Gero ch.9 Flashcards
(89 cards)
1
Q
Absorption
A
- This event is where the drug is into the bloodstream
- influenced by changes in GI motility
2
Q
what depends on several factors, such as the route of introduction (e.g., IV, oral, parenteral, transdermal, or rectal) and the bioavailability and dose of medication?
A
The amount of time between the administration of the drug and its absorption.
3
Q
What happens when the drug is administered by the IV route and is quickly delivered when using parenteral and transdermal route, or when mucous membranes become utilized?
A
The drug is delivered immediately to the bloodstream.
4
Q
Pharmacokinetics
A
- movement of medication in the body from the point of administration to excretion
- drugs are absorbed, distributed, and metabolized
- implications for safe drug use in later life occurs
5
Q
what type of drug is absorbed slowly, especially with enteric coatings compared with other routes of administration?
A
Orally administered drugs
6
Q
What slows the action of acid-dependent medications?
A
The increased gastric pH of the aging stomach
7
Q
What diminishes or negates the absorption and therefore the effectiveness of short-lived drugs?
A
Delayed emptying
8
Q
Enteric-coated medications
A
designed to bypass the stomach and to be absorbed in the small intestine
9
Q
What happens if absorption of the products become delayed?
A
gastric irritation or nausea may occur
10
Q
What happens if there is an increased motility in the small intestine bc of shortened contact time resulting in decreased absorption and effectiveness?
A
the effect of the drug is diminished
11
Q
What increases the contact time, the amount absorbed, and effect?
A
slowed intestinal motility, which is common in aging
12
Q
Distribution
A
based on the availability of plasma protein in the form of lipoproteins, globulins, and especially albumin
13
Q
What happens when drugs are absorbed?
A
- they have to be transported to the receptor site on a targeted organ to have the desired effect
- they bind with the protein and are distributed throughout the body
14
Q
What is inactivated as it binds to a protein?
A
the predictable percentage of the absorbed drug
15
Q
remaining free drug
A
available in the blood and has a therapeutic effect when an adequate concentration is reached in the plasma
16
Q
What do most older adults have during distribution?
A
insignificant reduction of albumin
17
Q
the presence of albumin becomes dramatically reduced in who?
A
- those who are frail
- those who have an inadequate diet
- those who have reduced protein intake
18
Q
Where are low serum albumin levels found?
A
- adults who are needing long-term care
- adults who have dementia
- adults who are socially isolated
19
Q
What may accumulate in the blood stream unpredictably?
A
- toxic levels of available free drug
- highly protein-bound medications (due to protein not being available) with narrow therapeutic windows
20
Q
What are the potential alterations of medication distribution in late life?
A
Changes in body composition such as:
- decreased lean body mass
- increased body fat
- decreased total body water
21
Q
What does decreased body water lead to?
A
higher relative serum levels of water-soluble drugs (e.g., lithium, digoxin, ethanol, aminoglycosides)
22
Q
What leads to toxicity during distribution?
A
- dehydration and increased serum levels with extended diarrhea, vomiting, or other conditions
23
Q
What doubles in older men and increases by one-half in older women?
A
adipose tissue
24
Q
what drugs are stored in the fatty tissue, extending and possibly elevating an effect?
A
drugs that are highly lipid-soluble
25
How does accidental and potential fatal overdoses happen?
when the medication accumulates in excess
26
Metabolism
- process by which the body modifies the chemical structure of the drug
- compound is converted to a metabolite that is later more easily excreted
- a drug will continue to exert a therapeutic effect as long as it remains either in its original state or as an "active" metabolite
27
Active metabolites
retains the ability to have a therapeutic effect, as well as the same or a greater chance of causing adverse effects
28
duration of drug action
defined by the metabolic rate and is measured in terms of half-life, or the length of time one-half of the drug remains active in the body
29
Why is it safer to consider 3 g of acetaminophen in 24 hrs?
because of the unpredictable nature of drug metabolism in the body
30
number of enzymes
plays an active part in drug metabolism with one of these
31
What affects the availability of enzymes and metabolism?
- age
- weight
- sex
- liver and kidney function
32
What is the primary site of drug metabolism?
liver
33
what does the reduction in liver function lead to?
a significant increase in the half-life of these drugs
34
What happens if the dose and timing are not adjusted?
drugs could accumulate and the administration of a single dose could have significantly more effects, and it can be found in a younger person
35
What is inappropriate to prescribe?
Valium, anyone older than 65 years
36
Excretion
drugs are being eliminated
37
Where are drugs excreted at?
- sweat
- saliva
38
what is the primary site of excretion?
through the kidneys
39
Kidney function declines significantly with aging, this means:
the ability to excrete or eliminate drugs in a timely manner declines as well
40
What further prolongs the half-life of drugs and the amount of time required to eliminate the drug, adding to the risk of accumulation and increasing the potential for toxicity or other adverse events?
Decreased glomerular filtration rate (GFR)
41
What happens when the CrCl is reduced?
reductions in dosages for drugs excreted by the kidneys are needed
42
reduction in dosages
may be necessary when the patient is very ill or dehydrated
43
Pharmacodynamics
interaction between the drug and the body
44
The older the person becomes...
the more likely there will be an altered or unreliable response of the body to the drug
45
What happens during the aging process?
a decreased response to beta-adrenergic receptor stimulators and blockers; decreased baroreceptor sensitivity; and increased sensitivity to a number of medications all occur
46
Chronopharmacology
relationship between the biological rhythms of the body and variations in pharmacokinetics and pharmacodynamics
47
If the same dose is taken in divided amounts over the say as labeled
unwanted effects of the drug may suppress the hormonal activities stemming from the hypothalamus-pituitary-adrenal axis
48
What influences absorption?
- increased gastric pH
- level of motility of the GI tract
- the degree of blood flow
they all obtain biorhythmical variations
49
distribution of protein-bound drugs
depends on the levels of albumin and glycoproteins produced by the liver
50
What happens during the day?
albumin levels are high, but they are low in the early morning
51
what else is rhythmical?
drug metabolism; b/c of changes in the liver over the course of the day
52
Renal elimination
- depends of kidney perfusion, glomerular filtration, and urine acidity
- also shows rhythmical variation
53
what varies rhythmicity to where it results in a cyclical response for beta blockers?
- brain
- heart
- blood cells
54
echinacea
enhances immunity
avoid use with anticoagulation drug b/c it increases the risk of bleeding
55
garlic
inhibits platelet aggregation
avoid use with any anticoagulant or antiplatelet drug b/c it can increase the risk of bleeding.
It can also cause hypotension when taken with antihypertensive drugs.
56
ginger
antiemetic
57
gingko biloba
improves memory
Avoid use with any anticoagulant, antiplatelet, & antidiabetic drugs b/c it increases the risk of bleeding.
It also alters blood glucose levels, so patients that are diabetic should avoid this herb but if they are taking it, they must be aware of how to monitor blood glucose closely.
58
ginseng
increases physical endurance
Avoid use with antidiabetic drugs, anticoagulants, antiplatelets, & MAOIs b/c it will increase the risk of bleeding.
It also can alter glucose levels
Use of MAOIs will cause mania, headaches, and tremors so the patient should be instructed to not take two medications all together
59
valerian root
promotes sleep and reduces anxiety
60
Green tea
Avoid with Warfarin sodium and stimulants b/c it has caffeine to where it increases the effects when taken with stimulants
use with warfarin can alter coagulation effects; so patients are instructed to not consume this herb on warfarin
61
St. John's Wort
Avoid use with everything
It interacts with a lot of medications and should not be used without talking to the doctor first
62
Warfarin
Avoid foods with vitamin K because K decreased the effect of the drug
kale, spinach, greens, broccoli, green tea, collards, parsley or any other dark green veggies are examples of vitamin K
63
Grapefruit juice
Interacts with multiple medications by altering metabolism and elimination
64
polypharmacy
- defined as the use of approximately five or more medications or the use of multiple medications for the same problem
- may occur "accidentally"
65
What if a patient has multiple chronic conditions?
simple polypharmacy may be necessary, even if the prescribing provider is following evidence-based guidelines
66
How would polypharmacy occur "accidently?"
If an existing drug regimen is not considered when new medications are prescribed
67
two major concerns of polypharmacy
- increased risk of drug interactions
- increased risk of adverse events
68
Adverse drug reaction (ADR)
an unwanted pharmacological effect such as a minor rash or nausea
69
Adverse drug event (ADE)
When a reaction reaches the level of harm, it is an adverse drug event (ADE) which may include withdrawal and therapeutic failures.
70
What is one of the most common ADRs for the older adult?
delirium and confusion - increases risk for falls
71
Misuse of drugs
- can occur for any number of reasons, from inadequate skills of the nurse or the prescriber to inadequate funds to purchase prescribed medications
- it happens when more drugs are taken
72
What affects drug misuse?
memory failures
73
problems with health literacy
limits the ability to take medications correctly
74
limitations in vision
will interfere with reading instructions, especially of bottle labels
75
psychoactive medications
Used to treat anxiety, depression, bipolar, and psychosis
Higher than usual risk for adverse reactions
Must be administered with caution and awareness of how the older adult will be able to tolerate
Implement nonpharmacological interventions with medications
76
antidepressants
Used to treat depression
Always assess the patient’s mood status
Assess if progress is occurring while taking antidepressants
We are worried about suicide risk
77
Antipsychotics
Haloperidol, chlorpromazaine
Should be used as a last result due to dangerous side effects
Should be used at lowest dose for shortest amount of time
78
mood stabilizers
- lithium
- treatment for bipolar disorder
79
If a patient is taking lithium
he/she will need frequent lab monitoring (narrow therapeutic window) and extensive patient education regarding diet
80
Neuroleptic Malignant Syndrome (NMS)
A rare, life threatening adverse drug event to antipsychotics
81
Extrapyramidal Syndrome (EPS)
Most common side effects of antipsychotics are movement disorders referred to as EPS reactions
Acute dystonia
Akathisia
Parkinsonian Symptoms
Tardive dyskinesia
82
acute dystonia
an abnormal involuntary movement consisting of slow and continuous muscular contractions or spasms
83
Akathisia
compulsion to be in motion and may occur at any time during therapy. The patient might feel restless, feel unable to be still, have an unrelentless desire to move, and feeling “like crawling out of my skin”.
The patient might be pacing, aimlessly walking, shifting weight from one leg to another, & fidgeting. Safety is our primary concern for this patient.
84
Parkinsonian Symptoms
bilateral tremors, slow movements, rigidity of muscles, the patient might not be able to move, flat facial expression
85
Tardive dyskinesia
irreversible movement disorder.
Patient will have wormlike movements of the tongue, facial grimacing and blinking. Slow involuntary twisting movements of the trunk, face, neck, and eyes.
86
Nursing implications
The nurse and patient should decide when a PRN medication is needed
The nurse will need to complete an extensive medication reconciliation
Assess for key persons involved
Ensure a safe environment to enhance communication
Choose the right timing
Communicate effectively
Reinforce teaching
87
Components of a medication assessment for Older Adults
Assess if the patient can afford their medications
Assess if the patient has means to get medications refilled
Assess how the patient remembers to take medications as scheduled
Does the patient get routine labs for medication levels?
Can the patient open bottles as needed?
Does anyone help with setting medications out or reminding the patient to take medications?
88
Administration
Due to chronic conditions such as osteoarthritis the patient might not able to open medication bottles
Moisten mouth then place pill on the front of the tongue and swallow a fluid
Never crush an enteric coated medication
Use consistent devices for measurement
Transdermal patches should not be cut or altered (always wear gloves to remove and place a patch)
89
Monitoring
Assess vital signs and for any changes noted in the patient’s functional abilities/cognitive functioning
TSH monitoring if someone is taking thyroid replacement therapy
INR monitoring for anyone taking warfarin
Hgb A1C monitoring for diabetic patients
Communicate acute changes with the PCP promptly
Be an educator and advocate for your patient
