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NURS 2518 > Polypharmacy > Flashcards

Polypharmacy Flashcards

1
Q

what are medications

A
  • substance that is taken into or placed on the body to cure, treat, relieve symptoms, or as a prophylactic
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2
Q

what are bioactive substances

A
  • any substance that has an effect on, causes a reaction, or triggers a positive or negative response in living tissues
    ex. herbs
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3
Q

what are pharmacodynamics

A
  • what a drug or med does to the body’s receptors
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4
Q

what is clearance rate

A
  • amount of blood cleared of drug per unit time
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5
Q

what is elimination half time

A
  • amount of time it takes to clear half the drug
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6
Q

what age-related changes affect the action of meds in the older adults?

A
  • renal changes affect the conc of meds in the body
  • water soluble meds have greater intensity
  • fat soluble substances have decreased intensity
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7
Q

what are age related changes that affect med safety in older adults

A
  • decreased body water
  • decreased lean tissue
  • increased body fat
  • decreased serum albumin
  • decreased renal functioning
  • decreased liver function
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8
Q

what factors challenge safe med practices?

A
  • pathological processes
  • knowledge & misunderstandings
  • med management
  • communicative/functional impairment
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9
Q

what kind of misunderstandings challenge safe med practice

A
  • people think meds are quick fix and prefer them over non-pharmacological
  • people think all herbal remedies are natural & safe –> not true
  • people may not understand why they are taking a med
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10
Q

how do communication/functional impairments challenge safe med practice

A
  • challenges people comprehension of med instructions

- vision changes & fine motor skills challenge self-admin

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11
Q

how can med managament challenge safe med practices

A
  • inappropriate prescribing practices
  • inadequate monitoring of meds
  • high price of drugs
  • non-adherence
  • polypharmacy
  • adverse med effects
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12
Q

how do pathological processes challenge safe med practices

A
  • older adults have increased prevalence of chronic conditions = increased complexity of medical prescriptions
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13
Q

what is meant by inappropriate prescribing practices

A
  • potentially inappropriate meds
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14
Q

what are the risks of polypharmacy

A
  • med nonadherence
  • adverse drug reactions
  • prescribing cascade
  • drug interactions
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15
Q

how can we identify inappropriate meds?

A
  • can use resources that assess if a med is necessary

- beers criteria, START, STOPP tools

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16
Q

what might make meds inappropriate

A
  • ineffective
  • low safety profile
  • better alternatives
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17
Q

what type of drug do older adults have a high susceptibility to adverse effects?

A
  • anti-cholinergics
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18
Q

what are side effects of anticholinergics

A
  • dry mouth
  • constipation
  • urinary retention
  • orthostatic hypotension
  • bowel obstruction
  • blurred vision, dilated pupils
  • increased HR
  • increased sweating
  • delirium
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19
Q

why is it important to be aware of anticholinergic effects

A
  • many OTC meds have anticholinergic effects
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20
Q

what is the risk of antipsychotics in those with dementia

A
  • can have anticholinergic effects
  • increased risk of orthostatic hypotension
  • increased risk of falls
  • contributes to polypharmacy
  • can contribute to delirium
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21
Q

despite the risks of antipsychotics, why do they continue to be prescribed for individuals with dementia? what is a better alternative?

A
  • to control responsive behaviors
  • better alternative –> identify underlying cause & treat that
  • personhood & behavioral strategies should always be approached first
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22
Q

what is polypharmacy

A
  • using meds which are not clinically indicated

- or taking 5 or more drugs

23
Q

when is polypharmacy problematic

A
  • when drugs are causing adverse effects
  • benefits outweigh the risks
  • can be seen in individuals who are taking a lot of meds which are unnescessary
24
Q

what are consequences of polypharmacy

A
  • med non-adherence
  • adverse drug reactions
  • drug interactions
  • risk for falls & injury
  • hospitalization
25
Q

what can cause polypharmacy

A
  • having a variety of different doctors who are all prescribing pills
  • fear of disclosure
  • meds from number of sources
  • nonadherence
  • belief that once meds are started they should be continues
  • belief that dosages do not need to be changes
26
Q

what is non-adherence

A
  • patterns of taking meds that differ from what was prescribed
  • includes missed dosages, not filling the meds, taking them too frequently
27
Q

what are the reasons for non-adherence

A
  • complex
  • financial issues
  • asymptomatic disease = decreased motivation
  • misunderstanding the reason you’re taking the drug
  • adverse effects
28
Q

what is the difference between non-adherence & non-compliance

A
  • non-adherence = not intentional
29
Q

what is an adverse drug event

A
  • adverse drug reaction or med effect

- unintended & undesired outcomes of a med that occur in doses normally used in humans

30
Q

what are consequences of adverse drug events

A
  • decline in function
  • risk for falls
  • increased # of healthcare visits
  • hospitalization
  • death
31
Q

what meds are most frequently cited for emergency hospitalization

A
  • warfarin
  • antiplatelets
  • antidiabetics
  • corticosteroids
  • antibiotics
  • antineoplastic
  • immunosuppressors
  • CV drugs
  • NSAIDs
  • opiates
32
Q

what is a prescribing cascade

A
  • when an adverse drug event is interpreted as a new condition which leads to new diagnosis & more meds
33
Q

what are med interactions

A
  • when two meds compete for same binding site, interfere w each other
  • can cause adverse effects
34
Q

what do med interactions cause

A
  • either too high or too low levels of the med

- increases risk of ADE & chances of toxicity

35
Q

what increases the risk of med interactions

A
  • increases depending on number of meds used
36
Q

what are things other meds can meds interact with

A
  • nicotine
  • alcohol
  • nutrients
  • herbs
37
Q

what kind of nutrients might meds interact with

A
  • foods
  • bererages
  • enteral formulas
  • dietary supplements
38
Q

what specific food is notorious for drug interactions

A
  • grapefruit juice

- decrease absorption & increase conc of many meds

39
Q

what are the elements of an effective med review?

A
  • are the patients meds indicated?
  • is it effective?
  • consider dose, route, formulation, duration
  • is it safe for the patient? consider contraindications, interactions, ADE
  • can the patient adhere to the meds? size, freq, cost
40
Q

describe nursing assessment for meds

A
  • record all meds & bioactive substances used
  • alcohol, caffeine, nicotine, cannibus use
  • patient’s understanding
  • allergies
  • adverse effects
  • preferences
  • observe patterns of meds used
  • overall assessment
41
Q

how can we observe patterns of meds used

A
  • ask to see all meds
  • directly assess med containers
  • storage of meds
42
Q

describe the overall assessment of med use

A
  • link meds to complaints
  • assess outcomes of meds
  • functional assessment
  • home enviro
  • nonadherence
43
Q

what are 2 approaches for nursing interventions

A
  • multidimensional approach

- interdisciplinary approach

44
Q

what is a nurses role in med interventions

A
  • alert prescriber to potential problems
  • question unnecessary meds
  • start low, go slow
  • risk versus benefit
45
Q

when does med reconcilliation occur

A
  • during transitions in care
46
Q

what is med reconcilliation

A
  • a comprehensive review of the meds
47
Q

what is a nurses role in med reconcilliation

A
  • view all meds
  • on discharge: how will they fill the prescription
  • how do they administer meds?
  • an opportunity for pt education
48
Q

how can nurses encourage safe & effective med taking behaviors?

A
  • educate the patients & caregivers
  • involve the patients in decisions
  • empower older adults to ask questions & understand their meds
  • support their independence
49
Q

what should nurses education patients on regarding med

A
  • med organization
  • how to take them
  • why are they on them
  • what side effects to expect
50
Q

how can nurses help reduce adverse drug events

A
  • use non-pharmacological approaches (ex. sleep)
  • med reconcillation (identify patient med errors)
  • ensure client is able to safely & appropriately take their meds
51
Q

what is deprescribing

A
  • coordinating with the prescriber to dicontinue duplicate meds or meds no longer appropriate
52
Q

what should you consider when deprescribing

A
  • what factors warrant discontinues use?
  • how can patients be engaged in the deprescribing process?
  • tapering?
  • what should be monitored and how?
  • how to manage symptoms
53
Q

what are some factors for nonadherence

A
  • lack of knowledge of meds
  • adverse effects of meds
  • cognitive wellness

NURS 2518 (4 decks)

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