Chapter 9 – Safe Medication Use.
Chapter 10 – Nutrition.
Question(s): The gerontological nurse working in a long-term care facility is responsible to administer psychoactive medications for older adults for conditions such as depression, anxiety, bipolar disorder or psychosis. After reading your textbook, select one class of drug or 1 medication used for the treatment of the mentioned conditions and discuss important nursing considerations (at least three) when given this medication due to its side effects, drug interaction or food interaction.
Guidelines: The answer should be based on the knowledge obtained from reading the book, no just your opinion. If there are 2 questions in the discussion, you must answer both of them. Your grade will be an average of the 2 questions.
Grading Criteria: Mention one class of drug or one medication used for the treatment of conditions such as depression, anxiety, bipolar disorder or psychosis mentioned in the textbook (30%). Discuss important nursing considerations (at least 3) when given this medication due to its side effects, drug interaction or food interaction (70%)
Chapter 9
Safe Medication Use
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Older adults who are 65 years and older are the largest user group of prescription and over-the-counter medications
Prescription medications can afford survival or enhance quality of life for those with chronic conditions and disabilities
Older Adults and Medications
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Pharmacokinetics is the movement of a drug throughout the body from the point of its administration as it is
Absorbed
Distributed
Metabolized
Excreted
Pharmacokinetics
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Amount of time between drug administration and absorption depends on
Bioavailability
Amount of drug that passes into the body
Route of administration
Routes of administration include intravenous, oral, parenteral, transdermal, and rectal methods
Absorption
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Physiological changes and effect of other drugs can alter absorption
Increased gastric pH retards acid-dependent drugs
Delayed stomach emptying diminishes the effectiveness of short-lived drugs
Increased motility in the small intestine diminishes drug effect because of shortened contact time
Slowed intestinal motility increases the contact time, amount absorbed, and effect
Absorption (Cont.)
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Medication must be transported to the receptor site on the target organ to have an effect
Distribution depends on the availability of plasma protein in the form of lipoproteins, globulins, and albumin
Age-related changes in distribution are related to changes in body composition, increased body fat, and decreased total body water
Distribution
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Process by which the body modifies the chemical structure of the drug
Primarily occurs in the liver
Normal age-related physiological changes can affect metabolism
Liver’s activity, mass, volume, and blood flow are normally reduced
Hepatic clearance of medication is decreased by 30% to 40%
Metabolism
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Medications are excreted in sweat, saliva, and other secretions, as well as mainly by the kidneys
Normal age-related physiological changes can affect metabolism
Kidney function decreases with aging (up to 50% by 80 years of age)
Prolongs the half-life of a drug or the amount of time required to eliminate the drug
Cockcroft-Gault equation estimates creatinine clearance
Excretion
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Interaction between a drug and the body
The older a person gets, the more likely there will be an altered or unreliable response of the body to the drug
Several known mechanisms
Decreased response to beta-adrenergic receptor stimulators and blockers
Decreased baroreceptor sensitivity
Increased sensitivity to anticholinergics, benzodiazepines, opioid analgesics, warfarin, and the cardiac drugs diltiazem and verapamil
Pharmacodynamics
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Relationship between biological rhythms to the variations in the body’s response to drugs
A developing science that may lead to a more effective drug therapy
Biorhythmic variations occur in
Gastric acid pH
Gastrointestinal tract motility and blood flow
Albumin levels
Glomerular filtration and urine acidity
Chronopharmacology
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Before administering a drug to an older adult, the nurse should understand that the dose may be impacted which age-related physiological change?
Older adults have increased liver metabolism
Gastric emptying often occurs more rapidly
Older adults have reduced glomerular filtration rates
The sensitivity to baroreceptors is often reduced
Question
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C—The decreased glomerular filtration rate prolongs the half-life of drugs, adding to the risk for accumulation and increasing the potential for toxicity or other adverse events.
Answer
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Polypharmacy
Drug interactions
Medication–herb/supplement interactions
Medication–food interactions
Drug–drug interactions
Adverse drug reactions
Misuse of drugs
Medication-Related Problems and Older Adults
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Use of approximately five or more medications or the use of multiple medications for the same problem
Major concerns are the increased risk for drug interactions and the increased risk for adverse events
May be unavoidable but can result from fragmented communication
Polypharmacy
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When two or more medications or foods are taken together or close together, they may cause a change in the effectiveness of the other
Effects may be increased, decreased, or variable
Polypharmacy increases the risk for and the frequency of medication–medication interactions
Drug Interactions
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Medication–Medication Reactions
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An unwanted pharmacologic effect
Range from minor annoyances to unwanted pharmacological effects and death
Common in those older than 65 years of age
Commonly observed adverse reactions in older adults include drug-induced delirium, confusion, and lethargy
Adverse Reactions
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Includes
Overuse
Underuse
Erratic use
Contraindicated use
May be accidental or deliberate
Misunderstanding or inability to read labels or understand instructions
Make medication last longer for financial reasons
Believe the dose is either too low or high
Forget to take the medication correctly
Misuse of Drugs
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Their potential for harm is greater than their potential benefits
Beers list (1997)
Identifies drugs that carry a higher-than-usual risk when prescribed for older adults
Incorporated into regulatory policy for long-term care (LTC) facilities and are part of quality measures
Using a “do not use” medication in LTC without documentation of overwhelming benefit is considered medication misuse by the prescriber
Inappropriate Medications
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Alter brain chemistry, emotions, and behaviors
Have a high risk of adverse events
Medications included in this category are
Antidepressants
Antianxiety agents
Mood stabilizers
Antipsychotics
Sedative-hypnotics
Psychoactive Medications
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SSRIs (e.g., Zoloft, Prozac, Lexapro, and Celexa) and SNRIs (e.g., Effexor)
Drugs of choice for use in older adults
Effective, with minimal side effects
May cause nausea, dry mouth, sexual dysfunction
Use with caution in persons with a history of falls because of the potential to produce ataxia or dizziness
Tetracyclic mirtazapine (Remeron) useful in treating sleep problems in older adults
Antidepressants
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