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OA Exam 1 > OA: Med Safety > Flashcards

OA: Med Safety Flashcards

1
Q

GI changes in OA regarding medications

A
  • decreased acidity

- decreased blood flow to GI tract and GI motility delay the time it takes for meds to absorb

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2
Q

Fat/water distribution in OA regarding medications

A

-more fat, less water

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3
Q

Decreased available proteins lead to…

A

levels of unbound drug increase in blood stream

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4
Q

Renal function and OA meds

A

-decrease in renal function means drug not eliminated and drug level increases

decreased renal function —> increased drug levels

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5
Q

Liver function and OA meds

A

decreased hepatic enzymes —> increased drug levels

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6
Q

Functional decline in OA

A
  • cognition
  • taste
  • hearing
  • manual dexterity
  • vision
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7
Q

Polypharmacy

A

use of four or more medications by a patient, generally adults aged over 65 years

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8
Q

Risks with polypharmacy

A

increased risk of ADRs and drug interactions

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9
Q

Causes of polypharmacy

A
  • comorbidities
  • multiple providers
  • herbal therapy
  • OTC meds
  • “discontinued” rx drugs
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10
Q

ADRs

A

Adverse Drug Reactions

-3 to 4x greater than those in middle-aged and young adults

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11
Q

Reasons for ADRs

A
  • increase number of prescriptions
  • physiologic changes (general and individual)
  • therapeutic ranges may lead to toxicity
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12
Q

Causes of ADRs

A
  • living arrangements
  • multiple providers
  • incorrect/inappropriate drug dosing
  • providers unaware of self-med habits
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13
Q

Self-med Practices

A
  • OTC
  • herbals
  • rx meds
  • non-adherence of med regimen
  • expired meds
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14
Q

Ways OA do not adhere to medication regimen

A
  • overuse
  • underuse
  • erratic use
  • confusion or lack of knowledge
  • financial (“stretch out” meds to last longer)
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15
Q

Types of ADRs

A
  • falls
  • bleeds
  • confusion
  • renal/liver impairment
  • electrolyte imbalances
  • orthostatic hypotension
  • drug to drug interactions
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16
Q

National Patient Safety Goals for Safe Med in OA

A
  • take extra care of patients who take medicines to thin their blood
  • record and pass correct info about meds
  • find out what meds pt is taking
  • compare meds to new meds given to the patient
  • make sure pt knows what meds to take at home
  • tell pt it is important to bring up-to-date meds every time they visit the doctor
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17
Q

Beer’s Criteria

A
  • evidence based

- list of inappropriate meds (PIMs) in OA 65 and up

18
Q

3 categories of Beer’s Criteria

A
  1. PIMs to avoid in all OAs
  2. PIMs to avoid in OAs with certain diseases
  3. Meds to be used with caution in OAs
19
Q

PIM

A

Potentially Inappropriate Medications

20
Q

Most Common Drugs with ADRs

A
  • cardiovascular agents
  • antibiotics
  • diuretics
  • anticogulants
  • hypoglycemics
  • steroids
  • opioids
  • anticholinergics
  • benzodiazepines
  • NSAIDs
21
Q

Risks for OA: Anticoagulants

A

OTC meds may interact

22
Q

Risks for OA: Antihistamines (1st generation)

A

anticholinergic effects

23
Q

anticholinergic effects

A

dry mouth, constipation, urinary retention, highly sedating

24
Q

Risks for OA: Diuretics & Antihypertensives

A
  • give reduced doses to decreased side effects

- non-pharmacologic methods suggested to decrease BP

25
Q

Risks for OA: Selective NSAIDs

A

Naproxen: GI bleed, renal failure, HTN, CHF

26
Q

Risks for OA: Long acting Benzodiazepams

A

(hypnotics)

  • half-life exceeds 24 hrs
  • increased sedative effect and risk of falls
  • short term therapy suggested with low doses
27
Q

Risks for OA: Antipsychotics in dementia

A

increased risk of CVA and mortality

28
Q

Risks for OA: Opioid analgesics

A

hypotension, respiratory depression, constipation

29
Q

Risks for OA: Muscle relaxants

A

anticholinergic effects, sedation

30
Q

Risks for OA: Digoxin

A

increase risk of toxicity due to decreased albumin and decreased renal clearance

-limit daily dose

31
Q

Risks for OA: Antibiotics

A
  • aminoglycosides, quinolones, vancomycin excreted in urine
  • not usually used over 75 years old or reduced dose
  • monitor trough levels
  • monitor creatine clearance, measures GFR
32
Q

GFR

A

Glomerular filtration rate

33
Q

Risks for OA: GI drugs: antispasmodics

A

increased anticholinergic effects and toxic effects

34
Q

Risks for OA: GI drugs: cimetidine

A

histamine blocker

-multiple potential drug interactions

35
Q

Nurse’s Role for OA & Med Safety

A
  • comprehensive hx
  • physical exam
  • comprehensive medication assessment
  • educate regarding meds
  • ADVOCATE
36
Q

comprehensive medication assessment

A

nurses role

Review/Do the following:

  • drugs, herbals, supplements
  • medication reconciliation
  • annual brown bag assessment
  • Beer’s criteria review
37
Q

Medication reconciliation

A

formal review of medication list comparing to active orders

38
Q

Annual brown bag assessment

A

encouraging patients to bring all of their medicines and supplements to their visit and reviewing them. The goal is to determine what medicines patients are taking and how they are taking them.

39
Q

What do we educate the OA in regards to medication

A
  • drug’s purpose, benefits, ADRs, dosing

- S/S to notify provider

40
Q

How do we advocate for the OA

A
  • encourage pt/family questions
  • collaborate with interdisciplinary team
  • “Start low, Go slow”
  • carefully monitor when new meds are started
  • assist with pill box, med list, etc..
  • listen to concerns

OA Exam 1 (6 decks)

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