Transcript Pharmacology and Older Adults

Pharmacology and Older Adults
Nursing 246
Janet Duffey, RN, MS, APRN, BC
Pharmacological Use vs. Misuse
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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
Absorption Factors
GI: decreased HCl acid
 Delayed emptying of food
 Antacid interaction
 Multiple concurrent medications
 Slowed GI motility
 Decreased enzyme production
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Distribution Factors
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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
Metabolic Factors
Decreased liver mass
 Decreased blood supply
 Enzyme activity reduced
 Inadequate protein intake
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Specific Agents for Liver Function
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Long acting
benzodiazapines
Tricyclic antidepressants
Beta-blockers
Narcotic analgesics
Watch total
acetaminophen
Renal Excretion of Drugs
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Decreased blood
supply
Slowed filtration rate
Inadequate fluid intake
Frequent and easily
dehydrated
Renal Function and Specific
Agents
Allopurinol
 Cephalosporins
 Ciprofloxacin
 Digoxin
 H-2 receptor blockers (cimetidine)
 Fluoxitine (Prozac)
 Lithium
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Drug-Induced Impairment in
Mobility
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Arthralgia, myopathies
Osteoporosis
Movement disorders: EPS, tardive dyskenesia
Balance: neuritis, neurapathy
Tinitus, vertigo
Hypotension
Psychomotor retardation
What is SAFE Medication Use?
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Dosage adjustments for elderly
Anticipation of side effects
Management of adverse effects
 Falls
 Anticholernergic
 Sedation and lethargy
 Edema & electrolyte disturbances
 Decreased cardiac output
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
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Drug/Drug Interaction Risk
Reduction
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Herbal agents
OTC vs. prescribed
Increases with
multiple providers
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Minimize # agents
Alternatives if
possible
Start low, go slow
Titrate therapy
Educate client and
caregiver
Review regularly
Enhancing Medication
Adherence
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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
Nursing Interventions
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Teaching about specific agents
 Purpose
 Therapeutic effect
 Side effects
 Minor
 Major
 Drug/drug interactions
 Dietary factors
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
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