1 / 16

Pharmacology and Older Adults

Pharmacology and Older Adults. Nursing 246. Janet Duffey, RN, MS, APRN, BC. Pharmacological Use vs. Misuse . Adverse drug events (ADE) contribute to hospitalization 6 million with inappropriately prescribed medications Less supervision and MD visits in SNF

burke
Download Presentation

Pharmacology and Older Adults

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pharmacology and Older Adults Nursing 246 Janet Duffey, RN, MS, APRN, BC

  2. Pharmacological Use vs. Misuse • Adverse drug events (ADE) contribute to hospitalization • 6 million with inappropriately prescribed medications • Less supervision and MD visits in SNF • JACHO regulations / documentation of psychotropics

  3. Absorption Factors • GI: decreased HCl acid • Delayed emptying of food • Antacid interaction • Multiple concurrent medications • Slowed GI motility • Decreased enzyme production

  4. Distribution Factors • Decreased cardiac output • Less total body water • Diminished thirst awareness • Increased fat with less muscle mass • Diminished blood brain barrier • Altered protein binding • Changing body composition & size

  5. Metabolic Factors • Decreased liver mass • Decreased blood supply • Enzyme activity reduced • Inadequate protein intake

  6. Specific Agents for Liver Function • Long acting benzodiazapines • Tricyclic antidepressants • Beta-blockers • Narcotic analgesics • Watch total acetaminophen

  7. Renal Excretion of Drugs • Decreased blood supply • Slowed filtration rate • Inadequate fluid intake • Frequent and easily dehydrated

  8. Renal Function and Specific Agents • Allopurinol • Cephalosporins • Ciprofloxacin • Digoxin • H-2 receptor blockers (cimetidine) • Fluoxitine (Prozac) • Lithium

  9. Drug-Induced Impairment in Mobility • Arthralgia, myopathies • Osteoporosis • Movement disorders: EPS, tardive dyskenesia • Balance: neuritis, neurapathy • Tinitus, vertigo • Hypotension • Psychomotor retardation

  10. What is SAFE Medication Use? • Dosage adjustments for elderly • Anticipation of side effects • Management of adverse effects • Falls • Anticholernergic • Sedation and lethargy • Edema & electrolyte disturbances • Decreased cardiac output

  11. Factors Contributing to Increased Drug Sensitivity in Older Adults • Atypical presentation of disease • Atypical presentation of drug-related problems • CNS dysfunction such as confusion missed as sx of toxicity • Age-related pharmokinetic and pharmacodynamic differences • Increased intrinsic sensitivity

  12. Herbal agents OTC vs. prescribed Increases with multiple providers Minimize # agents Alternatives if possible Start low, go slow Titrate therapy Educate client and caregiver Review regularly Drug/Drug Interaction Risk Reduction

  13. Enhancing Medication Adherence • Cost benefit ratio • Management of side effects • Removing ineffective agents • Complete drug review with client/caregiver • Instruct re: purpose, minor/major side effects • Indicate when to discontinue • Memory enhancement tools for compliance

  14. Nursing Interventions • Teaching about specific agents • Purpose • Therapeutic effect • Side effects • Minor • Major • Drug/drug interactions • Dietary factors

  15. Beer’s Criteria • Used to evaluate risk • Doesn’t preclude use • Raise awareness in clinicians • Evaluate full pharmacology • OTC and prescribed • Drug reconciliation at admit, discharge or transfer

  16. THEEND

More Related