greater analgesic effect, a higher peak, and longer duration of effect Sedation, respiratory depression, and impaired cognition often occur Increased risk for falls and injury Bowel regimen necessary to prevent constipation Pain management consult for unrelieved pain
74
Use of adjuvant meds in pain management:
Tricyclics for neuropathic pain Avoid drugs that precipitate or potentiate extrapyramidal symptoms Avoid tranquilizers that produce sedation and have long half-life --> Drugs with short half-life are more suitable Corticosteroids Topical agents Muscle relaxants
75
What is the three-step analgesic ladder? World health organization (WHO)
#1 = non-opioid + adjuvant --> pain persisting or increasing #2 = opioid for mild to moderate pain + non-opioid + adjuvant --> pain persisting or increasing #3 = opioid for moderate to sever pain + non-opioid + adjuvant --> freedom from pain
76
Non-Pharm measures to promote comfort?
energy/touch therapies transcutaneous electrical nerve stimulation (TENS) acupuncture and acupressure relaxation, meditation, and guided imagery music hypnosis activity cognitive-behavioral therapy
77
Promoting healthy aging: implications for gero nursing
Pain clinics Provide specialized, comprehensive, and multidisciplinary approach to pain management that has not responded to standard approaches
78
promoting healthy aging: implications (pt.2)
Experience of pain is multifactorial with physical, psychological, and spiritual components Pain is subjective; unique to each person Careful assessment of presence or absence of pain is possible regardless of cognitive status of person It is never acceptable to fail to treat pain to the extent possible Western and complementary therapies both work together to manage pain Frequent qualitative and quantitative reevaluation of perceived pain is necessary to provide adequate pain relief and promote patient comfort

Gerontological Nursing (26 decks)

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