Lecture 3 Flashcards
(74 cards)
1
Q
Pharmacokinetics
A
The way the body uses medication
2
Q
Pharmacokinetics: Absorption
A
How the medication is taken into the body.
3
Q
Pharmacokinetics: Distribution
A
How the medication is dispersed throughout the body
4
Q
Pharmacokinetics: Metabolism
A
How the medication is broken down
5
Q
Pharmacokinetics: Excretion
A
How the medication is removed from the body
6
Q
Absorption: Route of administration
A
Oral
Sublingual
Transdermal- long absorption, fat-soluble meds
7
Q
Absorption: Age related changes
A
- Reduction of saliva- anticholinergic effects
- Difficulty swallowing
- Slowed Motility (Not a normal part of aging, but a common condition in the aged)
- Reduction in gastric acids
- Delayed stomach emptying
8
Q
Distribution: Systemic Circulation
A
Transportation to target cell receptors
9
Q
Distribution: Target Organs
High Blood flow
A
Brain, kidneys, lungs, and liver
Rapid reception, increased concentration of medications
10
Q
Distribution: Target Organs
Low Blood Flow
A
Skin, muscles, fat
Lower concentrations of medications
11
Q
Distribution: Age-related changes
A
- Less body water
- Increased body fat
- Decreased availability of plasma proteins
12
Q
Distribution: Common in the aged
A
- Peripheral vascular disease
- Chronic illness
- Acute illness
13
Q
Metabolism: Biotransformation
A
transforms substances making them more easily eliminated from the body.
14
Q
Metabolism: Age-related change
A
- Reduction of liver mass
- Reduction of liver perfusion (30% to 40%)
- Reduces the amount of medication metabolized during the first pass
15
Q
Excretion
A
As metabolites or unchanged
16
Q
Excretion: Through what?
A
Lungs, sweat, biles feces breast milk hail saliva tears semen urine (the renal system)
17
Q
Excretion: Age-related changes
A
- Reduction of Glomerular Filtration Rate (measured by CrCl)
- Prolonged medication half-life
18
Q
Pharmacodynamics
A
Physiological interactions between a medication and the body.
Ex. chemical compounds and cell receptors.
19
Q
Pharmacodynamics: Age-related changes
A
- Reduction in baroreceptor reflex response (slow response)
- Increased susceptibility to orthostatic hypotension (careful pt. movement)
20
Q
Pharmacodynamics: Beta agonist?
A
- Decreased responsiveness in the a-adrenergic system
- Decreased sensitivity to B-agonist (beta agonist)
21
Q
Pharmacodynamics: other sensations
A
- Decreased thirst sensation (dehydration, excreting more)
- With a low dose go slow especially w/ heavy meds
22
Q
Polypharmacy
A
Approximately five or more medications (common problem)
- increases the risk for morbidity and mortality
- the more prescribed medications taken, the greater the possibility of drug interactions
23
Q
Polypharmacy: Increased risk for adverse events
A
- number of providers (cardio, renal, osteo)
- the presence of chronic illness
- OTC ( drug interaction)
- possible drug interaction w/ disability
24
Q
Medication- Food Interactions
Calcium
A
Dairy binds to receptors that med needs already, causing the reduced therapeutic effect
(best to take w/ water)
- Levothyroxine
- Tetracycline
- Ciprofloxacin
- Spironolactone
–increase potassium (K+)
25
Medication- Food Interaction
Green Leafy Vegetables (Vitamin K)
Decrease anticoagulant effect-- regulate a regimen and schedule for meds
give based off lifestyle
26
Medication- Food Interaction
Altered Absorption
Binding
27
Medication-Food Interaction
Altered distribution
Receptor displacement
28
Medication-Food Interaction
Altered Excretion
- Medication-related pH changes- (doesn't break down as it should)
- Increase/ decrease in active transport
29
Medication-Food Interactions
Additive Effects
-Especially dangerous in CNS effects (depression or mental)
((falls/ low respiratory rates))
-Grapefruit juice affects statins to be in body longer/ cause muscles to hurt (muscle atrophy, liver/kidney failure) s/e
30
Adverse Drug Interactions and Events
- May range from minor to fatal
- Inappropriate medications (OTC meds)
- Allergic reactions
(ask about what type of allergy, some could be s/e and not deadly if nvd? could just be allergy if its pain/ swelling of the throat could be deadly)
31
Beers Criteria
- Potentially inappropriate for older adults with certain conditions
- Should only be taken with caution
- Avoid
Select medication:
- first-generation antiistamines
- nitrofurantoin (Macrobid)
- Alpha1-blockers
- Antiarrhythmics, esp (amiodarone)
- Digoxin
- Nifedipine (immediate release)
- Many antipsychotics
- Barbiturates
- Benzos
- Sliding scale insulin
- Sulfonylureas, long duration
- Glyburide
- Demerol
- Non-COX selective NSAIDS
32
Psychoactive Medications
-Tx. for depression, anxiety, bipolar disorder, and issues related to DEMENTIA
• Require an assessment
• Cost/Benefit
• Used after non-pharmacological approaches found ineffective
• Watch Your Patient Closely!!!
33
Antipsychotics
Affect the hypothalamic and thermoregulatory pathways
- Neuroleptic Malignant Syndrome (Assess Body Temp) (Thermo changes)
• Known for side effects – Watch your patient closely
* Sedation
* Hypotension
* Extrapyramidal and anticholinergic side effects (EPSEs)
* Movement
* Drying
* Typical - haloperidol (never used in dementia with Lewy bodies)
* Atypical – Seroquel (produce fewer EPS s/s)
34
Movement Disorders: Extrapyramidal Syndrome (EPS)
Acute Dystonia
- Involuntary, slow, continuous muscular contractions of the face, jaw, mouth, and neck
- Oculogyric Crisis: eyes in a fixed position
35
Movement Disorders: Extrapyramidal Syndrome (EPS)
Akathisia
* Compulsion to be in motion, restless
| * Mistaken for worsening psychosis
36
Movement Disorders: Extrapyramidal Syndrome (EPS)
Parkinsonian Symptoms
* Bilateral tremor
| * Bradykinesia and rigidity that may progress to inability to move
37
Movement Disorders: Extrapyramidal Syndrome (EPS)
Tardive Dyskinesia (TD)
* When antipsychotics used continuously for 3 - 6 months
* Irreversible
* Worm like movements of the tongue (beginning)
* Facial movements
* Involuntary twisting movements
• Risk Factors: Female, African American, dementia, advanced age
38
Promoting Healthy Aging
Assessment
- " Brown Bag" (What medications are you taking?)
- Discuss each medication with the patient
- Stop/start tool
39
Herbs and Supplement Regulation
- Regulated by Dietary Supplement Health and Education Act
- Herbal manufacturers label herbs as foods
- NOT FDA REGULATED
- Good Manufacturing Practices required since 2007
- Preparation and storage, product identification, purity, strength, composition
40
Herbs and Supplement Regulation:
CoQ10
- Use: For people who can’t take statins
- Caution: Do not take Warfarin
- Adverse Reactions: Elevated liver function tests, mild GI upset
41
Herbs and Supplement Regulation
Garlic
- Use: Decreased blood clots and reduced total serum cholesterol and low-density lipoprotein
- Caution: With the use of anticoagulants
- Adverse Reactions: severe allergic reactions, increased flatulence, and upper gastrointestinal (GI) irritation with nausea and heartburn
42
Herbs and Supplement Regulation
Ginkgo Biloba
- Use: Cognitive function, memory
- Caution: With the use of anticoagulants
- Adverse Reactions: Bleeding
43
Herbs and Supplement Regulation
St. John's Wort (Mental)- Serotonin Syndrome
* Use: Mild or moderate depression, anxiety, pain
* Caution: Warfarin, Contraindicated with other antidepressants Esp. SSRIs
* Separate SJW and other antidepressants by two weeks
* Adverse Reactions: Serotonin syndrome, photosensitivity
44
Herbs and Supplement Regulation
Melatonin
-Use: Promote sleep
-Caution: When taking other medications that can cause drowsiness
-Adverse Reactions: Headache, nausea
(Not supposed to take with specific antihypertensive)
45
Herbs and Supplement Regulation
Ginseng
- Use: Promotes overall wellbeing and immunity
- Caution: With the use of anticoagulants
- Adverse Reactions:
- Tachycardia
- Hypertension
- Hypotension
- Hypoglycemia
- Insomnia
46
Herbs and Supplement Regulation
Glucosamine and Chondroitin Sulfate
- Use: Support cartilage and connective tissue, has anti-inflammatory effects
- Caution: With allergies, diabetes, and asthma
- Adverse Reactions: Nausea, GI upset
47
Herbs and Supplement Regulation
Dietary Supplements for Select Conditions
Hypertension
```
Coenzyme Q10
Fish oil
Garlic
Green tea
Melatonin
```
48
Herbs and Supplement Regulation
Dietary Supplements for Select Conditions
HIV
Saint John Warts
49
Herbs and Supplement Regulation
Dietary Supplements for Select Conditions
GI Disorders
Psyllium
Milk Thistle
Probiotics
50
Herbs and Supplement Regulation:
Dietary Supplements for Select Conditions
Cancer
- Calcium (colorectal)
- Fish oil (endometrial)
- Garlic (colorectal, prostate)
- Ginseng (breast, stomach, lung, liver, ovarian)
51
Herbs and Supplement Regulation:
Dietary Supplements for Select Conditions
Alzheimer's Disease
Gingko
52
Herbs and Supplement Regulation:
Diabetes
- Herbs have been used to manage diabetes since before the 1921 discovery of insulin.
- Some of the nearly 400 different plants that affect blood glucose are still used.
- There is not enough evidence to support the use of herbal supplements for treating diabetes
- Cinnamon- typically use
(increased likelihood an interaction will occur)
53
Implications for Gerontological Nursing:
| Educate
- Talk with and help patients to understand herbal supplements
- Discuss the s/e, a/r, and possible interactions between herbs, supplements, meds, and foods
- Review product safety
- Offer relevant info and correct use of the product
- Seek to discontinue if s/e occur
- Urge the pt. to discontinue use if possible interactions or harmful s/e
54
Pain
-Defined by the International Association for the Study of Pain as
“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described as such"
-Pain is what the patient says it is "0/10?"
55
Pain Components
- Multidimensional
- sensory
- psychosocial
- emotional
- personal
- spiritual components
56
Pain Category
- acute
- chronic (can come and go)
- persistent( doesn’t go away)
57
Pain: Neuropathic
shooting or burning pain
58
Pain in the Older Adult
- Reported by MORE MEN than women
- Barriers to pain management
- Persistent pain
- Decrease in the density of both myelinated and unmyelinated nerve fibers.
- Delaying sensation of pain from the periphery and there is slower resolution once triggered
59
Pain With Cognitive Impairments in Older Adults
- Consistently untreated or undertreated for pain
| - Receive less pain medication, even when they experience the same acutely painful events
60
Pain With Cognitive Impairments in Older Adults: Providing comfort
- careful observation of behavior
- Watch for and know when subtle changes occur
- Give attention to caregiver reports
- Pain cues in persons with communication difficulties
61
Iatrogenic disturbance Pain (IDP)
-Be aware of the
pain that can be caused by caring for the older adult
(Pain we caused by turning them)
62
Promoting Healthy Aging
- Pain management is that in which both pharmacological and nonpharmacological interventions work in harmony
- The basic approach considers what has worked in the past and been effective without causing harm
63
Assessment
- pain diary
- old cart
- assess for coexisting depression and anxiety
64
Rating the Intensity of Pain
- Rating scales - the standard of care 0-10
- Scales may not be reliable for persons with delirium or more severe impairments
- Tools for a comprehensive review of pain
65
Assessment of Pain in Cognitively Impaired/Nonverbal
- Persons with impaired communication skills with non-communicative patients
- It is recommended that attempts are made to use standard assessment instruments first even when the person has advanced dementia
- The Pain Assessment in Advanced Dementia (PAINAD) Scale was developed for use for those who either cannot express or cannot reliably express pain
PACSLAC-2: behavioral assessment tool that may be helpful as an initial pain screen
66
Non-Pharmacological Interventions
* Heat/cold
* Transcutaneous electrical nerve stimulation
* Acupuncture and acupressure
* Relaxation, meditation, and guided imagery
* Music
* Activity
* Cognitive-behavioral therapy
67
Pharmacological interventions
* Erase the “memory of pain”
* Around the Clock (ATC)
* PRN medications for breakthrough pain
* Start Low, Go Slow But Go
* Pain Control Choices: Non-opioid, Opioid, Other
68
Evaluation of Effectiveness
* Quantitatively measured – repeat intensity scale
* Qualitative observations
* Adjust interventions
69
Pain Assessment Checklist for Seniors: Facial Expressions
- Grimacing
- Tighter face
- Pain expression
- Increased eye movement
- Wincing
- Opening mouth
- Creasing forehead
- Lowered eyebrows or frowning
- Raised cheeks, narrowing of the eyes, or squinting
- wrinkled nose and raised upper lip
- eyes closing
70
Pain Assessment Checklist for Seniors: Verbalizations and Vocalizations
- Crying
- A specific sound for pain (e.g. 'ow', 'ouch'
- moaning and groaning
- grunting
- gasping or breathing loudly
71
Pain Assessment Checklist for Seniors: Body Movement
- flinching
- thrashing
- refusing to move
- moving slow
- guarding the sore area
- rubbing or holding sore area
- limping
- clenched fist
- going into fetal position
- stiff or rigid
- shaking and trembling
72
Pain Assessment Checklist for Seniors: Changes in interpersonal interactions
- not wanting to be touched
| - not allowing people near
73
Pain Assessment Checklist for Seniors: Changes in Activity Patterns or Routines
Decreased activity
74
Pain Assessment Checklist for Seniors: Mental Status Changes
Are there mental status changes that are due to pain and are not explained by another condition (delirium due to medication, etc)
