Pharm Issues Related to Older Adult and Peds Pop (complete) Flashcards
What is the biggest concern in the older adult?
Polypharmacy; higher chance of drug-drug interactions or side effects
What is polypharmacy?
Most people over 65 with 1-3 chronic diseases commonly take 5-10 medications a day
increases risk for drug-drug interactions
Pharmacokinetics related to the older adult
Have more adverse evens
- decreased number of receptors needed for drug distribution
- decreased absorption
- slower elimination due to decreased renal function
everything slows down
What is the Beers Criteria
updated list every 3 years; looks at medications that increase the risk for falls
dose adjustments for kidney disease
looks for drug-drug interactions
What is important in preventing complications in older adults?
- perform medication reconciliation
- always know patients renal status (excretion)
- always know your patients liver status (metabolism)
- if applicable, assess therapeutic drug levels
- patient education
What meds should be included in medication reconciliation to prevent complications in the older adult?
OTC, supplements, herbal, prescriptions, borrowed medications
do they have outdated meds?
What is important to include in patient education to prevent complications in the older adult?
- why they are on a med
- potential interactions with other meds and diet
- review generic and trade names
- keep one primary care provider
- keep meds at one pharmacy
- assess and provide help for adherence
- discuss key side effects
What are anticholinergic side effects r/t to the older adult?
- older adults have diminished function of cholinergic receptors
Anticholinergic Drug Scale:
- scores greater than 3 have higher risk for altered cognition
- believed that up to 20% of nursing home residents have scores greater than 3 – increasing risk for falls
- increases risk for falls, confusion, and/or decreased alertness
Absorption considerations with the older adult
- changes in GI tract
- decreased muscle mass
- changes in circulation
- can require increased doses, but then have concerns about toxicity
What are changes in the GI tract of the older adult affecting absorption?
- decreased acid and increased gastric pH (more alkaline)
- slower gastric emptying can change absorption and cause N/V
- decrease in number, structure and functioning ability of absorbing cell surfaces
- decreased intestinal motility
What are distribution considerations r/t the older adult?
Decreases in: cardiac output, body mass, body fat, fluid balance, albumin
- lipid soluble medications remain in fat for longer time
- decrease in fluid can cause increased drug levels
- protein binding decreases with age
- low cardiac output may decrease distribution
What are metabolism (biotransformation) considerations r/t older adults?
- decrease blood flow to the liver/decreased liver function
– any comorbidities? alcoholism? smoking? - around 60 y/o: liver size and mass decrease, decreasing metabolism
- decrease in portal circulation
- half lives will be longer due to changes in liver
- genetic changes - affect CYP450 system
What are excretion considerations r/t older adults?
- kidneys! renal function
- looking at creatinine clearance
- may need to lower doses in long half life medications
- creatinine can be normal due to decreased muscle mass even when GFR is decreases
- have tendency to drink less, so then have less elimination
What are factors impacting adherence in the older adult?
- many medications both prescribed and self-prescribed
- difficult to keep a regular schedule
- decreased vision, hearing, memory impairment, decreased detexrity
– can increase risk for errors - economic issues:
– Medicare Part D; paying out of pocket
– Pace and Pacenet (PA state)
Other factors:
- asymptomatic diseases (need to make sure they take meds still)
- adverse reactions influence people to not take meds
Health teaching tips with the older adult
- have patients’ sense as sharp as possible (clean glasses, functional hearing aids)
- speak in tones that they can hear
- face patient when speaking
- limit distractions
- treat patient with respect (expect they can learn)
- use large print and bright colors in teaching aids
What are pediatric considerations related to medication?
- are NOT small adults
- consider growth and development
- limited research in medication
- dosing based on age, height and weight
– nurse must perform calculations as well - do not have same albumin receptors or muscle mass as adults
- education is critical; must be accurate
- make no assumptions
- parent education
- small amounts of adult medication is not okay
- few OTC are effective and safe
- use measuring spoon
- ask questions
those under 2 should not be given OTCs unless child-specified
What are absorption considerations r/t pediatrics?
- slower rate of absorption than adults
– increases as child ages - topical medications are not okay
What are factors affecting absorption in pediatrics?
- hydration status: can dehydrate quickly; made up of higher water percentage than adults
- variability of gastric pH
– more alkaline at birth
– full acidity age 1-3 y/o - decreased bile secretion
- decreased gastric emptying
What are distribution considerations r/t pediatrics?
- lower levels of albumin (decreased protein binding to drugs)
- infants and neonates about 70% water (adults about 60%)
- less body fat in infants
- increased penetration of blood-brain barrier in infants b/c not as matured
What are metabolism considerations r/t pediatrics?
- depends on maturity of the child
- mostly in liver:
– under age 2: have slower metabolism than older kids
– hepatic function begins to mature at 1-2 months - higher metabolism rate may need more frequent dosing
What are excretion considerations r/t pediatrics?
- before age 9 months: decreased renal blood flow
- puberty impacts:
– adolescents will reduce again (renal blood flow doesn’t always keep up)
– need to be hydrated
Nursing considerations for the pediatric population
- monitor for drug toxicity
- safe drug calculations
- orders in mg/kg
- must assess cognitive ability of child and the family: know developmental stages
– can have delays
– know how to interact with children and how best to educate
– know how to decipher responses to medications
What is important to consider when caring for adolescents (ages 12-19)?
- They are NOT mini-adults and have their own health needs
- Emotional development: like to experiment
- Mature minor laws and laws for contraception: 14+ allowed to seek contraception and STI screening w/out parental consent (for now)
What are care considerations for the adolescent population?
- issue of chronic illness
– can respond good or bad
– need to be taught compliance, management, self-administration - compliance concerns:
– self-administration of medications
– self-monitoring (consider maturity) - assess cognitive levels
- difference between 13 and 17 y/o: maturity, set good habits to carry into adulthood
What is important to consider overall with older adults?
There are changes in responses to medications that often begin in middle age years relating to:
- heart disease
- pulmonary
- obesity
- diabetes
- substance use
- depression
Biggest concern: polypharmacy
Risk to benefit ratio must be considered
