pharm 12 13

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Author:
BrigittaLisPanther
ID:
101731
Filename:
pharm 12 13
Updated:
2011-09-14 18:20:36
Tags:
geriatric cultural genetic differences
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Description:
geriatric, cultural and genetic differences
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  1. How does aging affect teh GI system
    • –Motility decreases
    • –pH increases (decreased acid prodcution), may delay availablitly of drugs requiring low ph for absorption
    • –Decrease in blood flow
    • –Reduced albumin synthesis
  2. How does the delayed emptying of gastric contents which an older person experiences affect pharmacology?
    • Slows rate of absorption
    • Increases time drug remains in digestive tract
    • Increases chance of adverse drug reactions
  3. How does decreased gastric acid production affect pharmacology?
    • Increases gastric pH
    • May delay availability of drugs requiring a low pH for absorption
  4. How does aging affect the cardiovascular system?
    • –Heart muscle weakens
    • –Cardiac output decreases (slows distribution of nutrients and drugs)
    • –Blood pressure increases
  5. Physiological changes to the renal system occuring with age
    • –Blood flow decreases
    • –Fewer functional nephrons
    • –Renal function declines
    • --•Glomerular filtration rate decreases
    • --•Results in prolonged exposure to certain medications
  6. Decreased glomerular filtration and tubular secretory
    functions cause
    • Reduced rate of drug excretion
    • Prolonged duration of drug action
    • Increased risk of drug interactions
  7. CNS affected by age
    • –Brain mass decreases
    • –Quantity of neurons decrease
    • --•Cognition and sensory functions decline
    • –Blood brain barrier more easily penetrated
  8. Endocrine system affected by age
    • –Insulin secretion decreases
    • –Production of growth hormone declines
    • -Fat increases, Muscle mass decreases
  9. Absorption affected by age
    • •Slower, yet still complete
    • •Exaggerated GI adverse effects possible
  10. Distribution affected by age
    • •Fat-soluble drugs stored in fat tissue
    • •Water-soluble drugs build up in higher concentrations due to decreased total-body water
    • •Decreased drug binding to plasma proteins
    • --–Results in increased free drug concentrations
    • --–Greaterpharmacologic effect
    • •Increased permeability of the blood brain barrier leads to an enhanced CNS effects of certain drugs
    • •Reduced cardiac output
  11. Metabolism affected by age
    Liver function declines which leads to higher concentrations of active drug
  12. Excretion affected by age
    Renal function declines which leads to an increased serum drug level
  13. The elderly have a decreased response to
    • –Beta-receptor agonists
    • –Beta-receptor antagonists
  14. The elderly have an increased response to
    • –Anticholinergics
    • –CNS depressants
    • –Warfarin
  15. What do concentration and effects respectively involve?
    • Concentration – phamacokinetics
    • Effects– pharmacodynamics
  16. Common adverse drug reactinos seen in the elderly
    • –Sudden change in mental status
    • –Rapid weight loss
    • –Restlessness
    • –Anorexia
    • –Changes in fluid balance
    • –Changes in bowel habits
  17. About BEERS criteria drugs
    –Drugs that have a high risk of causing adverse drug reactions

    –Use of these drugs should be avoided or closely monitored

    –Nurses should be familiar with the list and potential adverse effects
  18. BEERS criteria drugs:
    • Antihistamines
    • Benzodiazepines
    • Digoxin (Lanoxin)
    • Muscle relaxants
    • Nonsteroidal antiinflammatory drugs (NSAIDs)
    • Phenytoin (Dilantin)
    • Tricyclic antidepressants
  19. BEERS: Antihistamines cause
    Sedation, confusion, anticholinergic effects
  20. BEERS: benzodiazepines cause
    Confusion, depression, anticholinergic effects
  21. BEERS: Digoxin (Lanoxin)
    Reduced renal clearance can cause serious toxicity
  22. BEERS: Muscle relaxants cause:
    Sedation, weakness, anticholinergic effects
  23. BEERS: NSAIDS cause
    Photosensitivity,nephrotoxicity, fluid retention
  24. BEERS: Phenytoin (Dilantin) causes:
    Confusion, ataxia, slurred speech
  25. BEERS: tricyclic antidepressants cause:
    Hallucinations, confusion, anticholinergic effects
  26. What are some barriers to adherence seen with the elderly?
    • –Visual impairment
    • –Hearing impairment
    • –Functional impairment
    • –Cognitive dysfunction
  27. Nurse's role in improving adherence:
    • •Nurses can suggest
    • –Daily or weekly pill boxes
    • –Calendars to assist in adherence
    • –Provide education in a way that is easy to understand
    • –Recommend ways to simplify the medication regimen
  28. Ways to minimize polypharmacy
    • •Review patient’s drug profile for any therapeutic duplications
    • •Simplify patient’s drug regimen as much as possible
    • •Encourage reporting of all OTC and herbal remedies taken
    • •Encourage use of one primary care provider and one pharmacy
  29. Ways to minimize druginteractions
    • •Review all medications (including OTC and herbal supplements) for possible interactions
    • •Educate patient on potential interactions with foods
    • •Review patients’ comorbid conditions for potential drug – disease interactions
  30. What does holistic mean?
    • •Treating the whole person rather than just the symptoms
    • •Assessing the entire person when developing pharmacotherapy outcomes
    • •To deliver high quality health care the synergy of the individuality and the totality of the patient must be recognized
  31. Wht does psychosocial mean?
    • •Term used in health care to describe psychological development in context of social environment
    • •Involves both social and psychological aspects of a person’s life
    • •Includes the spiritual nature of a person
    • •Psycho-social-spiritual term used in health care
  32. What's included in a psychosocial assessment?
    • •Living arrangements
    • •Family involvement/interactions
    • •Financial resources
    • •Emotional condition
    • •Physical condition
    • •Cognitive functioning
    • •Support (spiritual and relational)
  33. What type of metabolism is influenced by specific regions on various chromosomes?
    hepatic metabolism
  34. What is cultural competence?
    • •Ability of practitioners to provide care to people with diverse values, beliefs, and behaviors
    • •Ability to adapt delivery of care to meet needs of these patients
    • •Requiresknowledge of diversity
    • •Attitude of awareness, openness, and sensitivity
  35. polymorphism
    • two or more versions of the same protein created by a mutation
    • These proteins are responsible for metabolism, which changes how a drug is metabolised with someone who has a polymorphism
    • •Discovered in enzymes that metabolize drugs
    • •Discovered in proteins that serve as receptors for drugs
    • •Can have an affect on drug action
    • –“Mutated” version of enzyme may increase or decrease speed of drug metabolism and excretion
  36. Polymorphisms seen in receptors
    • •Receptors are proteins that accept the endogenous molecule in a lock-and-key type interaction
    • •Simple changes in structure can result in defective protein receptor that no longer “accepts” drug
    • •Receptor polymorphisms associated with increased risk for schizophrenia, prostate cancer, breast cancer, and many other disorders
  37. What does the polymorphism found in acetyl transferase do?
    • Polymorphism discovered in the enzyme acetyl transferase
    • Metabolizes isoniazid (INH), drug prescribed for tuberculosis
    • “Mutated” form of enzyme performs metabolic action (acetylation) slower
    • Reduced hepatic metabolic process and clearance by kidneys result in INH levels reaching toxic levels
  38. In whom are slow and fast acetylators found?
    • Slow acetylators are usually Caucasians
    • Fast acetylators found in patients of Japanese descent
  39. Asian Americans have an absence of what enzyme?
    • Asian Americans have an inherent absence of enzyme debrisoquin
    • Defect that interferes with analgesic properties of codeine
    • Interferes with metabolism of codeine to
    • morphine
  40. African American's have decreased effects from...
    • African Americans have decreased effects from beta-adrenergic antagonist drugs (eg. propranolol (Inderal)
    • Results from genetically influenced variance in plasma renin levels
  41. Oxidation enzyme polymorphisms alter response to which drugs?
    Oxidation enzyme polymorphisms alter response to drugs warfarin (Coumadin) and diazepam (Valium)
  42. What meds may cause male impotence and what is the risk of stopping these meds?
    • –Antihypertensives (beta-blockers) may cause male impotence
    • •Males suffer strokes related to abruptly stopping the medication (b/c they have profound rebound htn,
    • can’t just stop beta-blocker, it needs to be tapered down)
  43. Do men or women eliminate benzodiazapines more slowly?
    • –Benzodiazepines
    • for anxiety eliminated slower by women
    • •More significant if the woman is on oral contraceptives
  44. In whom is asprin more effective in preventing heart attacks, men or women?
    •Aspirin is more effective in preventing heart attacks in men than women
  45. To what type of blood pressure meds do African Americans respond best?
    A pt of African-American background responds better to calcium channel blocker than other meds used to treat htn! (better than beta-blocker, diuretic, etc.)

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