safe medication use in older population

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safe medication use in older population
2015-06-25 15:30:49

taking meds the right way for our elders
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  1. terms
    • Adverse reaction- harmful, unintended reaction to a drug
    • bioavailabllity- metabolism- amt of drug that becomes available to the target tissue
    • half life- longer in elder bc of kidneys
    • iatrogenic- happens from medication weird reaction
    • potentiation- the strengthen of the effect of one or more substance- like food with drug
    • regime- schedule pain
    • side effects- consequence of drug or procedure
    • target tissue- the one that is receiving the greatest concentration of the drug
    • therapeutic window- safe and effective range
  2. **Pharmacokinetics- age related changes
    • Absorption: GI- decre absorption, incre Ph, decrease in GI activity, slower perstalisis, meds sit longer (aspirin, nsaids) and causes irritation
    • Distribution: less protein binding, diets are protein poor so meds that are protein binding cant bind, decre serum albumin, BBB more easily penetrated
    • metabolism: liver enzyme decre, smaller, blood flow decreases, enzyme production decres
    • Excretion: decres renal blood, decre GFR, decre tubular secretions, other drugs they take will be toxic bc not excreting
  3. specific interactions of aging and drug response
    • Analgesic- morphine- incr analgesia,
    • Anticoagulant- coumadin- alot of pt on on these but they are also taking herbal supplements that cause bleeding- incre blood time
    • bronchodilators-albuterol- decre bronchodilation
    • CV agents- ace inhibitors, diltiazem, verapamil- incre bp reduction
    • duirectic- decres maximum response
    • other- levodopa= increase side effects
  4. use of herbal meds and OTC meds
    • chamomile- warfarin- risk bleeding
    • garlic-
    • ginko
    • ginseng-
    • green tea
    • hawthorn- may cause loss of K
  5. Chronopharmacy and biorhythms
    • in the morning we are perkers- bc corticordsteriods are higher in the morning
    • think about their REM sleep which can interfere with drugs and ability to be affected
  6. Polypharmacy
    • just be aware there are many many 8-9 meds
    • many different interaction and drugs in each
    • pt like to share meds.
  7. Common meds with potential to cause cognitive impairement
    alcohol, analgesics, antichol, antidepressants, antihistamines, antiparkinson, antipsychotics, benzo, beta blockers, muscle relaxants, diuretics, sedatives, hyponotics
  8. potentially inapproriate medications
    • be careful of food interactions
    • use of other therapy
    • digoxin, coumadin, insulin- can put pt's in the hospital, lead to GI bleeding, falls, delirium
    • BEERS criteria to say which meds put them at risk
  9. Drug misuse
    • taking other drugs
    • doubling up on meds- narrow safety window
    • not taking meds
    • taking drugs wrong,
    • mindful of antiHTN, DM, anticoag
  10. Nursing process
    comprehensive drug assessment- make sure taking it right and safe and it is working, look at meds, who is caregiver

    pt education- teach back, teach at their level, see/hearing teaching (make they have everything they need for teaching), make sure they know why they are taking their meds, teach how to take it. have them bring their meds, watch transfer- home, hospt, rehab
  11. Specific meds and benefits
    psychoactive meds
    • alters brain chemistry- playing with their neurotramister
    • baseline assessment of confusion is it the meds or are they confused to tell changes
    • functional assessment
    • social ability
  12. specific meds and their benefits
    • stay away from tricylectic TCH to many side effects
    • MOA inhibitors not good neither
    • SSRI- are better for elders
    • - less s/e
    • - low doses can help
    • - conteract there s/e dry mouth, falls, sleep
  13. antianxiety meds
    • metabolized very slowly, like valium not tolerated very well in the elders, cause memory impairment, falls, CNS s/e. can resemble dementia
    • even beta blocker and antihistamine bc of the anticholin affects
  14. Antipsychotic drugs
    • difficulty in the elder bc it effects their thinking and behaviors
    • neurotins work better
    • antipsychotic drugs cause cardiac events, strokes
    • if have to use lowest dose
    • cause- eps symptoms, orthostatic hypotension
    • risk for falls are high
  15. Review EPS symptoms
    • 1 acute dystonia- abnormal involuntary movement
    • 2. akathsia- restlessness
    • 3. parkinson syndrome- tremors at risk, purposeless movements
    • 4. Tardive dyskinesia- lip smacking, frowning, tongue movement
  16. Mood stablizer
    • given to pt with bi-polar disease
    • elders check their drug level
    • cause- confusion, memory loss, tremors
    • becareful at looking are they from the meds or disease process itself
  17. summary and nursing implications
    • know your pt
    • know assessment- baseline information can tell u if changes are based on the meds or changes in their behavior
    • know your aging changes- kinetics- look at picture
    • know herbal meds- cause bleeding
    • baseline mental status
    • vital signs
    • listen to pt
    • why are they being non compliant= cultural, financial, social
    • know they myths about pain and giving meds.