Week 3 Outline Flashcards
What are the ways the body uses medications? (SATA)
- 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.
Route of administration for absorption ?
Oral, sublingual, transdermal
It is best to take medication with :
Water
Age related changes that affect absorption?
- 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
Distribution
systemic circulation:
Transportation to target cell receptors.
Distribution
targets organs:
-Hight blood flow: brain, kidneys, lungs, and liver
•Rapid reception, increased concentrations of medications
-Low blood flow: skin, muscles, fat
•Lower concentrations of medications
Age related changes that affect distribution:
- less body water
- increased body fat
- decreased availability of plasma proteins
Distribution
common in the aged
- peripheral vascular disease
- chonic illnes
- acute illness
Metabolims:
biotransformation-
transforms substances making them more easily eliminated from the body.
Age related changes that affect the metabolism:
- Reduction of liver mass
- Reduction of liver perfusion (30% to 40%)
- Reduces the amount of medication metabolized during the first pass
Excretion is done through
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
Age related chnages in excretion:
- Reduction of Glomerular Filtration Rate (measured by CrCl)
- Prolonged medication half-life
Pharmacodynamis is:
Physiological interactions between a medication and the body. Ex. chemical compounds and cell receptors.
Pharmacodynamis and age related changes:
- 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
Polypharmcy:
oApproximately five or more medications
oIncrease risk for morbidity and mortality
oThe more prescribed medications taken, the greater the possibility of interactions
Reasons that polypharmcy occurs (SATA)
- # of providers
- Presence of chronic illness
- Use of over counter meds
- Disability that impacts a patient not taking medications
Medication food interactions:
Calcium in dairy
- Levothyroxine
- Tetracycline
- Ciprofloxacin
- Spironolactone
- Increase potassium (K+)
Medication food interactions
Green leafy vegetables:
Decreases anticoagulant effects
Medication-food interactions
Grape fruit juice
Causes issues with statin
- leaving it in the body longer which can lead to liver and kidney damage
Medication food interaction:
- Altered absorption
- Alrered distribution
- Altered excretion
- Additive effects
- 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
Adverse drug reactions and events:
- May range from minor to fatal
- Inappropriate medications
- Allergic reactions
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
- Potentially inappropriate
- Potentially inappropriate for older adults w/certain conditions
- Should only be taken with caution
- Avoid
- Not meant to be policy
Psychoactive medicaitons things to know:
- 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)
How do antipsychotics affect the hypothalamic and thermoregulatory pathways:
- Neuroleptic Malignant Syndrome – Assess Body Temp.
- Known for side effects – Watch your patient closely
- Sedation
- Hypotension
- Extrapyramidal and anticholinergic side effects (EPSEs)
- Movement
- Drying
Antipsychotic typical and atypical medications:
- Typical - haloperidol (never used in dementia with Lewy bodies)
- Atypical – Seroquel newer most affective (fewer EPS symptoms)
Movement disorders that we need to watch for:
*recognize what is not right and figure out if you have a problem
Extrapyramidal syndrome EPS
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
Promoiting health aging in assessment:
- ”Brown Bag” have them bring all meds in there.
- Discuss each medication with the patient
- Stop/Start tool
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
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
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)
Use of dietary supplements and herbal products:
Ginkgo Biloba
- Use: Cognitive function, memory
- Caution: With use of anticoagulants
- Adverse Reactions: Bleeding (GI)
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
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
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)
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
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
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
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.
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.
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)
What does box 27.1 NEUROPATHIC say?
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
Barriers to pain management box 27.4:
PERSISTENT PAIN BOX 27.5
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)
Pain cues in persons with communication difficulties
BOX 27.6 :
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.
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
Assessment of pain in older adults:
- pain diary
- old cart
- assess for coexisting depression and anxiety
- can make anxiety worse
What is OLD CART:
NOT ON EXAM JUST NEED TO KNOW
- Onset
- Location
- Duration
- Character
- Aggravating
- Relieving
- Treatments
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)
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
Persons with impaired communication skills with noncommunicative patients (Box 27-10)
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
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
How do you evaluate the effectiveness of pharmacological interventions:
- Quantitatively measured – repeat intensity scale;
- Qualitative observations
- Adjust interventions
Pain assessment check list for senions with limited ability to communicate
