Prevent Toxicity
For Geriatric, initially Give 1/2 of normal adult dose because they are prone to adverse side effects.
Teach Med administration
Teach geriatric patient hoe to administer their meds, and make sure you receive a return explanation or demonstration so you know they understood you.
** A lot of times, elderly take their meds wrong; educating them will make it correct.
Medication reconciliation
- to check drug-drug interaction and drug-food interaction
- Ex. Vit K interacts with coumadin, so patient is not taking vit. K. But, patient eats food rich in Vit K such as green leafy vegetables. == It means that those food if they are not eating it regularly will interact also with Coumadin.
- Gingkgo Biloba, garlic, St John’s worth also interacts wth Coumadin.
- Tell patient to bring the brown bag and not just “give me the list” (bec they might not list everything esp the OTC meds.
- Aloe Vera is also a blood thinner – so do not take too much.
- Teach also the side effects and possible adverse effects of the drugs they are on and when they need to call the PCP is the adverse effects occur.
Monetary Matter and Pharmacy
- Assess if the patient are able to afford or have the resource to get/buy the meds prescribed to them.
- You may refer the patient to the social worker to make sure that patient gets the therapy he/she needs.
Toxicity in the elderly
– Prone to toxicity bec of a lot of comorbidities, and slow in metabolism caused by aging.
Problems with Elderly
- POLYPHARMACY
POLYPHARMACY
- Patient may not be aware that they are taking 2 or more medications of the same kind.
- Ex. is Tylenol/acetaminophen – a lot of meds has tylenol in it that patient may not know of.
- Better if they go to the same pharmacy that pharmacist may pick up if you are taking the same meds.
Problems with Elderly
- COMPLIANCE
– SHARING OF MEDS
COMPLIANCE
- Patient should understand the reason why they are on a certain medication therapy to be able to increase compliance and adherence.
- RN should need to investigate why the patient is not in compliance.
SHARING OF MEDS
– Teach them not to take meds that are not prescribed to them.
Problems with Elderly
- DRUG ADMINISTRATION
- TAKE one pill at a time.
- Take them with at least 8 oz of water
- 6 Rights: Patient, meds, dose, route, time, documentation
Problems with Elderly
- PHARMACOKINETICS
PHARMACOKINETICS
- Absorption, Distribution, Metabolism, Excretion
- Geriatric has SLOWER pharmacokinetics !!
- Due to: Decreased Metabolism (aging) GI, kidney function, etc.
Problems with Elderly
- PEAK CONCENTRATION
PEAK CONCENTRATION
– Therapeutic may not be reached so tendency is to give more dose that can also lead to TOXICITY
Problems with Elderly
- DISTRIBUTION
DISTRIBUTION
– Subcut administration is slower bec geriatric has not much adipose tissue.
PROTEIN-BOUND DRUGS
– some elderly has decrease serum albumin level that is needed in distribution of the meds, so pt has increased amt of meds circulating in the system that can also lead to toxicity.
FIRST-PASS EFFECT
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BEER’S LIST
– List of meds that elderly should not be on because they are prone to adverse effects such as confusion, etc. BUT, they are ON them bec the PCP prescribed them.
Problems with Elderly
- SLOW METABOLISM
- Means the drug stays in the system longer that can lead to TOXICITY
Problems with Elderly
- SLOW EXCRETION
- Means the drug stays in the system longer also that can lead to TOXICITY
Problems with Elderly
- PRONE TO ADVERSE EFFECT
– Be careful because the elderly they experience some eradic adverse effects on drugs
– Digoxin Toxicity/Adverse symptoms such as: Decreased HR, Hollow Effect ( they see greenish hollow light on objects), Confusion,
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