lect 3: chapter 9 Flashcards by Frances Gabrielle Bartolome

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

anticholinergic & sedating medications

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what causes higher likelihood of orthostatic hypotension?

decreased baroreceptor reflex responses

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anticholinergic effects

cannot see, pee, spit, shit

dizziness and confusion

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which drug class is less effective in older people?

beta agonists & antagonists

due to decreased responsiveness of the adrenergic system

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Beer’s List

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

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what physiologic problems do older adults have regarding medications?

increased gastric pH
decreased GI motility and absorption
decreased metabolism

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ginkgo biloba

improves memory

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ginseng

reduces stress

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echinacea

cold and flu therapy

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garlic

prevents stroke & arteriosclerosis

that is why you can’t take it with anticoags

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glucosamine sulfate

reduced joint pain

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red yeast rice

lowers LDL

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St. John’s wort

mostly used to treat depression (NOT bipolar disorder)

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CoQ10

antioxidant

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nursing implications for garlic, ginkgo, and ginseng

stop 2 weeks before surgery

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nursing implications for St. John’s wort

stop 5 days before surgery

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pain assessment (OLDCARTS)

Onset
Location
Duration
Characteristic
Aggravation
Relieving factors
Treatments
Severity

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symptoms of neuroleptic malignant syndome (NMS)

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

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interventions for malignant syndrome

avoid direct sunlight
hydration
regular assessment of body temperature

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what are the barriers to pain management among older adults?

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

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many people believe that pain is a normal part of aging

true

what factors affect pain and its assessment among the older population?

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

pain scales for the cognitively impaired, nonverbal adults

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)

which medication does CoQ10 affect?

anti-hyperlipidemic or anticoagulative drugs

what are the nursing actions for **echinacea**?

advise person not to take without provider approval

what are the nursing actions for **garlic**?

monitor glucose levels

what are the nursing actions for **ginkgo**?

monitor glucose levels and BP

what are the nursing actions for **red yeast rice**?

- warn patient of increased risk for bleeding - monitor glucose levels

what are the nursing actions for **St. John's Wort**?

* monitor lipid levels * use sunscreen * educate that it may lower estrogen/ progesterone levels

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

* occluded tube * reduced effects * drug toxicity

what are the most common OTC meds for older adults?

* GI * analgesics * cough medicine * eye drops * vitamins

what are the most common Rx medications for older adults?

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

common psychotherapeutic medications

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

common SNRIs used by the older population

Bupropion and Trazodone

what is the action of Buproprion?

reduces nicotine dependency

what is the action of Trazodone?

sleep aid

common anxiolytics for the older adults

Benzodiazepine and Buspirone

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

true

buspirone must be taken daily

true

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

true

antipsychotic medication action

blocks dopamine

side effects of antipsychotic medications

* sedation * hypotension * anticholinergic effects * EPS * Malignant Syndrome

EPS | extrapyramidal symptoms

*movement disorders* * dystonia * akathisia * Parkinsonian symptoms * Tardive dyskinesia

what do you need to look for with NMS?

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

pseudoparkinsoniansim

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

akathisia

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

acute dystonia

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

tardive dyskinesia

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

what are the indications for *polypharmacy*?

- staying in LCT factilities - disabled older adults - multiple HCPs

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

tricyclic antidepressants | Amitriptyline, Amoxapine

what are other types of adjuvant treatments for pain?

- corticosteroids - topical agents - muscle relaxants