pharm 12 13
Card Set Information
pharm 12 13
geriatric cultural genetic differences
geriatric, cultural and genetic differences
How does aging affect teh GI system
–pH increases (decreased acid prodcution), may delay availablitly of drugs requiring low ph for absorption
–Decrease in blood flow
–Reduced albumin synthesis
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
How does decreased gastric acid production affect pharmacology?
Increases gastric pH
May delay availability of drugs requiring a low pH for absorption
How does aging affect the cardiovascular system?
–Heart muscle weakens
–Cardiac output decreases (slows distribution of nutrients and drugs)
–Blood pressure increases
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
Decreased glomerular filtration and tubular secretory
Reduced rate of drug excretion
Prolonged duration of drug action
Increased risk of drug interactions
CNS affected by age
–Brain mass decreases
–Quantity of neurons decrease
--•Cognition and sensory functions decline
–Blood brain barrier more easily penetrated
Endocrine system affected by age
–Insulin secretion decreases
–Production of growth hormone declines
-Fat increases, Muscle mass decreases
Absorption affected by age
•Slower, yet still complete
•Exaggerated GI adverse effects possible
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
•Increased permeability of the blood brain barrier leads to an enhanced CNS effects of certain drugs
•Reduced cardiac output
Metabolism affected by age
Liver function declines which leads to higher concentrations of active drug
Excretion affected by age
Renal function declines which leads to an increased serum drug level
The elderly have a decreased response to
The elderly have an increased response to
What do concentration and effects respectively involve?
Concentration – phamacokinetics
Common adverse drug reactinos seen in the elderly
–Sudden change in mental status
–Rapid weight loss
–Changes in fluid balance
–Changes in bowel habits
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
BEERS criteria drugs:
Nonsteroidal antiinflammatory drugs (NSAIDs)
BEERS: Antihistamines cause
Sedation, confusion, anticholinergic effects
BEERS: benzodiazepines cause
Confusion, depression, anticholinergic effects
BEERS: Digoxin (Lanoxin)
Reduced renal clearance can cause serious toxicity
BEERS: Muscle relaxants cause:
Sedation, weakness, anticholinergic effects
BEERS: NSAIDS cause
Photosensitivity,nephrotoxicity, fluid retention
BEERS: Phenytoin (Dilantin) causes:
Confusion, ataxia, slurred speech
BEERS: tricyclic antidepressants cause:
Hallucinations, confusion, anticholinergic effects
What are some barriers to adherence seen with the elderly?
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
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
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
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
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
What's included in a psychosocial assessment?
•Support (spiritual and relational)
What type of metabolism is influenced by specific regions on various chromosomes?
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
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
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
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
In whom are slow and fast acetylators found?
Slow acetylators are usually Caucasians
Fast acetylators found in patients of Japanese descent
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
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
Oxidation enzyme polymorphisms alter response to which drugs?
Oxidation enzyme polymorphisms alter response to drugs warfarin (Coumadin) and diazepam (Valium)
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)
Do men or women eliminate benzodiazapines more slowly?
for anxiety eliminated slower by women
•More significant if the woman is on oral contraceptives
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
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.)