OA: Med Safety Flashcards
GI changes in OA regarding medications
- decreased acidity
- decreased blood flow to GI tract and GI motility delay the time it takes for meds to absorb
Fat/water distribution in OA regarding medications
-more fat, less water
Decreased available proteins lead to…
levels of unbound drug increase in blood stream
Renal function and OA meds
-decrease in renal function means drug not eliminated and drug level increases
decreased renal function —> increased drug levels
Liver function and OA meds
decreased hepatic enzymes —> increased drug levels
Functional decline in OA
- cognition
- taste
- hearing
- manual dexterity
- vision
Polypharmacy
use of four or more medications by a patient, generally adults aged over 65 years
Risks with polypharmacy
increased risk of ADRs and drug interactions
Causes of polypharmacy
- comorbidities
- multiple providers
- herbal therapy
- OTC meds
- “discontinued” rx drugs
ADRs
Adverse Drug Reactions
-3 to 4x greater than those in middle-aged and young adults
Reasons for ADRs
- increase number of prescriptions
- physiologic changes (general and individual)
- therapeutic ranges may lead to toxicity
Causes of ADRs
- living arrangements
- multiple providers
- incorrect/inappropriate drug dosing
- providers unaware of self-med habits
Self-med Practices
- OTC
- herbals
- rx meds
- non-adherence of med regimen
- expired meds
Ways OA do not adhere to medication regimen
- overuse
- underuse
- erratic use
- confusion or lack of knowledge
- financial (“stretch out” meds to last longer)
Types of ADRs
- falls
- bleeds
- confusion
- renal/liver impairment
- electrolyte imbalances
- orthostatic hypotension
- drug to drug interactions
National Patient Safety Goals for Safe Med in OA
- 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
Beer’s Criteria
- evidence based
- list of inappropriate meds (PIMs) in OA 65 and up
3 categories of Beer’s Criteria
- PIMs to avoid in all OAs
- PIMs to avoid in OAs with certain diseases
- Meds to be used with caution in OAs
PIM
Potentially Inappropriate Medications
Most Common Drugs with ADRs
- cardiovascular agents
- antibiotics
- diuretics
- anticogulants
- hypoglycemics
- steroids
- opioids
- anticholinergics
- benzodiazepines
- NSAIDs
Risks for OA: Anticoagulants
OTC meds may interact
Risks for OA: Antihistamines (1st generation)
anticholinergic effects
anticholinergic effects
dry mouth, constipation, urinary retention, highly sedating
Risks for OA: Diuretics & Antihypertensives
- give reduced doses to decreased side effects
- non-pharmacologic methods suggested to decrease BP
Risks for OA: Selective NSAIDs
Naproxen: GI bleed, renal failure, HTN, CHF
Risks for OA: Long acting Benzodiazepams
(hypnotics)
- half-life exceeds 24 hrs
- increased sedative effect and risk of falls
- short term therapy suggested with low doses
Risks for OA: Antipsychotics in dementia
increased risk of CVA and mortality
Risks for OA: Opioid analgesics
hypotension, respiratory depression, constipation
Risks for OA: Muscle relaxants
anticholinergic effects, sedation
Risks for OA: Digoxin
increase risk of toxicity due to decreased albumin and decreased renal clearance
-limit daily dose
Risks for OA: Antibiotics
- aminoglycosides, quinolones, vancomycin excreted in urine
- not usually used over 75 years old or reduced dose
- monitor trough levels
- monitor creatine clearance, measures GFR
GFR
Glomerular filtration rate
Risks for OA: GI drugs: antispasmodics
increased anticholinergic effects and toxic effects
Risks for OA: GI drugs: cimetidine
histamine blocker
-multiple potential drug interactions
Nurse’s Role for OA & Med Safety
- comprehensive hx
- physical exam
- comprehensive medication assessment
- educate regarding meds
- ADVOCATE
comprehensive medication assessment
nurses role
Review/Do the following:
- drugs, herbals, supplements
- medication reconciliation
- annual brown bag assessment
- Beer’s criteria review
Medication reconciliation
formal review of medication list comparing to active orders
Annual brown bag assessment
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.
What do we educate the OA in regards to medication
- drug’s purpose, benefits, ADRs, dosing
- S/S to notify provider
How do we advocate for the OA
- 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
