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Gero > Week 3 Outline > Flashcards

Week 3 Outline Flashcards

1
Q

What are the ways the body uses medications? (SATA)

A
  • Absorption: How the medication is taken into the body.
  • Distribution: How the medication is dispersed throughout the body.
  • Metabolism: How the medication is broken down.
  • Excretion: How the medication is removed from the body.
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2
Q

Route of administration for absorption ?

A

Oral, sublingual, transdermal

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3
Q

It is best to take medication with :

A

Water

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4
Q

Age related changes that affect absorption?

A
  • Reduction of saliva
  • Difficulty swallowing
  • Slowed Motility (Not a normal part of aging, but a common condition in the aged)
  • Reduction in gastric acids
  • Delayed stomach emptying
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5
Q

Distribution

systemic circulation:

A

Transportation to target cell receptors.

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6
Q

Distribution

targets organs:

A

-Hight blood flow: brain, kidneys, lungs, and liver
•Rapid reception, increased concentrations of medications
-Low blood flow: skin, muscles, fat
•Lower concentrations of medications

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7
Q

Age related changes that affect distribution:

A
  • less body water
  • increased body fat
  • decreased availability of plasma proteins
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8
Q

Distribution

common in the aged

A
  • peripheral vascular disease
  • chonic illnes
  • acute illness
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9
Q

Metabolims:

biotransformation-

A

transforms substances making them more easily eliminated from the body.

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10
Q

Age related changes that affect the metabolism:

A
  • Reduction of liver mass
  • Reduction of liver perfusion (30% to 40%)
  • Reduces the amount of medication metabolized during the first pass
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11
Q

Excretion is done through

A

o As metabolites or Unchanged

o Through: Lungs, sweat, bile, feces, breast milk, hail, saliva, tears, semen, and urine (the renal system)
-Most common system is renal system

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12
Q

Age related chnages in excretion:

A
  • Reduction of Glomerular Filtration Rate (measured by CrCl)

- Prolonged medication half-life

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13
Q

Pharmacodynamis is:

A

Physiological interactions between a medication and the body. Ex. chemical compounds and cell receptors.

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14
Q

Pharmacodynamis and age related changes:

A
  • Reduction in baroreceptor reflex response
    • Increased susceptibility to orthostatic hypotension
  • Decreased responsiveness in the a-adrenergic system
    • Decreased sensitivity to B-agonist (bronchodilators)
  • Decreased thirst sensation may lead to dehydration especially with medications
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15
Q

Polypharmcy:

A

oApproximately five or more medications
oIncrease risk for morbidity and mortality
oThe more prescribed medications taken, the greater the possibility of interactions

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16
Q

Reasons that polypharmcy occurs (SATA)

A
  • # of providers
  • Presence of chronic illness
  • Use of over counter meds
  • Disability that impacts a patient not taking medications
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17
Q

Medication food interactions:

Calcium in dairy

A
  • Levothyroxine
  • Tetracycline
  • Ciprofloxacin
  • Spironolactone
  • Increase potassium (K+)
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18
Q

Medication food interactions

Green leafy vegetables:

A

Decreases anticoagulant effects

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19
Q

Medication-food interactions

Grape fruit juice

A

Causes issues with statin

- leaving it in the body longer which can lead to liver and kidney damage

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20
Q

Medication food interaction:

  1. Altered absorption
  2. Alrered distribution
  3. Altered excretion
  4. Additive effects
A
  • Altered absorption
    * Binding
  • Altered distribution
    * Receptor displacement
  • Altered excretion
    * Medication related pH changes
    * Increase/Decrease in active transport
  • Additive effects
    • Especially dangerous in CNS effects (worry about falls and respiratory distress
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21
Q

Adverse drug reactions and events:

A
  • May range from minor to fatal
  • Inappropriate medications
  • Allergic reactions
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22
Q

Beers’ criteria 2019 list:

Will not be on test need to know “a guide to recognize wether a medication should be avoided by your patient

A
  • Potentially inappropriate
  • Potentially inappropriate for older adults w/certain conditions
  • Should only be taken with caution
  • Avoid
  • Not meant to be policy
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23
Q

Psychoactive medicaitons things to know:

A
  • In the older adult, treatment for depression, anxiety, bipolar disorder, and issues related to dementia
  • Require an assessment
    • Cost/Benefit
  • Used after non-pharmacological approaches found ineffective
  • Watch Your Patient Closely (emphasized)
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24
Q

How do antipsychotics affect the hypothalamic and thermoregulatory pathways:

A
  • Neuroleptic Malignant Syndrome – Assess Body Temp.
  • Known for side effects – Watch your patient closely
  • Sedation
  • Hypotension
  • Extrapyramidal and anticholinergic side effects (EPSEs)
    • Movement
    • Drying
25
Q

Antipsychotic typical and atypical medications:

A
  • Typical - haloperidol (never used in dementia with Lewy bodies)
  • Atypical – Seroquel newer most affective (fewer EPS symptoms)
26
Q

Movement disorders that we need to watch for:

*recognize what is not right and figure out if you have a problem

A

Extrapyramidal syndrome EPS

27
Q

What are the 4 EPS:

do not need to differentiate them just know the changes associated and how to recognize somethisn isnt righ

A
  • Acute Dystonia
    • Involuntary, slow, continuous muscular contractions of the face, jaw, mouth, and neck
    • Oculogyric Crisis: eyes in a fixed position
  • Akathisia
    • Compulsion to be in motion, restless
    • Mistaken for worsening psychosis
  • Parkinsonian Symptoms
    • Bilateral tremor
    • Bradykinesia and rigidity that may progress to inability to move
  • Tardive Dyskinesia (TD)
    • When antipsychotics used continuously for 3 - 6 months
    • Irreversible
    • Worm like movements of the tongue (beginning)
    • Facial movements
    • Involuntary twisting movements
    • Risk Factors: Female, African American, dementia, advanced age
28
Q

Promoiting health aging in assessment:

A
  • ”Brown Bag” have them bring all meds in there.
  • Discuss each medication with the patient
  • Stop/Start tool
29
Q

Herbs and supplemnt regulation:

A
  • Regulated by Dietary Supplement Health and Education Act
  • Herbal manufacturers label herbs as foods
    • NOT FDA regulated
    • Good Manufacturing Practices required since 2007
      • Preparation and storage, product identification, purity, strength, composition
30
Q

Use of dietary supplements and herbal products:

CoQ10:

A
  • Use: For people who can’t take statins
  • Caution: Do not take with Warfarin
  • Adverse Reactions: Elevated liver function tests, mild GI upset
31
Q

Use of dietary supplements and herbal products:

Garlic:

A
  • Use: Decreased blood clots and reduced total serum cholesterol and low-density lipoprotein
  • Caution: With use of anticoagulants
  • Adverse Reactions: severe allergic reactions, increased flatulence, and upper gastrointestinal (GI) irritation with nausea and heartburn (GI bleed)
32
Q

Use of dietary supplements and herbal products:

Ginkgo Biloba

A
  • Use: Cognitive function, memory
  • Caution: With use of anticoagulants
  • Adverse Reactions: Bleeding (GI)
33
Q

Use of dietary supplements and herbal products:

St. John’s wort

A
  • Use: Mild or moderate depression, anxiety, pain
  • Caution: Warfarin, Contraindicated with other antidepressants Esp. SSRIs
    • Separate SJW and other antidepressants by two weeks
  • Adverse Reactions: Serotonin syndrome, photosensitivity
34
Q

Use of dietary supplements and herbal products:

Melatonin

A
  • Use: Promote sleep
  • Caution: When taking other medications that can cause drowsiness
  • Adverse Reactions: Headache, nausea
  • Do not take with PRILs
35
Q

Use of dietary supplements and herbal products:

Ginseng

A
  • Use: Promotes overall wellbeing and immunity
  • Caution: With use of anticoagulants
  • Adverse Reactions: Box 10-1 (gi bleed)
36
Q

Use of dietary supplements and herbal products:

Glucosamine and chondroitin sulfate

A
  • Use: Support cartilage and connective tissue, has anti-inflammatory effects
  • Caution: With allergies, diabetes, and asthma
  • Adverse Reactions: Nausea, GI upset
37
Q

Dietary supplements for select conditons

A
  • Hypertension: Coenzyme Q10, Fish oil, Garlic, Green tea, Melatonin
  • HIV: SJW
  • GI Disorders: Psyllium, Milk thistle, Probiotics
  • Cancer: Calcium (colorectal), Fish oil (endometrial) , Garlic (colorectal, prostate), Ginseng (breast, stomach, lung, liver, ovarian)
  • Alzheimer’s disease: Ginkgo
38
Q

Diabetes and herbal supplements:

A
  • Herbs have been used to manage diabetes since before the 1921 discovery of insulin.
  • Some of the nearly 400 different plants that affect blood glucose are still used.
  • There is not enough evidence to support the use of herbal supplements for treating diabetes
  • Cinnamon
39
Q

Important note to know about supplemets and herbs:

A

The more supplements, herbs and other drugs that the client is taking, the increased likelihood an interaction will occur.

40
Q

Implications for Gero nursing

Educate

A
  • Talk with and help patients to understand herbal supplements.
    • Discuss the side effects, adverse reactions, and possible interactions between herbs, supplements, medications, and foods.
  • Review product safety
    • Offer relevant information and correct use of product
  • Seek to discontinue if side effects occur
    • Urge the patient to discontinue use if possible interactions or harmful side effects.
41
Q

What is pain:

A
  • Defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described as such”
  • Pain is what the patient says it is.
  • Multidimensional, sensory, psychosocial, emotional, personal, and spiritual components
  • Categorized as either acute, or chronic and persistent
  • Neuropathic (Box 27-1)
42
Q

What does box 27.1 NEUROPATHIC say?

A
43
Q

Pain in the older adult:

A
  • Reported by more men than women
  • Barriers to pain management (Box 27-4)
  • Persistent pain (Box 27-5)
  • Decrease in density of both myelinated and unmyelinated nerve fibers.
    •Delaying sensation of pain from the periphery and there is slower resolution once triggered
44
Q

Barriers to pain management box 27.4:

A
45
Q

PERSISTENT PAIN BOX 27.5

A
46
Q

Pain with cognitive impairments in older adults:

A
  • Consistently untreated or undertreated for pain
  • Receive less pain medication, even when they experience the same acutely painful events
  • Providing comfort
    • careful observation of behavior
    • Watch for and know when subtle changes occur
    • Give attention to caregiver reports
    • Pain cues in persons with communication difficulties (Box 27-6)
47
Q

Pain cues in persons with communication difficulties

BOX 27.6 :

A
48
Q

What is IDP

A

Iatrogenic disturbance pain

Be aware of pain that can be caused by caring for the older adult - pain that is caused by us as a result of caring for the patient, not intentional.

49
Q

How to promote healthy aging:

A
  • Pain management is that in which both pharmacological and nonpharmacological interventions work in harmony
  • The basic approach considers what has worked in the past and been effective without causing harm
50
Q

Assessment of pain in older adults:

A
  • pain diary
  • old cart
  • assess for coexisting depression and anxiety
    • can make anxiety worse
51
Q

What is OLD CART:

NOT ON EXAM JUST NEED TO KNOW

A
  • Onset
  • Location
  • Duration
  • Character
  • Aggravating
  • Relieving
  • Treatments
52
Q

How to rate the intensity of pain?

A
  • Rating scales - standard of care
  • Scales may not be reliable for persons with delirium or more severe impairments
  • Tools for comprehensive review of pain (Box 27.9)
53
Q

Assessment of pain in cognitively impaired/nonverbal

A
  • Persons with impaired communication skills with noncommunicative patients (Box 27-10)
  • It is recommended that attempts are made to use standard assessment instruments first even when the person has advanced dementia
  • The Pain Assessment in Advanced Dementia (PAINAD) Scale developed for use for those who either cannot express or cannot reliably express pain (Table 27-1)

-PACSLAC-2: behavioral assessment tool that may be helpful as an initial pain screen

54
Q

Persons with impaired communication skills with noncommunicative patients (Box 27-10)

A
55
Q

What are some non-pharmacological interventions?

always start with non-pharmalogical interventions first

A
  • Heat/cold
  • Transcutaneous electrical nerve stimulation
  • Acupuncture and acupressure
  • Relaxation, meditation, and guided imagery
  • Music
  • Activity
  • Cognitive-behavioral therapy
56
Q

Pharmacological interventions:

A
  • Erase the “memory of pain”
  • Around the Clock (ATC)
  • PRN medications for break through pain
  • Start Low, Go Slow, But Go
  • Pain Control Choices: Non-opioid, Opioid, Other
  • REASSESS FOR AFFECTIVENESS
57
Q

How do you evaluate the effectiveness of pharmacological interventions:

A
  • Quantitatively measured – repeat intensity scale;
  • Qualitative observations
  • Adjust interventions
58
Q

Pain assessment check list for senions with limited ability to communicate

A

Gero (4 decks)

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