Chapter 5

Question 1

-person who ranges from 19-64 years of age

Answer 1

Adult

Question 2

• physiologic events due to increasing age, which affect drug responses
• occur in middle age
• related to: heart disease, pulmonary insufficiency, cancer, arthritis, diabetes mellitus, obesity, substance abuse, and depression

Answer 2

Age related changes

Question 3

• person who is 65 years of age or older
• largest consumers of healthcare
• chronic conditions have roots in the aging process
• most common health problems: arthritis, heart disease, decreased sensory perception, bone disorders, and diabetes mellitus

Answer 3

Older adult

Question 4

• use of several drugs during the same period
• can lead to greater complications and diminished mental status
• optimizing drug therapy is an essential part of caring for an older person

Answer 4

Polypharmacy

Question 5

-poor outcome (adverse effects of meds) in relation to good outcome (desired med effects); increased with increasing age

Answer 5

Risk to benefit ratio

Question 6

• physiologic changes alter the meds ability to produce the desired effect
• prone to adverse drug reactions
  
  • decrease in the number of receptors needed for drug distribution

Answer 6

Pharmacodynamics in Older Adults

Question 7

• list of potentially inappropriate meds used by older adults
• names drugs to be avoided and gives adjustments in dosages related to chronic kidney disease and dismissed kidney function
• vital to implement strategies to identify age related changes associated with med admin
• approximately 66% of adverse drug event hospitalizations are related to unintentional overdoses in pts 65 years of age and older

Answer 7

Beers Criteria

Question 8

• amioderone (cordarone):altered QT interval
• amitriptyline hydrochloride: anticholinergic effects and sedation
• cimetidine (Tagamet):confusion
• cyclobenzaprine (flexeril): anticholinergic effects and weakness
• digoxin (lanoxin): digoxin toxicity
• diphenhydramine chloride (benedryl): urinary retention
• flurazepam hydrochloride (dalmane): sedation
• hydroxyzine hydrochloride (vistaril): confusion and sedation
• ketalorac: GI bleeding
• merperidine hydrochloride (Demerol): confusion
• methocarbamol (robaxin): anticholinergic effects and weakness
• methyldopa (Apo-methyldopa; aldomet): bradycardia and depression
• nitrofurantoin (macrodantin): renal toxicity
• propoxyphene hydrochloride (Darvon): respiratory depression

Answer 8

Drugs that produce adverse effects in older adults

Question 9

• asses pts health history and list of meds taken
• asses blood urea nitrogen and creatinine clearance, determine ability to excrete meds
• asses the ration of alanine aminotransferase to aspartate aminotransferase to determine the pts liver function and ability to metabolize drugs
• asses therapeutic drug levels as ordered by prescriber or determine the medication effectiveness and prevention of toxicity
• educate pt and family about all meds and possible drug-drug, drug-herb, and drug-diet interactions
• educate pt and family about generic and trade name of meds to prevent over medication
• educate pt and family to use one primary care provider
• educate pt and family to have all prescriptions filled at same pharmacy
• asses pts adherence to prescribed meds
• provide pt with med admin aids to increase adherence

Answer 9

Prevention of Adverse Effects

Question 10

• decreased function of vital organs needed for pharmacokinetic processes
• frail, elderly adults are at greatest risk for altered drug responses
• the more physically active older adults are, the less likely they will experience altered drug responses

Answer 10

Pharmacokinetics in Older Adults

Question 11

• changes in GI tract
  
  • decreased gastric acidity
  • increase in gastric pH
  • delayed absorption or lack of absorption of meds that require this decreased pH
• decreased blood flow and decreased surface area to support absorption
• diminished gastric emptying, causes med to be in the stomach for longer period of time
  
  • increases risk for developing nausea and vomiting
    
    • causing elimination of the med in emesis and promoting fluid volume deficit
• decreased circulation
  
  • parenteral meds are slowly absorbed
• decreased muscle mass and altered circulation can result in abnormal blood concentrations of meds admin IM
• slow rate of absorption can result in changes in peak serum drug levels
  
  • may require greater dosages to be administered to produce therapeutic results

Answer 11

Absorption in Older Adults

Question 12

• diminished cardiac output, increased body fat, decreased body mass and body fluid, and decreased serum albumin
• body mass changes; the proportion of body fat increases while lean body mass decreases
• lipid soluble drugs stay in the fat tissue longer
• amount of body fluid decreases in proportion to total body weight
  
  • water soluble drugs are distributed in smaller volumes due to the decrease in total body fluid volume
    - increases the risk of toxicity, drug concentrations are greater
• amount of free drug rises and the effect of the drug is more intense
• meds are not distributed adequately due to the decreased circulation and diminished cardiac output

Answer 12

Distribution in Older Adults

Question 13

• changes in the liver affect metabolism of meds
• 60 yrs of age, liver begins to decrease in size and mass
  
  • decrease in hepatic circulation, lowering rate of metabolism
  • hepatic enzymes of the liver are decreased, altering ability to remove metabolic by-products
• medications with a longer half-life will remain in the body for a greater amount of time
• some responses to drug therapy are genetically determined and may differ in various ethnic and racial populations

Answer 13

Metabolism in Older Adults

Question 14

• diminished renal blood flow, number of functioning nephrons, glomerular filtration rate, and tubular secretion
• assessment of pts CrCl is important indicator of the ability of the renal system to eliminate the med and prevent adverse drug effects
  
  • dosages of meds with increased half-life should be lowered
• prior to admin of meds excreted by the renal system, nurse assess the pts glomerular filtration rate and hydration status by using the serum creatinine value to calculate the estimated CrCl
  
  • decreased CrCl: necessary to reduce the dosage of med

Answer 14

Excretion in Older Adults

Question 15

• as pts increase in age, they use a greater number of meds
• difficult to remember meds or maintain appropriate admin schedules
• economic factors contribute to nonadherence
  
  • choose between cost of meds and ability to buy food and pay for utilities
  • order small quantities of meds and use generic
• starting slow and with low doses improves adherence to med regimen
  
  • minimizes adverse effects
• pts and families should be educated about adherence to med regimens

Answer 15

Med Adherence and Aging