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Nurs 100 > Week 7 And 8-Ch 15 > Flashcards

Week 7 And 8-Ch 15 Flashcards

1
Q

Do medications act diff in older adults

A

Yes

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2
Q

Do older adults medication require careful dosage adjustment and monitoring

A

Yes

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3
Q

Medication risks for older adults

A

Increased risk of interactions and adverse reactions

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4
Q

Med challenges for older adults

A

Age related changes

Polypharmacy

Increased risk of adverse reactions due to altered pharmokinetics and pharmodynamics

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5
Q

Early sign of adverse reaction to many meds

A

Mental dysfunction

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6
Q

Age related changes that cause medication issues

A

Decreased salivary flow and dentition(makes pills hard to swallow)

Kidney and liver changes alter pharmacokinetics

Biological half life on many drugs is longer
-drugs can build up to toxic levels
-liver and kidney tests let us know if drug is appropriate

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7
Q

Changes to body that impact pharmacodynamics

A

Increased myocardial sensitivity to anesthesia

Increased CNS receptor sensitivity to narcotics, alcohol, and bromides

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8
Q

Altered absorption (kinetics)

A

There are fewer priblems

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9
Q

Factors that impact absorption

A

Route

Concentration and solubility

Disease and symptoms

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10
Q

How to maximize absorption

A

Exercise

Heat

Massage

Preventing dehydration, hypothermia, hypotension, interactions with other meds

Use most effective route

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11
Q

Is drug distribution easy to predict

A

No

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12
Q

Drug distribution considerations with the older adult

A

Changes in circulation

Membrane permeability

Body temp

Tissue structure

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13
Q

What decreases drug distribution

A

Dehydration and hypoalbuminemia

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14
Q

Conditions that decrease metabolism of drug

A

Dehydration

Hyperthermia

Immobility

Liver disease

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15
Q

Extended half life

A

Close evaluation of drug clearance

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16
Q

Is detoxification and conjugation of drug reduced or increased

A

Reduced

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17
Q

Why is kidney efficiency important

A

Renal system excretes drugs

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18
Q

What organ impacts drugs detoxification and excretion

A

Liver

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19
Q

What percent of 70 YO use at least 1 drug/ more than 5

A

95%

68%

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20
Q

Adverse reactions and older adults

A

Signs and symptoms are different

Takes longer to present itself

May occur even after med is discontinued

May develop suddenly even after long term use

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21
Q

Is mental dysfunction always dramatic or can it be subtle

A

Can be subtle

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22
Q

Does cause of mental disfunction need to be determined before treating it

A

Yes. Can cause additional complications.

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23
Q

Causes/risks for med errors

A

Functional impairment-weak hands

Cognitive limitations

Education limitations

Sensory limitations-hearing, visual

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24
Q

Beers criteria

A

Identifying high risk drugs for elderly

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25
Q

Drug nursing assessment questions

A

Is smallest dose being ordered?

Why is drug ordered?

Is patient allergic to the drug?

Can drug interact with other med, herb, etc patient is taking

Are there any special instructions for drug administration?

Is the most effective route of drug administration being used?

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26
Q

Most common route to administer med

A

Oral

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27
Q

Issues with suppository

A

Lower body temp may cause it to melt slower

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28
Q

IM and sucut

A

Do not inject in immobile limb
-will cause slower absorption

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29
Q

Considerations for monitoring lab values

A

Blood test done to find levels

Specific meds require certain type and frequency of blood work

Find out if there is any limitations in being able to get lab testing done

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30
Q

Patient teaching

A

Med review

Med reconciliation

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31
Q

Things to consider before putting patient on drug

A

Does benefits outweigh risks

Consider lifestyle changes first

32
Q

How does renal and liver function affect medication

A

Contributes to changes in pharmokinetics

33
Q

Aspirin

A

Increased risk of GI bleeding

Caution with heparin and warfarin

Enteric coated preferred, take with food

34
Q

Acetaminophen

A

Total daily dose not to exceed 4,000 mg
-can cause hepatic necrosis

35
Q

Opiods

A

Respiratory distress

Risk for falls, sedation, constipation, confusion

36
Q

Least preferred Opiod for older adults

A

Meperidine

37
Q

Guidelines for analgesic

A

Assess pain symptoms

Try non-med options first

Begin with weakest type and dose of analgesic

Administer regularly to maintain constant blood level

Observe for signs if infection(other than fever if taking aspirin and acetaminophen)

Observe for signs of anemia and bleeding with aspirin

38
Q

Nursing guidelines:

Signs of aspirin toxicity

A

Note signs of aspirin toxicity-

Tinnitus, hearing loss

39
Q

Does acetaminophen have anti-inflammatory activity

A

No

40
Q

Antacids

A

Assess reason for use
-indigestion(can be symptom of more serious illness)
-require testing if constantly using

Monitor bowel movement
-constipation when using aluminum hydroxide and calcium antacids

-Diarrhea when magnesium hydroxide combinations are used

41
Q

Who should avoid using sodium bicarbonate as ant acid

A

Sodium restricted diets

42
Q

How long should you wait to give medication after giving antacid

A

2 hrs

43
Q

Antibiotics

A

-excessive use can cause antibiotic resistance

-secondary infection caused by antibiotics
•oral thrush, colitis, vaginitis

Side effects- nausea, vomiting, diarr

Iv vancomycin and amino-glycoside can cause hearing loss

44
Q

Side effects of antibiotics

A

Nauseau, vomiting, diarrhea, anorexia, allergies

45
Q

Meds with risk of hearing loss and renal failure

A

IV vancomycin and aminoglycosides(amikacin, gentamicin, and tobamycin

46
Q

Guidelines for antibiotics

A

Get blood culture when suspect infection

Administer on a schedule to keep blood levels the same

Reinforce not skipping doses

Observe for signs of superinfection with long term use

47
Q

Anticoaggulants

A

Prevents thrombosis

High risk for bleeding

Heparin and warfarin

Only prevents new clots. Does not get rid of old ones.

Risk of osteoporosis with long term use

48
Q

Slide 43

A
49
Q

What decreases effects of anticoggulants

A

Vitamin K
-green leafy veggies, bacon

50
Q

Herbal interactions with anticoagulants

A

Garlic/ginko-increased risk for bleeding

Green tea with warfarin-may alter anticoag. Effects

51
Q

Antidote for anticog.

A

Vitamin K

52
Q

Anticonvulsants

A

Monitor blood levels

Older adult shave higher risk for toxicities

Choice for older adults-carbamazepine, lamotrigine

53
Q

Anticonvulsants to avoid

A

Phenobarbital

Phenytoin

54
Q

Other uses for anticonvulsants

A

Bipolar, schizoaffective

55
Q

Guidelines for anticonvulsants

A

Ensure physical activity bc it can depress psychomotor activity

Periodic blood work

Can worsen liver and kidney disease

Should not be discontinued abruptly

Monitor closely with coronary artery disease, prostate disease

56
Q

Anti diabetic (hypoglycemic) drugs

A

Teach recognition if hypo and hyoerglycemia

Have paperwork that list diagnosis incase become unconscious

Insulin dose may require adjusting if prolonged diarrhea or Vomiting

57
Q

Antihypertensive medications

A

Diuretics-most common

Beta blockers

Angiotensin-converting enzyme inhibitor

Calcium channel blockers

Alpha blockers

58
Q

Guide for antihypertensive drugs

A

Assess blood pressure in lying sitting and standing positions

Monitor carefully bc some can cause hypotension

Monitor for thiazide effects-hyponatremia, hypokalemia, acute renal dysfunction

Advise taking at bedtime

59
Q

Nsaids

A

Treat mild to moderate pain

Narrow therapeutic window

60
Q

Nursing guidelines for NSAIDS

A

Narrow therapeutic window and can reach toxic levels quick

Observe for side effects; gi issues, cCNS diaturbance

Risk for developing delerium

Administer with food or milk

61
Q

Celebrex(NSAID)

A

Increases risk of heart attack and stroke

Swelling of body parts

Signs of bleeding

62
Q

cholesterol lowering drugs

A

Usage has increased

Decrease LDL and increase HDL

63
Q

Statins(cholesterol drug)

A

Usually first type of treatment

Ex: atrocastatin, rosuvastatin

Side effects: muscle pain, dizziness, ab cramping

64
Q

Niacin(cholesterol

A

Examples-niacor, niaspan

Adverse effects-headache, aggravate diabetes, makes gall bladder disease worse

65
Q

Bile acid resins(cholesterol)

A

Ex: cholestyramine, colestipok

Adverse effects-stomach issues, interacts with diuretics, beta blockers, NSAIDS

66
Q

Nursing guidelines for cholesterol drugs

A

Ensure good liver function and necessary tests are complete

67
Q

Digoxin

A

Used for congestive heart failure and other heart issues

Daily dose should not be more than 0.125 mg

68
Q

Guidelines for digoxin

A

Check pulse before use

Reduced kidney function causes half life to increase

Signs of toxicity-delirium, bradycardi

Hypokalemia increases risk of toxicity

69
Q

Diuretics

A

Thiazides: metolazone

Loop diuretics: bumetanide, ethacrynic acid, furosemide

Potassium soaring diuretic-amiloride, spironolactone, triamterene

70
Q

Guideline for diuretics

A

Monitor intake and output

Observe for adverse reactions with thiazide diuretics

Evaluate electrolytes, glucose, and BUN

71
Q

Laxatives

A

Bulk formers-

Stool softeners-

Osmotics-

Stimulants

Lubricants

72
Q

Guidelines for laxatives

A

Good fluid intake is useful with bulk forming laxatives and stool softeners

73
Q

Analgesics

A

Aspirin
Acetaminophen
Opiods

74
Q

Aspirin side effects

A

Increased risk of GI bleeding

Caution with heparin and warfarin

Enteric coated preferred (take with food)

75
Q

Acetaminophen daily dose

A

Total daily dose should not exceed 4,000 mg.

Can cause hepatic necrosis

76
Q

Opiod side effects

A

Respiratory distress

Falls

constipation

Confusion

77
Q

Least preferred opiod for elder

A

Meperidine

Nurs 100 (11 decks)

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