Medication and the OA

Question 1

What is pharmokinetics?

Answer 1

what the body does to the drug.

Question 2

What are the 4 pharmokinetic parameters?

Answer 2

Absorption (how drug gets in), distribution (through body), metabolism (in liver), elimination (through kidneys or bowel)

Question 3

What is absorption?

Answer 3

the passage of medication from its site of introduction into the general circulation. route of administration can be; by mouth through small intestines, cream or lotion through skin transdermally, injections through mm, inhalers through lungs, intravenously

Question 4

What are the age-related changes within absorption?

Answer 4

slower gastric emptying, decreased peristalsis , slower colon transit. these changes arent super clinically significant but smthn to consider

Question 5

What is distribution?

Answer 5

the dispersement of a drug from one part of the body to another. there are different properties of the body that impact distribution, and different properties of the drug that impact distribution. there are age related changes to distribution

Question 6

What are the impacts of age-related changes on the distribution of lipophilic drugs?

Answer 6

fat loving drugs, and fat increase in OAs, so meds bind to fat and are not eliminated as quickly. the consequences are that meds can stay in body longer, which increases the risk of drug toxicity.

Question 7

What are the impacts of age-related changes on the distribution of hydrophilic drugs?

Answer 7

water loving, and water decrease in oas, so theres less water available for drugs to bind to therefore higher concentration of drug, and increased risk of drug toxicity

Question 8

What are the impacts of age-related changes on the distribution of protein (albumin) binding drugs?

Answer 8

less albumin with age, so less bindin and higher concentration of drug, and increased risk of drug toxicity.

Question 9

What is metabolism?

Answer 9

the chemical alteration of a drug by the body. happens on the liver. metabolized by enzymes in intestine, lungs, kidneys and the liver.

Question 10

What are the age-related changes to metabolism?

Answer 10

reduced blood flow through the liver and reduced liver size. changes in enzymatic activity. so medications take longer to metabolize/be broken down and you have increased risk of drug toxicity.

Question 11

What is excretion?

Answer 11

removal of the drug from the body. excreted through kidneys and bowel. properties of the body influence excretion.

Question 12

What are the age-related changes that influence excretion?

Answer 12

decreased blood flow through kidney. decreased kidney function. 2/3 of ppl btwn 70-80 have half the renal fxn of young ppl. can also be due to comorbidities.

Question 13

What are anticholinergic medications?

Answer 13

treat several common problems like sleep problems, motion sickness, diarrhea, parkinson’s disease, colds, cough, allergies

Question 14

what are the effects of anticholinergic medications?

Answer 14

blocks acetylcholine which is a neurotransmitter for both the CNS and PNS. CNS is important for memory and learning and influences lvl of arousal (thats why get sleepy when taking these meds). PNS; decreases HR, increases digestion, increases salivation.

Question 15

What is anticholinergic syndrome?

Answer 15

adverse drug effects related to age-related factors and pathological conditions. the action of the med blocks or inhibits normal body fxn. effects on cogniton; problems with decreased STM, reasoning, and early onset of alzheimers. dry mouth, urinary retention, constipation, blurred vision. increased risk of heat stroke.

Question 16

What is serotonin syndrome?

Answer 16

caused by drugs that increase serotonin in brain. usu anti-depressants opioids, and some cold meds. symptoms can include hyperactive reflexes, repeating reflexes, clonus (uncontrolled mvmt). also confusion and hyperthermia

Question 17

Why are OAs at risk for drug dependence?

Answer 17

chronic conditions that cause pain, whic hmay lead to prescribing opioids. psycho-social changes, meds to relax or sleep, alcohol consumption. need to recognize risks and offer alternative management strategies.

Question 18

What are the risks with benzodiazepines?

Answer 18

common medications, that increase risk for motor vehicle accidents and falls. especially in women bc drug stays in body longer.

Question 19

what are the components of geriatric syndrome?

Answer 19

falls, delirium, urinary incontinence, frailty

Question 20

What is polypharmacy?

Answer 20

when taking a large number of medications (usu more than 5) that are contraindicated, potentially inappropriate, or duplicated or unneccessary.

Question 21

Why are OAs at higher risk for polypharmacy?

Answer 21

OAs have a higher incidence of chronic diseases, media pressure, availability of nutraceuticals, prescribing cascade

Question 22

What is the prescribing cascade?

Answer 22

latrogenic; when an adverse drug reaction is misinterpreted as a new medical condition, a drug is prescribed for the condition, so an additional medication is added to treat these symptoms. even tho its just bc of the first medication.

Question 23

Now why is polypharmacy a risk for OAs? (so how is it harmful)

Answer 23

increases risk for adverse drug effects. increases risk for falls, declines in cog fxn, and phys fxn. greater risk for nonadherence to meds. more meds makes for more risk of medication-medication interaction.

Question 24

What is medication nonadherence?

Answer 24

medication-taking that differs from the prescribed pattern, including missed doses, failure to fill precriptions, or meds taken too frequently. med nonadherence is at 80%.

Question 25

What factors affect med adherence?

Answer 25

complexity of OAs; knowledge, motivation, and fxn. so if they know how and why theyre taking it. also physical impairments with dexterity and vision. psychosocial factors; communication with drs, fear of disclosing info, misconceptions about medication, financial considerations. system issues; lack of info about pt, and what meds theyre taking. pt going to see multiple drs and pharmacies bc doesnt like one. lack of integration in system, HCP dont have enough time to dedicate to pt.

Question 26

How can we reduce the risk for adverse drug effects? What is Beer criteria?

Answer 26

multidimensional interventions, teaching about meds, addressing factors of adherence. using beers criteria that outlines the potential inappropriate meds. reducing polypharmacy.

Question 27

What is deprescribing?

Answer 27

reducing or stopping medications that may not be beneficial or cause harm. prevent prescribing cascade. encourage non pharmalogical pproaches