Module 11- Safe Medication Use for Older Persons

Question 1

Pharmacokinetic changes for older adults

Answer 1

• Adverse drug reactions increase
• Slower metabolism
• Lowered kidney function - excretion is slowed
• Decrease in gastric acid
• Delayed stomach emptying
• Changes to motility

Question 2

Pharmacokinetic - Food interactions changes

Answer 2

• Vegetables containing vitamin K interfere with warfarin

- Milk products can prevent absorption of some antibiotics

Question 3

Pharmacokinetic - Distribution changes

Answer 3

Changes to body composition may slower distribution of medication

Question 4

Pharmacokinetic - Metabolic changes

Answer 4

Liver’s activity, mass, volume and blow flow are reduced so liver function is reduced
- Higher risk for toxicity

Question 5

Pharmacokinetic - Excretion changes

Answer 5

Slower excretion of medications due to lowered kidney function
- Higher risk of toxicity in the kidney

Question 6

What is polypharmacy?

Answer 6

• Use of large numbers of medications
• Use of contraindicated or potentially inappropriate medications
• Use of medications that are duplicated or unnecessary

Question 7

Medication interactions issues

Answer 7

• The more medications interacting the higher the risk of toxicity
• Food and Nutritional supplement interactions
• Alterations in the absorption, distribution, metabolism, or excretion

Question 8

Medication issues - Adverse Reactions

Answer 8

• Unwanted effects ie) Nausea/Vomiting
• Ranges from a minor annoyance to death
• Allergic reactions
• Lowered kidney function
• Lowered liver function
• May be predictable or unpredictable

Question 9

Medication issues - Side effects

Answer 9

• May alter daily activity ie) Drowsiness
• Vision issues
• Hearing issues
• Cognitive issues

Question 10

Interventions to promote medication compliance - Resources and what to do

Answer 10

• Medication Review
• Ask the person how he or she actually takes medicine, rather than depending on label
• Education on side effects
• Monographs /Drug Guide
• Observations and documentation
• Changes in physical, functional and mental status
• Blood work
• Communicate findings of potential problems to charge nurse/physician

Question 11

What defines the misuse of medications in older adults?

Answer 11

• Overuse, under-use, erratic use, and contraindicated use
• Inadequate skills of nurse or doctor (prescribing issues)
• Misunderstanding instructions
• Inadequate funds to purchase prescribed medications - illegal substances

Question 12

Issues concerning psychotropic medication management in older persons

Answer 12

• Movement Disorders (Extra-pyramidal syndrome reactions) - most potential side effect
• Dementia like symptoms
• Change in mental/physical status

Question 13

Nursing education for psychotropic medication

Answer 13

• Encourage questions
• Educate on medications- side/adverse affects
• Assess for medication alternatives
• Pamphlets and booklets written in lay terms/appropriate language
• Communication
• Avoid medication interactions
• Ten rights to medication administration

Question 14

Psychotropic Issues - Acute Dystonia

Answer 14

Involuntary movement disorder

Question 15

Psychotropic Issues - Akathisia

Answer 15

Inability to stop moving

Question 16

Psychotropic Issues - Parkinson’s Syndrome

Answer 16

Symptoms similar to Parkinson’s disease - shakes, slow movement, decrease in fine motor ability and imbalance

Question 17

Psychotropic Issues - Tardive Dykinesia

Answer 17

Irreversible movement disorder