Medication Safety and Management

Question 1

Adverse Effects of Opioids

Answer 1

Constipation
Nausea and vomiting
Orthostatic hypotension
Dizziness
Potential CNS (respiratory) depression
Confusion, drowsiness

Question 2

Pharmacokinetics vs pharmacodynamics

Answer 2

Pharmacokinetics: how a drug is absorbed (most PO in SI), distributed, metabolized and excreted

Pharmacodynamics: how the body is affected by a drug at the cellular level in relation to the target organ

Question 3

5 Age-related physiological changes that affect the action of medications in OA

Answer 3

• Decline in renal function (eGFR)
• Hepatic blood flow declines (slower drug clearance)
• Decreased muscle mass and water content
• Low serum albumin protein
• Altered receptor sensitivity

Question 4

Polypharmacy

Answer 4

More medications than clinically indicated. Not number, but appropriateness and combination of medications (benefits > risks)

Question 5

9 factors that increase OA’s risk for adverse effects

Answer 5

• Higher number of meds
• Malnourishment or dehydration
• Multiple comorbidities
• An illness that interferes with cardiac, renal, or hepatic function
• Cognitive impairment
• Hx of med allergies or adve4rse effects
• Fever that can alter med action
• Recent change in health
• Certain meds: anticoagulants, antidiabetics, NSAIDs, CNS drugs

Question 6

Anticholinergic definition and adverse effects

Answer 6

• Drugs that block the action of acetylcholine, a neurotransmitter, or a chemical messenger
• Includes OTC cold and sleep meds
• examples: antihistamines (allergies), antidepressants, antipsychotics, CV agents, antiparkinsonians, GI and urinary agents
• Can counteract treatment for dementia (cholinesterase inhibitors)
• Long-term cognitive impairment such as delirium

Question 7

2 Risk factors of antipsychotics

Answer 7

• Tardive dyskinesia - rhythmic involuntary movement of the trunk, extremities, jaw, lips, mouth, tongue, eye blinking (can begin 3-6 months after initiation of antipsychotics)
• Drug-induced parkinsonism (reversible if drug is stopped, can be misdiagnosed as the condition)

Question 8

What are BEERS drugs and what is the screening process?

Answer 8

• A list of meds known to increase the risk of DELIRIUM and other adverse reactions in older adults
• Not prescribed for OA unless benefits > risks, then use for the shortest possible duration

3 categories: Potentially inappropriate meds for OA…
1. by organ system (anticholinergics, antithrombotics, anti-infective, CV, CNS, endocrine, GI, pain)
2. resulting from drug effects that may exacerbate the disease (HF, syncope, chronic seizures, delirium, dementia, falls, insomnia, Parkinson, chronic constipation)
3. that should be used cautiously (aspirin for cardiac events, antipsychotic and vasodilators)

Question 9

Medication Reconciliation

Answer 9

Nursing intervention to ID meds at any transition in care, view all meds, and address ability to get prescriptions filled and issues that affect adherence (whether Pts take meds as prescribed). Decrease number of meds, encourage nonpharmacologic approach.

Question 10

Risk factors that affect medication-taking behaviours

Answer 10

• Motivation
• Knowledge about the purpose
• Cultural and psychosocial influences
• Ability to understand directions of admin
• Med myths and misunderstandings
• Polypharmacy
• Inadequate monitoring/Medication nonadherence
• Financial concerns