Saftey In Meds Flashcards
Meds that brought pt to the ER
Five medication classes that led to ER admissions.
- Hematologic
- Endocrine agents
- Cardiovascular agents
- Central nervous system agents
- Anti-infective agents
Top offering medications (67% of cases)
- Walfarine
- Insulins
- oral Antiplatelet agents
- oral hypoglycemics
What’s different about how medications are processed by Geriatric patients?
~Absorption: Decreased acidity, blood flow to GI tract and GI motility delay the time it takes for meds to absorb.
~Distribtion:
More fat/less water
Decreased available protein: levels of unbound drug increase in blood stream.
~Metabolism
Decreased hepatic enzyme leads to increase drug levels
~Excretion: decreased renal function means drug not eliminated and drug level increased
Additional physiologic changes in the OA
-How do these changes affect the OA’s ability to take medication safely?
-Cognition
Forgetfulness, diminished understanding
-taste
-hearing
-manual dexterity
-vision
Older adults, age 65 yr no older:
- 44% of men and 57% of women take 5 or more meds/week.
- 12% of men and women take 10 or more meds/week.
- consume 40-50% of OTC (over the counter) meds
- Many OTC meds undisclosed to PCP (Primary care physician?)
Polypharmacy
-Increased risk of drug interactions and adverse drug reactions (ADRs) Causes of Polypharmacy -Coexisting health problems -Multiple health providers -Herbal therapy -OTC drugs -"discontinued" prescription drugs
To promote safe medication use in the OA, the American nursing association supports?
- “Ongoing evaluation and monitoring of the older adult’s medication profile to encourage safe medications use.
- Clear communication of medication information..
- reconciliation of medications…
- Research”
Adverse drug reactions (ADRs)
~ADRs in the OA are three to seven times greater than those in middle-aged and young adults.
~Reasons for ADRs
-Increased number of prescriptions
-Physiologic changes- general and individual
-Therapeutic ranges may lead to toxicity
Causes of ADR
~living arrangements -Long term care facilities -lack of continuity of care -Multiple provider -community living ~Multiple prescribers ~Incorrect/inappropriate drug dosing ~Providers unaware of self-medication habits What practice issues affect the safety of OA taking medications?
Self-medication practices/adherence
~OTC herbals or meds
~Non-adherence of medication regimen
-Overuse, underuse or erratic use of meds
-Confusion or lack of knowledge
-Financial -“stretch out” meds to last
~expired meds
What practice issues affect the safety of OA taking medication?
Types of ADRs
- Falls
- Bleeds
- confusion
- Renal and liver impairment
- Electrolyte imbalance
- Orthostatic hypotension
- Drug-Drug interactions
National Patient Safety Goals: use medicines safely
- NPSG.03.05.01 take extra care with patients who take medicines to thin their blood.
- NPSG.03.06.01 Record and pass along correct info about a patients medicines. Find out what medicines the pt is taking. Compare those meds to new meds given to pt. Make sure pt knows which meds to take when at home. Tell pt it’s important to bring their up to date list of meds every time they visit a doctor.
Medication Reconciliation
Patient reports taking: -Lorazapam 1 mg twice daily for anxiety -Lisinopril 10 mg "take half tab twice a day. My blood pressure's fine" -Enteric coated aspirin 81 mg daily Physician has ordered: -Larazepam 0.5mg q 12 hr for anxiety -Lisinopril 10mg bid -Enteric coated Aspirin 81mg daily
Beers’s Criteria
~Based on evidence- expert panel
~list of potentially inappropriate meds (PIMs) in OA 65 yr and older (3 categories)
-PIMs to avoid in all OAs
-PIMs to avoid in OAs with certain diseases
-Meds to be used with caution in OAs
Most Common Drugs with ADRs
- Cardiovascular agents
- Antibiotics
- Diuretics
- Anticoagulants
- Hypoglycemics
- steroids
- opioids
- Anticholinergics
- benzodiazepines
- NSAIDs
