Wk 4: Pharm: Geriatric Flashcards
BEERS criteria
Improve awareness of polypharmacy
Drug interaction
interaction between a drug and another substance
Mechanisms that affect drug interaction
absorption, distribution, alternations made to drug by body (metabolsm), elimination from body
Drug interactions
Most important come from change in absorption, metabolism, elimination
Changes in absorption
alter blood flow to intestines changes in metabolism in intestines inc/dec motility alter stomach acidity change in bacteria in intestines
Drug absorption
can be affected by solubility- ability to dissolve or if another substance binds to a drug and prevents absorption
Changes in Drug metabolism/ elimination
Most drugs are eliminated from kidneys either in unchanged form or alter from liver metabolism
Kidney and liver important sites of drug interactions
Metabolism
Process through which body converts drug into forms or as a byproduct results from alteration of drug by liver. Most occurs in liver but other organs play a role.
How to avoid drug interactions
give HC workers full med list including OTC, herbals and prns
Drug interaction factors
genes, physiology, age, lifestyle (diet/exercise), underlying disease, drug dose, duration of combined therapy, relative time of administration.
How to avoid drug interactions
- complete list to HC workers
- Inform HC when meds are added or DCed
- Life style chages
- Ask about serious/frequent interactions
- Eliminate unnecessary meds, as interactions increase as more meds get added
Consequences of drug interactions
inc/dec in beneficial or adverse drug effects
Absorption
sometimes increased by foods
Prescriptive Authority
1 authoritative source for Ohio Law- OBN.
Major elements: Title of APRN (CNS, CNP, CRNA, CNM) Licensure as RN and APRN Grad accredited school grad certification at advanced level from accredited program is maintained Independent practicing independent prescribing
Medication Reconciliation
Med list is exact, accurate and available, include herbals, OTC, vitamins
Match (Medication at transition and clinical handoffs)
AHRQ developed toolkit for medication reconciliation for system use. Make a single med list
Geriatric risk factors
falls, medications, physical (wt loss, fatigue, disease), psychosocial (depression, dependancy), and changes (lifestyle, finances, social support)
Institute for Safe Medication Practices
Pt safety organization- devoted to patient safety r/t medication error prevention and safe medication use.
Polypharmacy
inc medication therapy
delay in ordering med refills
pharmacy pick up of mail delivery
use of multiple pharmacies
Most common geriatric med errors
Coumadin, Insulin, antiplatelet, hypoglycemic
Non pharmacological factors
use of OTC meds
may play role in drug interactions
obtain good history
good counseling and coordination of services
4 basic prinicles
avoid unsafe med practices
recognize meds worseing ADLs
use EBP to determine meds
Consider concomitant disease states- communicate with other services
