gero lec 3

Question 1

Aging Changes Affecting: Absorption

Answer 1

^ gastric ph
decreased surface for absorption, blood flow to spleen and GI activity

Question 2

Aging Changes Affecting: Distribution

Answer 2

^ body fat
decreased cardiac Output
Total body water
LEAN body mass
Serum albumin
Protein binding

Question 3

Aging Changes Affecting: Metabolism

Answer 3

^ body fat
decreased hepatic mass
Hepatic blood flow
Enzyme activity
Enzyme inductability

Question 4

Aging Changes Affecting: Excretion

Answer 4

decreased renal blood flow
GFR
Tubular secretory function
Kidney size

Question 5

Normal aging response to geropharmacology

Answer 5

Decreased baroreceptor response (higher risk orthostatic hypotension)
Decreased myocardial sensitivity to catecholamines (norepi, epi)
Decreased response of α-adrenergic system Reduced effects due to alterations in adrenergic system activity

Question 6

Normal aging response to Anticholinergic drugs. What are the side effects to anticholinergic drugs?

Answer 6

Can’t…
SEE – blurry vision
PEE – urinary retention
Can’t…
SPIT – dry mouth
SH…..POOP – constipation

Also, confusion and dizziness

Question 7

Drug supplement interactions: echinacea

Answer 7

risk of bleeding, digoxin level altered

Question 8

Drug supplement interactions: garlic

Answer 8

(Risk of bleeding; monitor glucose)

Question 9

Drug supplement interactions: ginkgo

Answer 9

(Risk of bleeding; several meds contraindicated; monitor glucose and BP)

Question 10

Drug supplement interactions: ginseng

Answer 10

(Risk of bleeding; several meds contraindicated)

Question 11

Drug supplement interactions: Red yeast rice

Answer 11

(Risk of bleeding; monitor glucose)

Question 12

Drug supplement interactions: St Johns wort

Answer 12

(several meds contraindicated, monitor lipids, use sunscreen and educate that it may lower progesterone and estrogen levels)

Question 13

Drug-food interactions

Answer 13

May affect absorption
Calcium binds to some meds (reduce absorption)
Grapefruit (increase or decrease bioavailability)
Green Leafy veggies (Contain Vit K, antidote to warfarin, keep intake consistent)
High K+ diet (K+ sparing diuretics, risk of hyperkalemia, keep intake consistent)

Question 14

Drug-drug interactions

Answer 14

 with polypharmacy
Competition for receptor sites ( in bioavailabilty)
Antispasmotics slow GI motility (Competition for plasma proteins to bind to)
Altered distribution (Competition for plasma proteins to bind to)
Altered metabolism
 in pH
Alterations in renal tubules > prolonging half life of some meds
Similar SEs or MOAs (Simultaneous sedative effects)

Question 15

what are the two types of medications that are specifically less effective with the older population?

Answer 15

anticholinergic & sedating medications

Question 16

what causes higher likelihood of orthostatic hypotension?

Answer 16

decreased baroreceptor reflex responses

Question 17

anticholinergic effects

Answer 17

cannot see, pee, spit, shit

dizziness and confusion

Question 18

which drug class is less effective in older people?

Answer 18

A
beta agonists & antagonists

due to decreased responsiveness of the adrenergic system

Question 19

Beer’s List: what is it?

Answer 19

a list of medications that have a higher than usual risk in older adults

Question 20

ginkgo biloba use

Answer 20

improves memory

Question 21

ginseng use

Answer 21

reduces stress

Question 22

echinacea use

Answer 22

think “icky”
for flu and cold

Question 23

garlic use

Answer 23

prevents stroke & arteriosclerosis

that is why you can’t take it with anticoags

Question 24

glucosamine sulfate use

Answer 24

reduced joint pain

Question 25

red yeast rice use

Answer 25

lowers LDL

Question 26

St. John’s wort use

Answer 26

mostly used to treat depression (NOT bipolar disorder)

Question 27

CoQ10 use

Answer 27

Antioxidant

Question 28

nursing implications for garlic, ginkgo, and ginseng

Answer 28

stop 2 weeks before surgery

Question 29

nursing implications for St. John’s wort

Answer 29

stop 5 days before surgery

Question 30

pain assessment (OLDCARTS) what does it stand for?

Answer 30

Onset Location Duration Characteristic Aggravation Relieving factors Treatments Severity

Question 31

symptoms of neuroleptic malignant syndome (NMS)

Answer 31

hyperthermia, rigidity, altered mental status, tachycardia, and pallor

Question 32

interventions for malignant syndrome

Answer 32

avoid direct sunlight hydration regular assessment of body temperature

Question 33

what are the barriers to pain management among older adults?

Answer 33

HCP patient (inability to assess pain in cognitively impaired) AND family healthcare system (cost, time, cultural and political bias on opioid use)

Question 34

true or false: many people believe that pain is a normal part of aging

Answer 34

true

Question 35

what factors affect pain and its assessment among the older population

Answer 35

pain history how it affects function expressions of pain social resources how have they managed past pains

Question 36

pain scales for the cognitively impaired, nonverbal adults

Answer 36

Pain Assessment in Advanced Dementia Scale (for those who cannot reliably express their pain) Pain Assessment Checklist for Seniors with Limited Ability to Communicate (observe facial expression, verbalizations, vocalizations, body movements)

Question 37

which medication does CoQ10 affect?

Answer 37

anti-hyperlipidemic or anticoagulative drugs

Question 38

what are the nursing actions for echinacea?

Answer 38

advise person not to take without provider approval

Question 39

what are the main concerns for administrating medications by enteral tube?

Answer 39

occluded tube reduced effects drug toxicity patient harm and death

Question 40

what are the most common OTC meds for older adults? C.A.G.E

Answer 40

Cough medicine Analgesics GI Eye drops

Question 41

what are the most common Rx medications for older adults?

Answer 41

1) CV 2) diuretics 3) nonopioid analgesics 4) anticoagulants 5) antiepileptics

Question 42

common psychotherapeutic medications

Answer 42

1) antidepressants 2) anxiolytic agents 3) mood stabilizers 4) antipsychotics

Question 43

common SNRIs used by the older population

Answer 43

Bupropion and Trazodone

Question 44

what is the action of Buproprion?

Answer 44

reduces nicotine dependency

Question 45

what is the action of Trazodone?

Answer 45

sleep aid

Question 46

common anxiolytics for the older adults

Answer 46

Benzodiazepine and Buspirone

Question 47

true or false: bezodiazepines have a fast onset and long half life, and more likely can lead to toxicity

Answer 47

true

Question 48

true or false: buspirone must be taken daily

Answer 48

true

Question 49

true or false: buspirone takes a week to take into effect, that is why it is prescribed along with benzodiazepine (due to fast onset)

Answer 49

true

Question 50

antipsychotic medication action

Answer 50

blocks dopamine

Question 51

side effects of antipsychotic medications S.H.A.M.E

Answer 51

sedation hypotension anticholinergic effects Malignant syndrome EPS

Question 52

EPS symptoms

Answer 52

movement disorders dystonia akathisia Parkinsonian symptoms Tardive dyskinesia

Question 53

what do you need to look for with NMS?

Answer 53

potential for liver damage and heat stroke (due to hyperthermia and decreased thermoregulation)

Question 54

pseudoparkinsoniansim signs/symptoms T.R.A.P

Answer 54

stooped posture shuffling gait rigidity bradykinesia tremors at rest (pill rolling)

Question 55

akathisia signs/symptoms

Answer 55

restless trouble standing still paces the floor in constant motion (moving back and forth)

Question 56

acute dystonia signs/symptoms

Answer 56

facial grimacing involuntary upward eye movement spasms from the neck (larynx) up to the face

Question 57

tardive dyskinesia signs/symptoms

Answer 57

protrusion and rolling of tongue sucking and smacking movements of lips facial dyskinesia involuntary mvmnts of body and extremities chewing motion

Question 58

what are the indications for polypharmacy?

Answer 58

staying in LCT factilities disabled older adults multiple HCPs

Question 59

which type of drug can effectively treat neuropathic pain as an adjuvant?

Answer 59

tricyclic antidepressants Amitriptyline, Amoxapine

Question 60

what are other types of adjuvant treatments for pain?

Answer 60

corticosteroids topical agents muscle relaxants