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.
2
Q
Route of administration for absorption ?
A
Oral, sublingual, transdermal
3
Q
It is best to take medication with :
A
Water
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
5
Q
Distribution
systemic circulation:
A
Transportation to target cell receptors.
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
7
Q
Age related changes that affect distribution:
A
- less body water
- increased body fat
- decreased availability of plasma proteins
8
Q
Distribution
common in the aged
A
- peripheral vascular disease
- chonic illnes
- acute illness
9
Q
Metabolims:
biotransformation-
A
transforms substances making them more easily eliminated from the body.
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
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
12
Q
Age related chnages in excretion:
A
- Reduction of Glomerular Filtration Rate (measured by CrCl)
- Prolonged medication half-life
13
Q
Pharmacodynamis is:
A
Physiological interactions between a medication and the body. Ex. chemical compounds and cell receptors.
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
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
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
17
Q
Medication food interactions:
Calcium in dairy
A
- Levothyroxine
- Tetracycline
- Ciprofloxacin
- Spironolactone
- Increase potassium (K+)
18
Q
Medication food interactions
Green leafy vegetables:
A
Decreases anticoagulant effects
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
20
Q
Medication food interaction:
- Altered absorption
- Alrered distribution
- Altered excretion
- 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
21
Q
Adverse drug reactions and events:
A
- May range from minor to fatal
- Inappropriate medications
- Allergic reactions
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
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)
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
Antipsychotic typical and atypical medications:
* Typical - haloperidol (never used in dementia with Lewy bodies)
* Atypical – Seroquel newer most affective (fewer EPS symptoms)
26
Movement disorders that we need to watch for:
*recognize what is not right and figure out if you have a problem
Extrapyramidal syndrome EPS
27
What are the 4 EPS:
*do not need to differentiate them just know the changes associated and how to recognize somethisn isnt righ*
* 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
Promoiting health aging in assessment:
* ”Brown Bag” have them bring all meds in there.
* Discuss each medication with the patient
* Stop/Start tool
29
Herbs and supplemnt regulation:
* 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
Use of dietary supplements and herbal products:
CoQ10:
* Use: For people who can’t take statins
* Caution: Do not take with Warfarin
* Adverse Reactions: Elevated liver function tests, mild GI upset
31
Use of dietary supplements and herbal products:
Garlic:
* 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
Use of dietary supplements and herbal products:
Ginkgo Biloba
* Use: Cognitive function, memory
* Caution: With use of anticoagulants
* Adverse Reactions: Bleeding (GI)
33
Use of dietary supplements and herbal products:
St. John’s wort
* 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
Use of dietary supplements and herbal products:
Melatonin
* Use: Promote sleep
* Caution: When taking other medications that can cause drowsiness
* Adverse Reactions: Headache, nausea
* Do not take with PRILs
35
Use of dietary supplements and herbal products:
Ginseng
* Use: Promotes overall wellbeing and immunity
* Caution: With use of anticoagulants
* Adverse Reactions: Box 10-1 (gi bleed)
36
Use of dietary supplements and herbal products:
Glucosamine and chondroitin sulfate
* Use: Support cartilage and connective tissue, has anti-inflammatory effects
* Caution: With allergies, diabetes, and asthma
* Adverse Reactions: Nausea, GI upset
37
Dietary supplements for select conditons
* 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
Diabetes and herbal supplements:
* 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
Important note to know about supplemets and herbs:
The more supplements, herbs and other drugs that the client is taking, the increased likelihood an interaction will occur.
40
Implications for Gero nursing
| Educate
* 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
What is pain:
* 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
What does box 27.1 NEUROPATHIC say?
43
Pain in the older adult:
* 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
Barriers to pain management box 27.4:
45
PERSISTENT PAIN BOX 27.5
46
Pain with cognitive impairments in older adults:
* 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
Pain cues in persons with communication difficulties
| BOX 27.6 :
48
What is IDP
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
How to promote healthy aging:
* 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
Assessment of pain in older adults:
- pain diary
- old cart
- assess for coexisting depression and anxiety
- can make anxiety worse
51
What is OLD CART:
NOT ON EXAM JUST NEED TO KNOW
* Onset
* Location
* Duration
* Character
* Aggravating
* Relieving
* Treatments
52
How to rate the intensity of pain?
* 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
Assessment of pain in cognitively impaired/nonverbal
* 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
Persons with impaired communication skills with noncommunicative patients (Box 27-10)
55
What are some non-pharmacological interventions?
*always start with non-pharmalogical interventions first*
* Heat/cold
* Transcutaneous electrical nerve stimulation
* Acupuncture and acupressure
* Relaxation, meditation, and guided imagery
* Music
* Activity
* Cognitive-behavioral therapy
56
Pharmacological interventions:
* 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
How do you evaluate the effectiveness of pharmacological interventions:
* Quantitatively measured – repeat intensity scale;
* Qualitative observations
* Adjust interventions
58
Pain assessment check list for senions with limited ability to communicate
