Medications

Question 1

Definition: Pharmacokinetics

Answer 1

How a drug is absorbed, distributed, metabolized
and excreted

Question 2

Definition: Pharmacodynamics

Answer 2

How the body is affected by a drug at the
cellular level and in relation to the target organ

Question 3

Elimination/ Serum Half-Life

Answer 3

the time required to decrease the drug
concentration by one half of its original value

Question 4

Pharmacokinetics

Answer 4

• Absorption of oral (PO) medications can be
  affected by reduced gastric acid, increased
  gastric pH, delayed gastric emptying, and
  the presence of other substances (ie. food).
• Most PO meds are absorbed in the small
  intestine.
• It takes 5 half-lives to reach steady-state
  concentrations after a drug is initiated OR
  to eliminate a drug from the body after the
  drug is discontinued.

Question 5

Age-Related Physiological Changes that Affect the
Action of Medications in Older Adults

Answer 5

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

Question 6

What Affects medication-taking Behavior?

Answer 6

• Motivation
• Knowledge about the medication
• Cultural and psychosocial influences
• Physical ability to remove the substance from the container and administer it
• Ability to swallow oral preparations
• Additional skills related to administer nasal, transdermally, SC and by other routes

Question 7

What is Polypharmacy

Answer 7

More medications than are clinically indicated.
- Not about the number of medication

• About the appropriateness & combination of
  medications

Consider:
- All medications have side-effects

- Older adults are more likely to experience stronger
    side-effects

- ALWAYS consider whether the benefit outweighs the
     risk

Question 8

Functional
Consequences
Associated with
Medications in
Older Adults

Answer 8

• Disease or polypharmacy may alter the
  therapeutic effects of a medication
• Adverse effects
• Anticholinergic Adverse Effects
• Altered mental status
• Antipsychotics in people with dementia
• Tardive Dyskinesia and Drug-Induced
  Parkinsonism

Question 9

Adverse Effects Factors that increase older
adults’ risk for adverse events are:

Answer 9

• Higher number of medications
• Malnourishment or dehydration
• Multiple comorbidities
• An illness that interferes with cardiac, renal or
  hepatic function
• Cognitive impairment
• History of medication allergies or adverse effects
• Fever that can alter the action of certain
  medications
• Recent change in health
• Certain medications: anticoagulants/
  antiplatelets, antidiabetics, NSAIDs, CNS drugs

Question 10

Anti-Cholinergics

Answer 10

• Anticholinergics are drugs that block the
  action of acetylcholine, a neurotransmitter,
  or a chemical messenger, that transfers
  signals between certain cells to affect how
  your body functions.
• They inhibit the parasympathetic (stabilizing) nervous
  system.

Question 11

Anti-psychotics

Answer 11

• Increasingly used in LTC facilities.
• US is restricted by FDA to prescribe
  antipsychotics ONLY for psychotic symptoms,
  not for wandering, anxiety, or insomnia.
• Not similar in Canada.
• Studies confirm need for education of
  nursing staff to improve knowledge,
  attitudes and beliefs about antipsychotic use
  for nursing home residents.

Question 12

What are Anti-cholinergics used for

Answer 12

• OTC medications used for coughs, colds, flu and
  sleep problems.
• Treatments for older adults (antihistamines,
  antidepressants, antipsychotics, CV agents,
  antiparkinsonians, GI and urinary agents).
• Contribute to long-term cognitive impairment.
• Can counteract the effects of cholinesterase
  inhibitors, a primary treatment for dementia.
• Safer alternatives usually exist; try to advocate
  for them.

Question 13

Tardive Dyskinesia

Answer 13

• Rhythmic involuntary movements of the
  trunk, extremities, jaw, lips, mouth or
  tongue.
• Wormlike movements of the tongue,
  chewing, grimacing, lip smacking, jaw
  clenching, eye blinking, and side-to-side jaw
  movements.
• Can begin 3-6 months after initiation of
  antipsychotic use and persist after
  medication is discontinued.

Question 14

Drug-Induced Parkinsonism

Answer 14

• Parkinson-like symptoms such as shaking,
  involuntary or poorly controlled movement.
• Condition can be easily misdiagnosed as
  Parkinsonism and patients are started on
  new medications.
• Manifestations can be reversed if the drug is
  stopped.

Question 15

BEERS

Answer 15

• A list of medications known to increase
  the risk of delirium and other adverse
  reactions in older adults.
• These medications should not be
  prescribed for older adults unless there is
  a greater benefit-risk ratio for a particular
  situation, and then should only be used
  for the shortest possible duration.

Question 16

Medications are safest
and most therapeutic
when taken as
prescribed and when
they are regularly
reviewed

Question 17

Nursing Goals of Assessment

Answer 17

• Determine effectiveness of existing
  regimen
• Identify any factors that interfere with the
  current regimen
• Ascertain risks for adverse effects or
  altered therapeutic actions
• Detect adverse medication effects
• Identify teaching needs regarding
  medications

Question 18

Scope of Medication Assessment

Answer 18

• Prescription and OTC medications (all routes)
  taken regularly
• Medications taken “as needed” or PRN
• Vitamins, minerals, and dietary supplements
• Herb and Folk remedies and complementary/
  alternative modalities
• Alcohol, substances
• Smoking/inhaling

Question 19

Medication Reconciliation

Answer 19

• Identifying medications at any transition in
  care
• View all the medications
• Address ability to get prescriptions filled
• Address issues that affect adherence
• Allow the client to ask questions

Question 20

Nursing Intervention

Answer 20

• Recommend all older adults have a list of what the are currently
  taking
• Ensure clients and caregivers understand the appropriate use of
  “as needed” (PRN) medications
• Encourage use of devices and systems to improve medication
  adherence (ie. pillboxes, blisterpacks, etc.)
• Encourage nonpharmacologic approaches to manage behavior
• Decrease number of medications
• Assess for financial barriers: Generic vs brand

Question 21

Interdisciplinary
Intervention

Answer 21

• Encourage a review of medications with primary
  physician at every visit
• The pharmacist’s role is to review specific
  actions and interactions of medications
• Advocate for referral to Seniors Clinic for followup of complex clients
• Refer to Home Care if assistance is required for
  medication administration
• Social Worker referral for assistance with
  financing

Question 22

A healthy 70-year-old has been using diphenhydramine (Benadryl) for allergic rhinitis. One week later, the client begins to exhibit signs of confusion and disorientation. The spouse calls the primary care facility to speak with the nurse. Which event should the nurse suspect first?

Question 1Select one:

a.
The older adult has dehydration, leading to delirium.

b.
The older adult is having transient ischemic attacks/strokes.

c.
The older adult has an overwhelming infection.

d.
The older adult is experiencing an adverse drug effect.

Answer 22

The older adult is experiencing an adverse drug effect.

Question 23

A nurse assesses an older adult who has been having a difficult time sleeping throughout the night and incontinence. Which question by the nurse will best provide clues to these problems?

Question 2Select one:

a.
“What medications do you take when you need to stay asleep?”

b.
“What did your health care practitioner tell you about your medications?”

c.
“How many times a night do you get up to urinate?”

d.
“What beverages do you drink on a regular basis?”

Answer 23

“What beverages do you drink on a regular basis?”

Question 24

A nurse initiates an acute care for elders unit in a medical facility. Which factor should the nurse include when teaching the nursing staff about delivering medications to the older adults on the unit?

Question 3Select one:

a.
Drug metabolism shifts from the liver to the kidneys as individuals age.

b.
Older adults tend to need more frequent doses of a drug to achieve therapeutic effect.

c.
Older adults face an increased risk of adverse medication effects.

d.
Older adults tend to achieve clearance of medication faster than do younger clients.

Answer 24

Older adults face an increased risk of adverse medication effects.

Question 25

A nurse is conducting a medication assessment of an older adult. Which statement by the older adult indicates a need for further education?

Question 4Select one:

a.
“My family doctor has me on so many different pills now, so I want to talk about whether they’re all necessary.”

b.
“I’ve made a reminder system for myself so that I don’t miss any of my pills during the day.”

c.
“Overall, I much prefer to prevent getting sick than having to rely on different drugs to stay healthy.”

d.
“I use a lot of herbs and supplements, but I’m careful to make sure that they’re all natural.”

Answer 25

“I use a lot of herbs and supplements, but I’m careful to make sure that they’re all natural.”

Question 26

A nurse reviews the medication list of an older adult. Which age-related change leads to a slower drug clearance?

Question 5Select one:

a.
Decrease in hepatic blood flow

b.
Increase in glomerular filtration rate

c.
Increase in sensitivity to bioactive substances

d.
Elimination half-time is likely to be faster.

Answer 26

Decrease in hepatic blood flow

Question 27

A nurse is conducting a medication assessment of an older adult client who will soon be receiving home care. Which question is not necessary for the nurse to include in this assessment?

Question 6Select one:

a.
“Do you use any herbs or dietary supplements?”

b.
“What is your typical diet?”

c.
“Are you a smoker?”

d.
“Do you drink alcohol?”

e.
“What over-the-counter drugs do you use?”

Answer 27

“What is your typical diet?”

Question 28

Having completed a medication assessment and physical assessment of a new client, a home care nurse is now creating nursing diagnoses and choosing interventions appropriate to these diagnoses. What factor should the nurse prioritize in this process?

Question 7Select one:

a.
The importance of fostering client compliance

b.
The importance of the client’s safety

c.
The nurse’s responsibility to teach the client and minimize liability

d.
The need to maintain the client’s autonomy

Answer 28

The importance of the client’s safety

Question 29

A nurse reviews the medication list of an older adult upon transfer from the hospital to an extended care facility. Which method is most likely to reduce the occurrence of adverse effects?

Question 8Select one:

a.
Compare the list to the Beers criteria list and notify the health care provider of any on the list.

b.
Stop the administration of GI and narcotic pain medications.

c.
Request that the client’s medications be put on hold and restarted one at a time.

d.
Administer medications at the same time every day with meals.

Answer 29

Compare the list to the Beers criteria list and notify the health care provider of any on the list.

Question 30

A nurse notes that an older adult is unable to process complex thoughts and has difficulty forming sentences. Which action by the nurse is priority?

Question 9Select one:

a.
Review medication administration record.

b.
Assess muscle strength and deep tendon reflexes.

c.
Orient the client to environment.

d.
Place the client on high fall-risk precaution.

Answer 30

Review medication administration record.

Question 31

A home care nurse admits an older adult with macular degeneration. Which assessment question is most appropriate?

Question 10Select one:

a.
“How many medications do you take each day?”

b.
“How do you organize your medications?”

c.
“Do you have difficulty opening your medication bottles?”

d.
“What medications do you take each day?”

Answer 31

“How do you organize your medications?”