Unit 4 Key Concepts Worksheet: Clinical Judgment To Promote Safe Medication Use

Question 1

Pharmacokinetics

Answer 1

Movement of a medication in the body from the point of administration to excretion.

Question 2

Age-related changes/considerations of pharmacokinetics

Answer 2

Changes increase risk of adverse reactions or unpredictable effects

Question 3

Absorption

Answer 3

Absorption of medication into bloodstream

Question 4

Age-related changes/considerations of absorption

Answer 4

Increased gastric pH, delayed stomach emptying, changes in GI motility, drug-drug interactions, drug-food interactions (green leafy- warfarin)

Question 5

Distribution

Answer 5

After its absorbed it must be transported to the receptor site on a targeted organ to have the desired effects

Question 6

Age-related changes/consideration of distribution

Answer 6

Reduced serum albumin level, decreased lean body mass, increased body fat, decreased total body water.

Question 7

Metabolism

Answer 7

When the body modifies the chemical structure of the drug

Question 8

Age-related changes/considerations of metabolism

Answer 8

Reduced hepatic activity, mass, volume, blood flow, clearance

Question 9

Excretion

Answer 9

Drugs and their metabolites are excreted in sweet, saliva, and other secretions but primarily through kidneys

Question 10

Ages-related changes/considerations of excretion

Answer 10

Significant decline in kidney function, decreased GFR and creatinine

Question 11

Pharmacodynamics

Answer 11

Interaction between a drug and the body.

Question 12

Age-related changes/considerations of pharmacodynamics

Answer 12

The older the person becomes, the more likely there will be an altered or unreliable response of the body to the drug.

Question 13

Describe chrono pharmacology

Answer 13

The relationship between the biologic rhythms of the body and variations in pharmacokinetics and pharmacodynamics.

Ex: allergic rhinitis (sx worse in the morning). Arterial BP (circadian surge in the morning house). Asthma (greatest resp distress overnight)

Question 14

Define polypharmacy

Answer 14

5 or more medications, multiple medications for the same problem, increased risk for drug interactions, increased risk for adverse events, can result from fragmented communication.

Question 15

Fiber/ Digoxin

Answer 15

Absorption of drug into fiber, reducing drug reaction

Question 16

Foods with Vitamin K/ Warfarin

Answer 16

Decreases effect of drug

Question 17

Any food/ Many antibiotics

Answer 17

Reduced absorption rate of drug

Question 18

Vitamin B6 supplements/ Levodopa-Carbidopa

Answer 18

Reversed antiparkinsonian effect

Question 19

Grapefruit juice/ Multi medications

Answer 19

Altered metabolism and elimination can increase concentration of drug

Question 20

Citrus Juice/ CCB

Answer 20

Gastric reflux exacerbated

Question 21

Examples of potential med-med adverse interactions?

Answer 21

ACE inhibitors & K-Sparing diuretics
ACE inhibitors or ARBs & Sentra (Bactrim)
Macrolide antibiotics & either CCB or digoxin
Warfarin & any of the antibiotics or NSAIDs

Question 22

Medications that can easily impair cognitive function in older adults

Answer 22

Analgesics, anticholinergics, antihistamines, benzodiazepines, antiparkinson meds, BB, Lnoxin

Question 23

What is the BEERs Criteria

Answer 23

BEER’s Criteria:

1. Medications that are potentially inappropriate for the use with all older adults’
2. potentially inappropriate medications to avoid in older adults with certain conditions
3. Medications to be used with considerable caution in older adults
4. Medication combinations that may lead to harmful interactions
5. A list of medications that should have be avoided or dosed differently for those with poor renal functions

Question 24

Examples of Potentially Inappropriate Medications with Beer’s Criteria

Answer 24

PIMS
1. Sliding door scale insulin
2. PPI longer than the 8 weeks
3. Digoxin
4. Benzos
5. Tricyclic antidepressants
6. Meds with anticholinergic properties
7. Antispasmodics
8. Sulfonylurea

Question 25

psychoactive medications

Answer 25

Alter brain chemistry is, emotions, and behaviors. These meds have a high risk of adverse events.

Question 26

Antidepressants side effects and special considerations with older adults

Answer 26

SE: minimal (nausea, dry mouth, sexual dysfunction).
Use with caution in persons with hx of falls because of the potential to produce ataxia (neurological, lack of muscle coordination control) or dizziness

Question 27

Anti anxiety agents side effects and special considerations with older adults

Answer 27

SE: drowsiness, dizziness, ataxia, cognitive deficits, and memory impairment.
Older adults slowly metabolize these drugs and decreased excretion.

Question 28

Mood stabilizers side effects and special considerations with older adults

Answer 28

SE: Confusion, disorientation, memory loss, polyuria, polydipsia, n/v/d, fine resting tremor, benign goiter, tardive dyskinesia, and ataxia.