Unit 4 Key Concepts Worksheet: Clinical Judgment To Promote Safe Medication Use Flashcards
Pharmacokinetics
Movement of a medication in the body from the point of administration to excretion.
Age-related changes/considerations of pharmacokinetics
Changes increase risk of adverse reactions or unpredictable effects
Absorption
Absorption of medication into bloodstream
Age-related changes/considerations of absorption
Increased gastric pH, delayed stomach emptying, changes in GI motility, drug-drug interactions, drug-food interactions (green leafy- warfarin)
Distribution
After its absorbed it must be transported to the receptor site on a targeted organ to have the desired effects
Age-related changes/consideration of distribution
Reduced serum albumin level, decreased lean body mass, increased body fat, decreased total body water.
Metabolism
When the body modifies the chemical structure of the drug
Age-related changes/considerations of metabolism
Reduced hepatic activity, mass, volume, blood flow, clearance
Excretion
Drugs and their metabolites are excreted in sweet, saliva, and other secretions but primarily through kidneys
Ages-related changes/considerations of excretion
Significant decline in kidney function, decreased GFR and creatinine
Pharmacodynamics
Interaction between a drug and the body.
Age-related changes/considerations of pharmacodynamics
The older the person becomes, the more likely there will be an altered or unreliable response of the body to the drug.
Describe chrono pharmacology
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)
Define polypharmacy
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.
Fiber/ Digoxin
Absorption of drug into fiber, reducing drug reaction
Foods with Vitamin K/ Warfarin
Decreases effect of drug
Any food/ Many antibiotics
Reduced absorption rate of drug
Vitamin B6 supplements/ Levodopa-Carbidopa
Reversed antiparkinsonian effect
Grapefruit juice/ Multi medications
Altered metabolism and elimination can increase concentration of drug
Citrus Juice/ CCB
Gastric reflux exacerbated
Examples of potential med-med adverse interactions?
ACE inhibitors & K-Sparing diuretics
ACE inhibitors or ARBs & Sentra (Bactrim)
Macrolide antibiotics & either CCB or digoxin
Warfarin & any of the antibiotics or NSAIDs
Medications that can easily impair cognitive function in older adults
Analgesics, anticholinergics, antihistamines, benzodiazepines, antiparkinson meds, BB, Lnoxin
What is the BEERs Criteria
BEER’s Criteria:
- Medications that are potentially inappropriate for the use with all older adults’
- potentially inappropriate medications to avoid in older adults with certain conditions
- Medications to be used with considerable caution in older adults
- Medication combinations that may lead to harmful interactions
- A list of medications that should have be avoided or dosed differently for those with poor renal functions
Examples of Potentially Inappropriate Medications with Beer’s Criteria
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
psychoactive medications
Alter brain chemistry is, emotions, and behaviors. These meds have a high risk of adverse events.
Antidepressants side effects and special considerations with older adults
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
Anti anxiety agents side effects and special considerations with older adults
SE: drowsiness, dizziness, ataxia, cognitive deficits, and memory impairment.
Older adults slowly metabolize these drugs and decreased excretion.
Mood stabilizers side effects and special considerations with older adults
SE: Confusion, disorientation, memory loss, polyuria, polydipsia, n/v/d, fine resting tremor, benign goiter, tardive dyskinesia, and ataxia.
