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nurs2518 : the older client > Week 7: Pharmacokinetics > Flashcards

Week 7: Pharmacokinetics Flashcards

1
Q

who are the largest users of prescription users?

A

older adults

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2
Q

true or false: Adverse drug reactions are more common in the older adult

A

true

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3
Q

true or false: Adverse drug reactions (ADR) are associated with increased mortality and morbidity for older adults

A

true

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4
Q

what is pharmacokinetics?

A

lipophilcity
hydrophilicity
half life of medications

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5
Q

what are pharmacokinetics change?

A

What the body does to the drug from the point of administration to the point of its excretion

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6
Q

what does ADME stand for (Facebook)?

A

absorption
distribution
metabolism
elimination

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7
Q

What are the changes in the older adults’ body that might impact the time it takes for the drug to absorbed?

A

Diminished gastric acidity
Slower stomach emptying (diminish activity of short lived medications)
Slowed gastric emptying can increase the effect of the medication

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8
Q

How do the changes in the older adults’ body change the absorption of the medication?

A

Slower gastric emptying can cause a time delay in maximum drug concentration

Transdermal may lead to decreased concentration of drug in the blood

Inconsistent changes

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9
Q

Other medications or food can influence the absorption of medications

A

E.g. grapefruit juice delays with a medication for hypothyroidism (levothyroxine) may delay the absorption of the medication
Fosamax can not be taken with food

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10
Q

true or false: the amount of available fat can affect distribution because some medications are attracted to attach to fat cells (lipophilicity)

A

true

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11
Q

what are some drugs that have a narrow therapeutic window?

A

phenytoin and warfarin

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12
Q

What are the changes in the older adult body that might change the distribution of the drug?

A

increased body fat
effect: Drugs that bind to fat will have a prolonged effect (they last longer in the body- leads to unpredictable effect)
ex. Valproic Acid and diazepam

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13
Q

What are the changes in the older adult body that might change the distribution of the drug?

A

Older adults experience changes in body composition: decreased body water

effect: Drugs that bind to water will have an increased concentration (higher risk of toxicity and adverse medication effect)

ex. morphine, digoxin, Lithium

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14
Q

What are the changes in the older adult body that might change the distribution of the drug?

A

Frail older adults, prolonged illness and malnutrition can decreased serum albumin

effect: Higher concentration of drugs that bind to protein albumin leading to increase risk for toxicity of medication

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15
Q

where does metabolism most prominently occur?

A

in the liver

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16
Q

what is a half life?

A

the measure of the amount of time the drug is active in the system

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17
Q

How do the changes in the older adult’s body change the metabolism of the drug?

A

Change: Reduced blood flow through the liver
Effect: Can lead to an increase in the amount of time the medication stays in the body longer

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18
Q

how is the drug excreted from the body?

A

Primarily excreted through the kidneys, also bile, saliva, sweat

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19
Q

How do changes in the older adult influence excretion?

A

Decreased blood flow through kidney
Decreased kidney function (decreased glomerular filtration rate)

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20
Q

How do the changes in the older adults’ body change the excretion of the drug?

A

Often means that the drug is in the body longer and increases the risk for drug toxicity
Creatinine clearance is used as an indication of the efficiency of the Glomerular filtration rate therefore a decreased creatinine clearance should lead to a decrease in dosage of some medications

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21
Q

true or false: Older adults should start with lower doses of medications

A

true

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22
Q

What the clinician needs to do to compensate for changes in renal function?

A

What the clinician needs to do to compensate for changes in renal function:
Clinicians need to know what normal kidney function is in the older adult

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23
Q

true or false: Decreased renal function results in reduction in drug clearance (or the drug stays in the body longer)

A

true

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24
Q

what are some age related pharmacokinetic changes

A
  • Age-related changes in absorption can delay maximum concentration of drug
  • Age-related changes in distribution are related to change in body composition
  • The most significant age related changes that impact pharmacokinetic properties are related to changes in the blood flow to the liver and kidney
  • Prolonged illness, malnutrition and hydration can compound age related effects that can contribute to changes in pharmocokinetics
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25
Q

what is the definition of poly pharmacy?

A

“Use of more medications than is clinically indicated”

“Often associated with the chronic use of 5 or more medications”

“A large number of medications, contraindicated, potentially inappropriate or medications that are duplicated or unnecessary”

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26
Q

is it true: 1 in 4 Canadian seniors was prescribed 10+ drug classes in 2016

A

true

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27
Q

what are adverse drug reactions?

A

these are unwanted reactions to meds that range in severity

Medication induced delirium, falls and decline in function are the most common concerning ADR’s for older adults

Diet, physiological changes can change older adult’s response to medications

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28
Q

true or false: Older adults on 10-14 different drug classes were five times more likely to be hospitalized than those prescribed 4 or fewer drug classes

A

true

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29
Q

is adverse drug reactions the cause of iatrogenic mortality and morbidity for older adults?

A

yes

30
Q

true or false: Anti-cholinergic meds decrease the risk for geriatric syndromes including falls and delirium

A

false; it increases

31
Q

what are some increased risks for drug induced delirium?

A

Antidepressants
Antihistamines
Antiparkinsonian agents
Antipsychotics
Benzodiazepines

32
Q

what is Beer’s criteria?

A

Development of a criteria that identify medications that carry a higher than normal risk for adverse medication effect

33
Q

what does this describe? Medications are considered appropriate or not appropriate according to the patient’s condition

Identify potentially inappropriate medications that may exacerbate the disease or syndrome and those that should be used with caution

A

Beer’s list - reduce poly pharmacy

34
Q

what is anticholinergic syndrome?

A

Occurs when a person takes too many medications that block acetylcholine (blocks CNS and PNS)

Adverse medication effects can occur when the amount of acetylcholine blocked inhibits normal body function

some include antihistamines, antiemetics

35
Q

true or false: Adverse medication effects can occur when the amount of acetylcholine blocked inhibits normal body function

A

true

36
Q

what occurs when acetylcholine is blocked?

A

cognitive impairment, acceleration of neurogenerative process, appearance of psychotic or confusional symptoms and functional disturbances

37
Q

what is this signs and symptoms of: dry mouth, urinary retention, constipation, paralytic ileus, increased heart rate and blurred vision

A

blocked acetylcholine

38
Q

select all that is true regarding polypharmacy:
increase risk for med interaction

increase risk for age related changes to alter therapeutic effectiveness of the medication

decreases the risk for misuse of meds

A

true except for last statement; increases

39
Q

can polypharmacy potentiate the impact of another medication (either making it more effective or making one or both effective)

A

yes

40
Q

what falls under: polypharmacy increases risk for medication interaction?

A

medication administration
two or more meds are administered at the same time

when medications are taken with same foods
ex. Increased leafy green vegetables can counteract the anticoagulant effects of Coumadin and aspirin

41
Q

true of false: Medication interactions can change pharmacokinetic activity by altering the body’s ability to absorb, distribute, metabolize or excrete a medication

A

true

42
Q

is it true that there comes a change in the pharmacodynamics with age?

A

yes, pharmacodynamics is the effect the medication has on the body: Changes in sensitivity of cell receptors to medications can result in decreased or increased response to the medication

43
Q

what are some examples of the misuse of medications?

A

overuse, underuse, erratic use and contraindicated use

44
Q

true or false: Polypharmacy increases the risk or misuse because it becomes increasingly difficult to manage the medications

A

yes

45
Q

Polypharmacy decreases the risk of medication misuse when older adults do not understand why they are taking the medication or when they need to take the medication (health literacy)

A

nope its INCREASE u sucked in

46
Q

what are some factors that contribute to polypharmacy and misuse of medication

A

health provider/ systems factors

older adult factors

47
Q

how common is medication misuse within the older adult?

A

80% - so quite high

48
Q

what is the factors that are accosted with medication misuse?

A

Cognitive impairment, social isolation, depression, asymptomatic disease, low health literacy, adverse medication, long treatment duration, high number of medications, poor communication and misunderstanding about the medications or disease

49
Q

select all that apply:
Older adults have a higher incidence of chronic diseases

Media pressure on older adult

Availability of other nutraceuticals (herbs and homeopathic remedies)

A

true

50
Q

what are some psychosocial factors of the older adult?

A

knowledge and motivation and function:

urpose of the medication and information about how and when
to take medication (Health literacy)
* Sensory issues – ability to read print and directions, ability to hear
* Physical issues – ability to swallow, remove from the bottle, dexterity for applying medications administered nasally, transdermally…

myths and misunderstanding

communication barriers

51
Q

expand on how communication is a psychosocial factor of the older adult:

A

Older adult’s fear of disclosing information about medications from other sources

An assumption that once on a medication that they should stay on that medication and that it should not change

An assumption by the patient that you can not develop ADR after being on the medication for a long time

these assumptions are often true of the health practitioner as well

financial considerations

52
Q

what are some other factors that contribute to polypharmacy and misuse of medications by the older adult

A

cognitive impairment
social isolation, depression
asymptomatic disease
low health literacy
adverse medication reactions
long treatment duration
having a complex drug regime schedule

53
Q

true or false regarding health provider: Adverse drug reactions are likely to be misinterpreted or not recognized because of their similarities to disease symptoms

A

true

54
Q

what falls under prescribing cascade?

A

iatrogenic - practitioners adding medications to treat side effects

example:
An adverse effect of antihypertensives can be anxiety
If the older adult is put on medication to reduce this anxiety it is a prescribing cascade

55
Q

is it true: Health care providers lack of information about medications from the older adult’s various sources of medication

A

yes

56
Q

what are some lacks of info about the older adult?

A

Changes in weight
Daily habits changes
Mental-emotional patterns
Not recognizing ADR

57
Q

can a lack of information about the older adult lead to prescribing cascade?

A

yes

58
Q

what are some factors that contribute to polypharmacy and misuse of medications?

A

to the older adult:
Social expectations
Psychosocial factors
Communication barriers

to the health provider:
- Do not spend the time to understand the physical changes
- Prescribing Cascade
- Communication

59
Q

when are antipsychotic medication prescribed ?

A

it’s prescribed patients with history of schizophrenia and bi polar
older adults living with dementia
responsive behaviours
delirium

60
Q

haloperidol, perphenazine, or chlorpromazine are

A

first line with people with long term psychiatric symptoms

61
Q

what is the second antipsychotics ?

A

risperiodone, olanzapine, quetiapine

62
Q

what are some factors that contribute to polypharmay and misuse of meds?

A

factors related to the older adult:
* Social expectations
* Psychosocial factors
* Communication barriers

factors related to the health provider:
* Do not spend the time to understand the physical changes
* Prescribing Cascade -Communication

63
Q

what are the risks of antipsychotic medications?

A

Cause orthostatic hypotension

Anticholinergic effects

Impacts ability of the older adult to thermoregulate

Risk of Neuroleptic Malignant Syndrome

64
Q

what are some reasons when antipsychotic medications are use?

A

Used to manage delirium

Used to manage responsive behavior in older adults with dementia

Often used inappropriately in the older adult population (especially in Long term care facilities) to control responsive behaviors

Prescribing antipsychotics for a person with dementia as a first line of defense is not recommended because of adverse medication reactions

65
Q

what falls under the components of a comprehensive review of medication use?

A

Review of all medications – Brown bag assessment

Matching medical diagnosis with prescribed medication
* Formally done in the health care system: medication reconciliation

Current health status
* need for medication
* Older adults understanding of the reason to take medication

66
Q

what are some ways to reduce poly pharmacy?

A

instruct patients to bring all medications to appointments: prescriptions, OTC, herbal, supplements

Screen for unnecessary drugs at each medical visit.

prescribe drugs with better or less side effects or simplify drug regimens

Ensure the patient thoroughly understands their drug regimen by providing clear written instructions

67
Q

what is deprescribing?

A

The systematic process of identifying and discontinuing drugs in instances in which existing or potential harm outweigh existing or potential benefits within the context of an individual patients’ goal, current level of functioning, life expectancy, values and preferences”
or simply put - discontinuing drugs

68
Q

what is this term? reducing or stopping medications that may not be beneficial or may be causing harm. The goal of deprescribing is to maintain or improve quality of life.

A

deprescribing

69
Q

True of false: Encourage non-pharmacological approaches for behavior

A

true

70
Q

what is this describing: Medications are considered appropriate or not appropriate according to the patient’s condition

A

beers list

71
Q

what falls under collecting info on factors impacting med use and safety?

A

Look for potential of medication interactions

  • Recognize conditions that make it difficult for the older adult to self medicate
  • Recognize frailty (potential for fluid depletion and malnutrition)
  • Identify medications that could exacerbate disease or geriatric syndromes (BEERs Criteria)
72
Q

how do you monitor and evaluate the effective medication?

A

are you reaching the goal of the medication

focusing on improving function for the older client

identify changes in:
Sleeping
Eating (appetite)
Elimination
Watch blood level of some medications

identify changes in potential geriatric syndromes

nurs2518 : the older client (13 decks)

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