Flashcards in Week 3 Deck (105)
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1
What are the definitions of polypharmacy?
• Administration of many drugs together
• Administration of excessive medication
• Excessive or inappropriate use of medications
2
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
3
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
4
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
5
What are pharmacokinetic changes?
How the body handles the drug
6
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
7
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.
8
What are pharmacodynamic changes?
How drugs affect the body
9
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
10
What are the cellular level pharmacodynamic changes seen in the body?
Binding receptor changes
• Increased or decreased sensitivity
11
What are the biochemical response pharmacodynamic changes seen in the body?
Subcellular structural and functional changes
12
What are the common GI symptoms seen as a result of an adverse reactions to medication in the older adult?
Nausea, vomiting, diarrhea, constipation
13
In what medications are GI symptoms a common adverse reaction?
Common with opioids, non-opioids, and NSAIDS
14
In what medications is sedation a common adverse reaction?
Common with opioids, analgesics, antipsychotics
15
When is excessive sedation seen as a common adverse reaction to medication?
With sedative-hypnotics
16
In what medications is confusion a common adverse reaction?
Common with antidepressants, narcotic analgesics, drugs with
anticholinergic activity
17
In what medications is depression a common adverse reaction?
Common with barbiturates, antipsychotics, alcohol, some
antihypertensive drugs
18
In what medications is orthostatic hypotension a common adverse reaction?
Most common with drugs used to treat hypertension
19
In what medications is fatigue/weakness a common adverse reaction?
Common with skeletal muscle relaxants and diuretics (altered electrolyte balance)
20
In what medications is dizziness/falls a common adverse reaction?
Common with sedatives, antipsychotics, opioid analgesics, antihistamines
21
What do anticholinergic effects do as a common adverse reaction to medications?
Alters response of tissues to
acetylcholine
22
In what medications is an anticholinergic effect a common adverse reaction?
Common with antihistamines, antidepressants, and
antipsychotics
23
What are the CNS anticholinergic effects as a result of medication?
Confusion, nervousness, drowsiness, dizziness
24
What are the PNS anticholinergic effects as a result of medication?
Dry mouth, constipation, urinary retention, tachycardia, blurred vision
25
What are the extrapyramidal symptoms seen as a result of an adverse reactions to medication in the older adult?
Dsytonias, tardive dyskinesia,
pseudoparkinsonisms
26
In what medications are extrapyramidal symptoms a common adverse reaction?
Common with antipsychotics
27
What are the the general strategies for the physical therapist when treating a patient on medication?
• Differentiate between diagnosis/disease sequelae and
ADRs
• 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
28
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
29
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
30
