Medications Flashcards
pharmacokinetics
how a drug is absorbed
- meds can be affected by reduced gastric acid, increased gastric pH, delayed gastric emptying, and the presence of other substances (food)
- most PO meds are absorbed in the SI
distributed
metabolized
excreted
pharmacodynamics
how the body is affected by a drug at the cellular level and in relation to the target organ
elimination/serum half-life
the time required to decrease the [drug] by one half of its original value
age-related physiological changes that affect the action of medications in older adults
- decline in renal function (eGFR)
- hepatic blood flow decline
- decreased muscle mass and H2O content
- low serum albumin (protein)
- altered receptor sensitivity
what affects medication-taking behavior
- motivation
- knowledge about the meds
- 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 nasally, transdermally, SC and by other routes
polypharmacy
more meds than are clinically indicated
- about the appropriateness and combination of meds
consider:
- all meds have side-effects
- older adults are more likely to experience stronger side-effects
- ALWAYS consider whether the benefit outweighs the risk
functional consequences associated with medications in older adults
- disease or polypharmacy may alter the therapeutic effects of a med
- adverse effects
- anticholinergic adverse effects
- altered mental status
- antipsychotics in people w/ dementia
- tardive dyskinesia and drug-induces parkinsonism
adverse effects
- higher number of medications
- malnourishment or dehydration
- multiple comorbidities
- an illness that interferes w/ cardiac, renal or hepatic function
- cognitive impairment
- hx of medication allergies or adverse effects
- fever that can alter the action of certain meds
- recent changes in health
- certain meds: anticoagulants/ antiplatelets, antidiabetics, NSAIDs, CNS drugs
anticholinergics
drugs that block the action of acetylcholine, (neurotransmitter or a chemical messenger) that transfers signals between certain cells to affect how your body functions
- they inhibit the parasympathetic (stabilizing) nervous system
anticholinergics cont.
- 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 (primary treatment for dementia)
- safer alternatives usually exist; try to advocate for them
anti-psychotic
- increasingly used in LTC facilities
tardive dyskinesia
- rhythmic involuntary movements of the trunk, extremities, jaw, lips, mouth or tongue
- wormlike movements of the tongue, 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 meds are discontinued
drug-induced parkinsonism
- Parkinson-like symptoms such as shaking, involuntary or poorly controlled movement
- condition can be easily misdiagnosed as Parkinsonism and pts are started on new meds
- manifestations can be reversed if the drug is stopped
nursing assessment
- goals of assessment
- 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
scope of medication assessment
- prescription and OTC medications (all routes) taken regularly
- medications taken PRN
- vitamins, minerals, and dietary supplements
- herb and folk remedies and complementary/alternative modalities
- alcohol, substances
- smoking/inhaling
