T2: Safe Med Use (CH 17) Flashcards
There is an increased risk of interactions and __ __ in older adults when it comes to medications.
adverse reactions
Medications act ___ in older adults; and require careful dosage adjustment and __.
differently
monitoring
___: refers to the absorption, distribution, metabolism, and excretion of drugs
Pharmacokinetics
___: refers to the biologic and therapeutic effects of drugs at the site of action or on the target organ
Pharmacodynamics
The high prevalence of health conditions in the older population causes this group to use a large number and variety of ___
medications
Most common medications used:
cardiovascular agents, antihypertensive, analgesics, antiarthritic agents, sedatives, tranquilizers, laxatives, and antacids
Taking more than one drug increases the risk of __ interactions.
drug-food
Pharmacokinetics refers to the __, __, __, and ___ of drugs.
absorption
distribution
metabolism
excretion
The renal system is primarily responsible for the body’s ___ functions, and among its activities is the __ of drugs.
excretory
excretion
Changes in what 4 things can modify DISTRIBUTION of a drug?
- circulation
- membrane permeability
- body temperature
- tissue structure
Factors altering absorption:
- Route of administration
- Concentration and solubility of drug
- Diseases and symptoms
Difficult to predict drug __
distribution
___ and hypoalbuminemia decrease drug distribution
Dehydration
CONDITIONS decreasing metabolism of drugs: (4)
-Dehydration, hyperthermia, immobility, and liver disease
___ is the most common organ to deal with metabolism.
Liver
Extended biological __: requires close evaluation of drug clearance
half-life
Detoxification and conjugation of drugs is ___
reduced
__ influences drug detoxification and excretion
Liver
Refers to biologic and therapeutic effects of drugs at the site of action or targeted organs
Altered Pharmacodynamics
There is increased myocardial sensitivity to ___.
anesthesia
There is increase central nervous system receptor sensitivity to __, alcohol, and __.
narcotics
bromides
Risk of adverse drug reactions is higher in older adults related to altered __ and __.
pharmacokinetics and pharmacodynamics.
Mental ___ is often an early sign of adverse reaction to many medications.
dysfunction
This criteria included drugs that were inappropriate to use in general and drugs that were inappropriate to use in the presence of specific conditions. (Identification of drugs that carry high risks for older adults)
Beer’s criteria
Ensure drugs are selectively and __ used.
cautiously
Suppository form: due to lower body temperature may take __ to melt
longer
Immobile limb will reduce rate of __.
absorption
What are some factors interference with safe administration?
- Functional limitations
- Cognitive limitations
- Educational limitations
- Sensory limitations
- Financial limitations
- Choice
Theirs a therapeutic range- if their level is high (“toxic”) you ____
won’t give them it, you would hold off on that medication.
Benefits versus risk must be weighed meaning ____ .
more good than harm
__: gastrointestinal bleeding
Aspirin
__: Lacks anti-inflammatory properties; potential for hepatic necrosis
Acetaminophen
Can cause liver failure
Acetaminophen
Max dose of acetaminophen is __ in a day.
4G (4000mg)
__-Acting opioids: mild to moderate pain
Short
__-acting opioids: severe pain
Long
Assess the symptom of pain carefully for its ___ cause.
underlying
Observe for signs of infection other than fever in patients who are taking __ or ___.
aspirin or acetaminophen (an NSAID)
Administer analgesics regularly to maintain a constant __ level.
blood
Note signs of salicylate toxicity, which include:
dizziness, vomiting, tinnitus, hearing loss, sweating, fever, confusion, burning in the mouth and throat, convulsion, and coma.
Because bleeding and delayed clotting times can result from long-term aspirin use, observe for signs of:
anemia, bleeding, and altered hemoglobin, and prothrombin time
Observe for hypoglycemic reactions in persons with diabetes who combine __ with sulfonylureas.
aspirin
Chronic use of ___ warrants a diagnostic evaluation
antacids
Avoid administering other medications within ___ of administration of an antacid, unless otherwise ordered, to prevent the antacid from interfering with drug absorption.
2 hours
__ can result from the use of aluminum hydroxide and calcium antacids.
Constipation
__ can occur when magnesium hydroxide combinations are used.
Diarrhea
Advise patients who are on sodium-restricted diets to avoid using sodium __ as an antacid
bicarbonate
Excessive use of antibiotics leads to antibiotic-resistant __
bacteria
__ infections may result from antibiotic use.
Secondary
Examples of secondary infections:
MRSA, MDRO, colitis, vaginitis.
Ensure that patients using anticoagulants have their __ blood level monitored.
PT/INR
Use __ razor when on blood thinners.
electric
A larger intake of vitamin k-rich foods can reduce the effectiveness of ___.
Mango and papya can increase __.
High doses of vitamin E can increase __ risk.
anticoagulants
INR
bleeding
Keep Vitamin __ readily available as an antidote when patients are receiving anticoagulants.
K
Advise patients to avoid using __ as it can interfere with platelet aggregation and cause bleeding.
aspirin
Seizure meds are called ___.
anticonvulsants
___ increases the risk of toxicity. (food)
Grapefruit
Antihypertensive drugs examples:
- diuretics (most common)
- beta-blockers
- angiotension-converting (ACE)
- calcium
- alpha-blockers
Antidiabetic drugs (hypoglycemic): Report conditions that could alter antidiabetic drug requirements, such as fever, severe trauma, prolonged diarrhea or vomiting, altered thyroid function, or heart, kidney, or liver __.
disease
Advise patients to avoid drinking __ as this can lead to a significant drop in blood sugar.
alcohol
__ have a narrowed therapeutic window, and toxic levels accumulate much easier and at lower doses in older adults.
NSAIDS
Increased use of __-lowering drugs
cholesterol
What are 2 cognitive enhancing drugs?
cholinesterase inhibitors
and NMDA receptor antagonists
__ is used to treat congestive heart failure and to slow the heart rate in patients with atrial fibrillation.
Digoxin
The usual biological half-life of these drugs can be extended in older adults, increasing their risk of digitalis __.
toxicity
__ makes patients more susceptible to toxicity.
Hypokalemia
3 major types of diuretics:
Thiazides
loop diuretics
Postassium-sparing diuretics
Diuretics have a potential for fluid and electrolyte __
imbalance
Monitor ___ in patients receiving loop diuretics as these drugs can cause transient ototoxicity.
hearing
With a diuretic, what electrolyte do you want to look at?
Potassium level
Antidiabetic drugs can cause __.
hypoglycemic
___ can drop the blood sugar.
Alcohol
NSAIDS are used with caution in the older adults bc of the risk of ___.
GI bleeds
Increased use of cholesterol-___ drugs.
lowering
Use Digoxin with caution in patients with impaired ___ function
renal
Have patient do what before they administer digoxin at home?
-check heart rate
You lose __ when vomiting and having diarrhea.
potassium
Diuretics can lead to what type of imbalance?
fluid and electrolyte imbalance
Thiazides and loop diuretics lead to a decrease in what electrolytes? (3)
POTASSIUM, chloride, and sodium
What diuretic spares the potassium?
potassium-sparing diuretics
Opioids (morphine) should be used with caution in older adults due to an increased risk of adverse effects, especially __ __.
respiratory depression.
Common adverse effects of morphine includes :
constipation, nausea, vomiting, sedation, lethargy, weakness, risk of falls, confusion, and dependency
Of the analgesics, the ____ ___ is particularly popular because of its effectiveness and low cost.
NSAID aspirin
___ is another popular analgesic among older people with mild to moderate pain.
Acetaminophen
__ is the least preferred opioid because it is excreted by the kidney
Meperidine
Any ___ can cause diarrhea, nausea, vomiting, anorexia, and allergic reactions.
antibiotic
Usually, __ is prescribed for rapid anticoagulation.
heparin
Usually, __ is prescribed for long-term use anticoagulation.
warfarin (coumarin)
Beta-blockers stop the effects of the sympathetic division, the part of the nervous system that can rapidly respond to stress by __ __ __.
increasing blood pressure
Side effects of __ __ can include dizziness, fainting, bronchospasm, bradycardia, heart failure, possible masking of low blood sugar levels, impaired peripheral circulation, insomnia, fatigue, shortness of breath, depression, Raynaud’s phenomenon, vivid dreams, hallucinations, sexual dysfunction, and, with some beta-blockers, an increased triglyceride level.
beta-blockers
__ __ are well-tolerated antihypertensive drugs and are popular initial agents in the treatment of hypertension.
(ACE) inhibitors
They dilate arterioles by preventing the formation of angiotensin II, which causes arterioles to constrict and block the action of ACE, which converts angiotensin I to angiotensin II
ACE inhibitors
Cough is a common side effect of this drug
ACE inhibitors
Side effects of these drugs include headache, dizziness, flushing, fluid retention, problems in the heart’s electrical conduction system (including heart block), bradycardia, heart failure, enlarged gums, and constipation.
Calcium Channel Blockers
The main goal in lowering cholesterol is to lower __ and raise ___.
LDL
HDL
Effective in relieving mild to moderate pain
NSAIDS
Signs of fluid and electrolyte imbalance:
dry oral cavity, confusion, thirst, weakness, lethargy, drowsiness, restlessness, muscle cramps, muscular fatigue, hypotension, reduced urinary output, slow pulse, and GI disturbances.
__ __ absorb fluid in the intestines and create extra bulk, which distends the intestines and increases peristalsis.
Bulk formers
___ pull fluid into the colon, causing bowel distension that increases peristalsis.
Hyperosmolars
__ irritate the smooth muscle of the intestines and pull fluid into the colon, causing peristalsis.
Stimulants
__ coat fecal material to facilitate its passage.
Lubricants
__ __ collect fluid in the stool, which makes the mass softer and easier to move.
Stool softeners
