Polypharmacy Flashcards
what are medications
- substance that is taken into or placed on the body to cure, treat, relieve symptoms, or as a prophylactic
what are bioactive substances
- any substance that has an effect on, causes a reaction, or triggers a positive or negative response in living tissues
ex. herbs
what are pharmacodynamics
- what a drug or med does to the body’s receptors
what is clearance rate
- amount of blood cleared of drug per unit time
what is elimination half time
- amount of time it takes to clear half the drug
what age-related changes affect the action of meds in the older adults?
- renal changes affect the conc of meds in the body
- water soluble meds have greater intensity
- fat soluble substances have decreased intensity
what are age related changes that affect med safety in older adults
- decreased body water
- decreased lean tissue
- increased body fat
- decreased serum albumin
- decreased renal functioning
- decreased liver function
what factors challenge safe med practices?
- pathological processes
- knowledge & misunderstandings
- med management
- communicative/functional impairment
what kind of misunderstandings challenge safe med practice
- people think meds are quick fix and prefer them over non-pharmacological
- people think all herbal remedies are natural & safe –> not true
- people may not understand why they are taking a med
how do communication/functional impairments challenge safe med practice
- challenges people comprehension of med instructions
- vision changes & fine motor skills challenge self-admin
how can med managament challenge safe med practices
- inappropriate prescribing practices
- inadequate monitoring of meds
- high price of drugs
- non-adherence
- polypharmacy
- adverse med effects
how do pathological processes challenge safe med practices
- older adults have increased prevalence of chronic conditions = increased complexity of medical prescriptions
what is meant by inappropriate prescribing practices
- potentially inappropriate meds
what are the risks of polypharmacy
- med nonadherence
- adverse drug reactions
- prescribing cascade
- drug interactions
how can we identify inappropriate meds?
- can use resources that assess if a med is necessary
- beers criteria, START, STOPP tools
what might make meds inappropriate
- ineffective
- low safety profile
- better alternatives
what type of drug do older adults have a high susceptibility to adverse effects?
- anti-cholinergics
what are side effects of anticholinergics
- dry mouth
- constipation
- urinary retention
- orthostatic hypotension
- bowel obstruction
- blurred vision, dilated pupils
- increased HR
- increased sweating
- delirium
why is it important to be aware of anticholinergic effects
- many OTC meds have anticholinergic effects
what is the risk of antipsychotics in those with dementia
- can have anticholinergic effects
- increased risk of orthostatic hypotension
- increased risk of falls
- contributes to polypharmacy
- can contribute to delirium
despite the risks of antipsychotics, why do they continue to be prescribed for individuals with dementia? what is a better alternative?
- to control responsive behaviors
- better alternative –> identify underlying cause & treat that
- personhood & behavioral strategies should always be approached first
what is polypharmacy
- using meds which are not clinically indicated
- or taking 5 or more drugs
when is polypharmacy problematic
- when drugs are causing adverse effects
- benefits outweigh the risks
- can be seen in individuals who are taking a lot of meds which are unnescessary
what are consequences of polypharmacy
- med non-adherence
- adverse drug reactions
- drug interactions
- risk for falls & injury
- hospitalization
what can cause polypharmacy
- having a variety of different doctors who are all prescribing pills
- fear of disclosure
- meds from number of sources
- nonadherence
- belief that once meds are started they should be continues
- belief that dosages do not need to be changes
what is non-adherence
- patterns of taking meds that differ from what was prescribed
- includes missed dosages, not filling the meds, taking them too frequently
what are the reasons for non-adherence
- complex
- financial issues
- asymptomatic disease = decreased motivation
- misunderstanding the reason you’re taking the drug
- adverse effects
what is the difference between non-adherence & non-compliance
- non-adherence = not intentional
what is an adverse drug event
- adverse drug reaction or med effect
- unintended & undesired outcomes of a med that occur in doses normally used in humans
what are consequences of adverse drug events
- decline in function
- risk for falls
- increased # of healthcare visits
- hospitalization
- death
what meds are most frequently cited for emergency hospitalization
- warfarin
- antiplatelets
- antidiabetics
- corticosteroids
- antibiotics
- antineoplastic
- immunosuppressors
- CV drugs
- NSAIDs
- opiates
what is a prescribing cascade
- when an adverse drug event is interpreted as a new condition which leads to new diagnosis & more meds
what are med interactions
- when two meds compete for same binding site, interfere w each other
- can cause adverse effects
what do med interactions cause
- either too high or too low levels of the med
- increases risk of ADE & chances of toxicity
what increases the risk of med interactions
- increases depending on number of meds used
what are things other meds can meds interact with
- nicotine
- alcohol
- nutrients
- herbs
what kind of nutrients might meds interact with
- foods
- bererages
- enteral formulas
- dietary supplements
what specific food is notorious for drug interactions
- grapefruit juice
- decrease absorption & increase conc of many meds
what are the elements of an effective med review?
- are the patients meds indicated?
- is it effective?
- consider dose, route, formulation, duration
- is it safe for the patient? consider contraindications, interactions, ADE
- can the patient adhere to the meds? size, freq, cost
describe nursing assessment for meds
- record all meds & bioactive substances used
- alcohol, caffeine, nicotine, cannibus use
- patient’s understanding
- allergies
- adverse effects
- preferences
- observe patterns of meds used
- overall assessment
how can we observe patterns of meds used
- ask to see all meds
- directly assess med containers
- storage of meds
describe the overall assessment of med use
- link meds to complaints
- assess outcomes of meds
- functional assessment
- home enviro
- nonadherence
what are 2 approaches for nursing interventions
- multidimensional approach
- interdisciplinary approach
what is a nurses role in med interventions
- alert prescriber to potential problems
- question unnecessary meds
- start low, go slow
- risk versus benefit
when does med reconcilliation occur
- during transitions in care
what is med reconcilliation
- a comprehensive review of the meds
what is a nurses role in med reconcilliation
- view all meds
- on discharge: how will they fill the prescription
- how do they administer meds?
- an opportunity for pt education
how can nurses encourage safe & effective med taking behaviors?
- educate the patients & caregivers
- involve the patients in decisions
- empower older adults to ask questions & understand their meds
- support their independence
what should nurses education patients on regarding med
- med organization
- how to take them
- why are they on them
- what side effects to expect
how can nurses help reduce adverse drug events
- use non-pharmacological approaches (ex. sleep)
- med reconcillation (identify patient med errors)
- ensure client is able to safely & appropriately take their meds
what is deprescribing
- coordinating with the prescriber to dicontinue duplicate meds or meds no longer appropriate
what should you consider when deprescribing
- what factors warrant discontinues use?
- how can patients be engaged in the deprescribing process?
- tapering?
- what should be monitored and how?
- how to manage symptoms
what are some factors for nonadherence
- lack of knowledge of meds
- adverse effects of meds
- cognitive wellness
