Flashcards in Week 3 Deck (105)
What are the definitions of polypharmacy?
• Administration of many drugs together
• Administration of excessive medication
• Excessive or inappropriate use of medications
Why do older adults consume more drugs as compared to their younger counterparts?
• More illness
• More adverse drug reactions (ADRs)
- Altered response to drug therapy
• Physician reliance on drug therapy over non pharmacologic options
• Multiple prescriptions from multiple providers
• Over the counter and self-help remedies
• Sharing of medications
What is included in the polypharmacy cycle?
- More illness in older adults leads to
- Need/take more drugs leads to
- Increased risk of side effects leads to
- Side effects seen as symptoms leads to
- More drugs administered leads to
- More illness in older adults
What are the characteristics of polypharmacy?
• Use of medications for no apparent reason
• Use of duplicate medications
• Concurrent use of interacting medications
• Use of contraindicated medications
• Use of inappropriate dosage of medications
• Use of drug therapy to treat ADRs
• Patient improves with discontinuation of medications
What are pharmacokinetic changes?
How the body handles the drug
What are the pharmacokinetic changes in response to drugs?
• Absorption- altered gastrointestinal function
• Distribution- changes in total body water, lean body mass, % body fat, plasma protein concentrations
• Metabolism- reduced liver mass, decreased hepatic blood flow, decreased activity of drug metabolizing enzymes
• Excretion- decreased renal blood flow and mass, decreased function of renal tubules
What do pharmacokinetic changes result in?
Drugs and drug metabolites remaining active for longer periods of time and prolonging drug effects thereby increasing risk for toxic side effects.
What are pharmacodynamic changes?
How drugs affect the body
What are the physiologic systemic pharmacodynamic changes seen in the body?
• Homeostatic control of circulation – impacts cardiovascular drugs
• Impaired postural control
• Decreased visceral muscle function
• Changes in thermoregulation
• Declining cognitive ability
What are the cellular level pharmacodynamic changes seen in the body?
Binding receptor changes
• Increased or decreased sensitivity
What are the biochemical response pharmacodynamic changes seen in the body?
Subcellular structural and functional changes
What are the common GI symptoms seen as a result of an adverse reactions to medication in the older adult?
Nausea, vomiting, diarrhea, constipation
In what medications are GI symptoms a common adverse reaction?
Common with opioids, non-opioids, and NSAIDS
In what medications is sedation a common adverse reaction?
Common with opioids, analgesics, antipsychotics
When is excessive sedation seen as a common adverse reaction to medication?
In what medications is confusion a common adverse reaction?
Common with antidepressants, narcotic analgesics, drugs with
In what medications is depression a common adverse reaction?
Common with barbiturates, antipsychotics, alcohol, some
In what medications is orthostatic hypotension a common adverse reaction?
Most common with drugs used to treat hypertension
In what medications is fatigue/weakness a common adverse reaction?
Common with skeletal muscle relaxants and diuretics (altered electrolyte balance)
In what medications is dizziness/falls a common adverse reaction?
Common with sedatives, antipsychotics, opioid analgesics, antihistamines
What do anticholinergic effects do as a common adverse reaction to medications?
Alters response of tissues to
In what medications is an anticholinergic effect a common adverse reaction?
Common with antihistamines, antidepressants, and
What are the CNS anticholinergic effects as a result of medication?
Confusion, nervousness, drowsiness, dizziness
What are the PNS anticholinergic effects as a result of medication?
Dry mouth, constipation, urinary retention, tachycardia, blurred vision
What are the extrapyramidal symptoms seen as a result of an adverse reactions to medication in the older adult?
Dsytonias, tardive dyskinesia,
In what medications are extrapyramidal symptoms a common adverse reaction?
Common with antipsychotics
What are the the general strategies for the physical therapist when treating a patient on medication?
• Differentiate between diagnosis/disease sequelae and
• Identify polypharmacy and refer for reevaluation of meds
• Schedule according to drug effect and rehab needs
• Encourage adherence to prescribed medication regimen
• Provide education on why prescribed meds may be
beneficial and their potential side effects
• Implement non-pharmacologic options to manage conditions
What are the generalized goals of therapy when working with patients with Parkinson's?
• Maintaining or increasing activity level
• Decreasing rigidity or bradykinesia
• Optimizing gait
• Improving balance and motor coordination
What are the benefits of exercise in patient with parkinson's?
• Increase synapses formed
• Increased blood vessels in the brain
• Increased cell survival factors
• Better use of remaining dopamine
• Lowers the risk of PD for those with +genetic & environmental factors
• Protects vs. development of PD
• Improves efficacy of levodopa improves cognitive function
• Improves scores reported on QOL measures
• Decreases depression & apathy
• Improves stress & reported fatigue
• Decreases rigidity and bradykinesia