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Nurs 100 > Week 7 And 8-Ch 15 > Flashcards

Week 7 And 8-Ch 15 Flashcards

(77 cards)

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1
Q

Do medications act diff in older adults

A

Yes

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2
Q

Do older adults medication require careful dosage adjustment and monitoring

A

Yes

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3
Q

Medication risks for older adults

A

Increased risk of interactions and adverse reactions

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4
Q

Med challenges for older adults

A

Age related changes

Polypharmacy

Increased risk of adverse reactions due to altered pharmokinetics and pharmodynamics

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5
Q

Early sign of adverse reaction to many meds

A

Mental dysfunction

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6
Q

Age related changes that cause medication issues

A

Decreased salivary flow and dentition(makes pills hard to swallow)

Kidney and liver changes alter pharmacokinetics

Biological half life on many drugs is longer
-drugs can build up to toxic levels
-liver and kidney tests let us know if drug is appropriate

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7
Q

Changes to body that impact pharmacodynamics

A

Increased myocardial sensitivity to anesthesia

Increased CNS receptor sensitivity to narcotics, alcohol, and bromides

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8
Q

Altered absorption (kinetics)

A

There are fewer priblems

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9
Q

Factors that impact absorption

A

Route

Concentration and solubility

Disease and symptoms

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10
Q

How to maximize absorption

A

Exercise

Heat

Massage

Preventing dehydration, hypothermia, hypotension, interactions with other meds

Use most effective route

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11
Q

Is drug distribution easy to predict

A

No

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12
Q

Drug distribution considerations with the older adult

A

Changes in circulation

Membrane permeability

Body temp

Tissue structure

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13
Q

What decreases drug distribution

A

Dehydration and hypoalbuminemia

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14
Q

Conditions that decrease metabolism of drug

A

Dehydration

Hyperthermia

Immobility

Liver disease

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15
Q

Extended half life

A

Close evaluation of drug clearance

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16
Q

Is detoxification and conjugation of drug reduced or increased

A

Reduced

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17
Q

Why is kidney efficiency important

A

Renal system excretes drugs

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18
Q

What organ impacts drugs detoxification and excretion

A

Liver

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19
Q

What percent of 70 YO use at least 1 drug/ more than 5

A

95%

68%

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20
Q

Adverse reactions and older adults

A

Signs and symptoms are different

Takes longer to present itself

May occur even after med is discontinued

May develop suddenly even after long term use

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21
Q

Is mental dysfunction always dramatic or can it be subtle

A

Can be subtle

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22
Q

Does cause of mental disfunction need to be determined before treating it

A

Yes. Can cause additional complications.

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23
Q

Causes/risks for med errors

A

Functional impairment-weak hands

Cognitive limitations

Education limitations

Sensory limitations-hearing, visual

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24
Q

Beers criteria

A

Identifying high risk drugs for elderly

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25
Drug nursing assessment questions
Is smallest dose being ordered? Why is drug ordered? Is patient allergic to the drug? Can drug interact with other med, herb, etc patient is taking Are there any special instructions for drug administration? Is the most effective route of drug administration being used?
26
Most common route to administer med
Oral
27
Issues with suppository
Lower body temp may cause it to melt slower
28
IM and sucut
Do not inject in immobile limb -will cause slower absorption
29
Considerations for monitoring lab values
Blood test done to find levels Specific meds require certain type and frequency of blood work Find out if there is any limitations in being able to get lab testing done
30
Patient teaching
Med review Med reconciliation
31
Things to consider before putting patient on drug
Does benefits outweigh risks Consider lifestyle changes first
32
How does renal and liver function affect medication
Contributes to changes in pharmokinetics
33
Aspirin
Increased risk of GI bleeding Caution with heparin and warfarin Enteric coated preferred, take with food
34
Acetaminophen
Total daily dose not to exceed 4,000 mg -can cause hepatic necrosis
35
Opiods
Respiratory distress Risk for falls, sedation, constipation, confusion
36
Least preferred Opiod for older adults
Meperidine
37
Guidelines for analgesic
Assess pain symptoms Try non-med options first Begin with weakest type and dose of analgesic Administer regularly to maintain constant blood level Observe for signs if infection(other than fever if taking aspirin and acetaminophen) Observe for signs of anemia and bleeding with aspirin
38
Nursing guidelines: Signs of aspirin toxicity
Note signs of aspirin toxicity- Tinnitus, hearing loss
39
Does acetaminophen have anti-inflammatory activity
No
40
Antacids
Assess reason for use -indigestion(can be symptom of more serious illness) -require testing if constantly using Monitor bowel movement -constipation when using aluminum hydroxide and calcium antacids -Diarrhea when magnesium hydroxide combinations are used
41
Who should avoid using sodium bicarbonate as ant acid
Sodium restricted diets
42
How long should you wait to give medication after giving antacid
2 hrs
43
Antibiotics
-excessive use can cause antibiotic resistance -secondary infection caused by antibiotics •oral thrush, colitis, vaginitis Side effects- nausea, vomiting, diarr Iv vancomycin and amino-glycoside can cause hearing loss
44
Side effects of antibiotics
Nauseau, vomiting, diarrhea, anorexia, allergies
45
Meds with risk of hearing loss and renal failure
IV vancomycin and aminoglycosides(amikacin, gentamicin, and tobamycin
46
Guidelines for antibiotics
Get blood culture when suspect infection Administer on a schedule to keep blood levels the same Reinforce not skipping doses Observe for signs of superinfection with long term use
47
Anticoaggulants
Prevents thrombosis High risk for bleeding Heparin and warfarin Only prevents new clots. Does not get rid of old ones. Risk of osteoporosis with long term use
48
Slide 43
49
What decreases effects of anticoggulants
Vitamin K -green leafy veggies, bacon
50
Herbal interactions with anticoagulants
Garlic/ginko-increased risk for bleeding Green tea with warfarin-may alter anticoag. Effects
51
Antidote for anticog.
Vitamin K
52
Anticonvulsants
Monitor blood levels Older adult shave higher risk for toxicities Choice for older adults-carbamazepine, lamotrigine
53
Anticonvulsants to avoid
Phenobarbital Phenytoin
54
Other uses for anticonvulsants
Bipolar, schizoaffective
55
Guidelines for anticonvulsants
Ensure physical activity bc it can depress psychomotor activity Periodic blood work Can worsen liver and kidney disease Should not be discontinued abruptly Monitor closely with coronary artery disease, prostate disease
56
Anti diabetic (hypoglycemic) drugs
Teach recognition if hypo and hyoerglycemia Have paperwork that list diagnosis incase become unconscious Insulin dose may require adjusting if prolonged diarrhea or Vomiting
57
Antihypertensive medications
Diuretics-most common Beta blockers Angiotensin-converting enzyme inhibitor Calcium channel blockers Alpha blockers
58
Guide for antihypertensive drugs
Assess blood pressure in lying sitting and standing positions Monitor carefully bc some can cause hypotension Monitor for thiazide effects-hyponatremia, hypokalemia, acute renal dysfunction Advise taking at bedtime
59
Nsaids
Treat mild to moderate pain Narrow therapeutic window
60
Nursing guidelines for NSAIDS
Narrow therapeutic window and can reach toxic levels quick Observe for side effects; gi issues, cCNS diaturbance Risk for developing delerium Administer with food or milk
61
Celebrex(NSAID)
Increases risk of heart attack and stroke Swelling of body parts Signs of bleeding
62
cholesterol lowering drugs
Usage has increased Decrease LDL and increase HDL
63
Statins(cholesterol drug)
Usually first type of treatment Ex: atrocastatin, rosuvastatin Side effects: muscle pain, dizziness, ab cramping
64
Niacin(cholesterol
Examples-niacor, niaspan Adverse effects-headache, aggravate diabetes, makes gall bladder disease worse
65
Bile acid resins(cholesterol)
Ex: cholestyramine, colestipok Adverse effects-stomach issues, interacts with diuretics, beta blockers, NSAIDS
66
Nursing guidelines for cholesterol drugs
Ensure good liver function and necessary tests are complete
67
Digoxin
Used for congestive heart failure and other heart issues Daily dose should not be more than 0.125 mg
68
Guidelines for digoxin
Check pulse before use Reduced kidney function causes half life to increase Signs of toxicity-delirium, bradycardi Hypokalemia increases risk of toxicity
69
Diuretics
Thiazides: metolazone Loop diuretics: bumetanide, ethacrynic acid, furosemide Potassium soaring diuretic-amiloride, spironolactone, triamterene
70
Guideline for diuretics
Monitor intake and output Observe for adverse reactions with thiazide diuretics Evaluate electrolytes, glucose, and BUN
71
Laxatives
Bulk formers- Stool softeners- Osmotics- Stimulants Lubricants
72
Guidelines for laxatives
Good fluid intake is useful with bulk forming laxatives and stool softeners
73
Analgesics
Aspirin Acetaminophen Opiods
74
Aspirin side effects
Increased risk of GI bleeding Caution with heparin and warfarin Enteric coated preferred (take with food)
75
Acetaminophen daily dose
Total daily dose should not exceed 4,000 mg. Can cause hepatic necrosis
76
Opiod side effects
Respiratory distress Falls constipation Confusion
77
Least preferred opiod for elder
Meperidine

Nurs 100 (11 decks)

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