Pharm Issues Related to Older Adult and Peds Pop (complete)

Question 1

What is the biggest concern in the older adult?

Answer 1

Polypharmacy; higher chance of drug-drug interactions or side effects

Question 2

What is polypharmacy?

Answer 2

Most people over 65 with 1-3 chronic diseases commonly take 5-10 medications a day

increases risk for drug-drug interactions

Question 3

Pharmacokinetics related to the older adult

Answer 3

Have more adverse evens
- decreased number of receptors needed for drug distribution
- decreased absorption
- slower elimination due to decreased renal function

everything slows down

Question 4

What is the Beers Criteria

Answer 4

updated list every 3 years; looks at medications that increase the risk for falls

dose adjustments for kidney disease
looks for drug-drug interactions

Question 5

What is important in preventing complications in older adults?

Answer 5

• perform medication reconciliation
• always know patients renal status (excretion)
• always know your patients liver status (metabolism)
• if applicable, assess therapeutic drug levels
• patient education

Question 6

What meds should be included in medication reconciliation to prevent complications in the older adult?

Answer 6

OTC, supplements, herbal, prescriptions, borrowed medications

do they have outdated meds?

Question 7

What is important to include in patient education to prevent complications in the older adult?

Answer 7

• 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

Question 8

What are anticholinergic side effects r/t to the older adult?

Answer 8

• 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

Question 9

Absorption considerations with the older adult

Answer 9

• changes in GI tract
• decreased muscle mass
• changes in circulation
• can require increased doses, but then have concerns about toxicity

Question 10

What are changes in the GI tract of the older adult affecting absorption?

Answer 10

• 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

Question 11

What are distribution considerations r/t the older adult?

Answer 11

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

Question 12

What are metabolism (biotransformation) considerations r/t older adults?

Answer 12

• 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

Question 13

What are excretion considerations r/t older adults?

Answer 13

• 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

Question 14

What are factors impacting adherence in the older adult?

Answer 14

• 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

Question 15

Health teaching tips with the older adult

Answer 15

• 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

Question 16

What are pediatric considerations related to medication?

Answer 16

• 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

Question 17

What are absorption considerations r/t pediatrics?

Answer 17

• slower rate of absorption than adults
  – increases as child ages
• topical medications are not okay

Question 18

What are factors affecting absorption in pediatrics?

Answer 18

• 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

Question 19

What are distribution considerations r/t pediatrics?

Answer 19

• 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

Question 20

What are metabolism considerations r/t pediatrics?

Answer 20

• 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

Question 21

What are excretion considerations r/t pediatrics?

Answer 21

• 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

Question 22

Nursing considerations for the pediatric population

Answer 22

• 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

Question 23

What is important to consider when caring for adolescents (ages 12-19)?

Answer 23

• 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)

Question 24

What are care considerations for the adolescent population?

Answer 24

• 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

Question 25

What is important to consider overall with older adults?

Answer 25

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