Questions and Answers
Which beta blocker is avoided in stages 4 and 5 of chronic kidney disease?
Which antibiotic requires a dosage adjustment in the setting of chronic kidney disease?
Which change causes orthostatic hypotension in older adults?
Which drug can be given to a patient with stage 4 chronic kidney disease without a dosage adjustment?
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Which physiologic change is a major cause of increased central nervous system (CNS) drug side effects in the older adult?
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Which member of the health care team is responsible for conducting a clinical review of the patient’s drugs to ensure the appropriateness of therapy and reduce the risk for polypharmacy in the older adult?
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Which term describes the use of more medications than is medically necessary?
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Which method is a cornerstone to drug adherence in older adults?
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Which common phrase may help the nurse remember the general practice recommended to reduce the chances of drug toxicity in older adults?
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Which reason influences the commonly stated practice of 'start low and go slow' in older patients?
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Which condition leads to increased central nervous system (CNS) drug side effects in an older adult?
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Which change causes orthostatic hypotension in older adults?
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Which pharmacokinetic alteration necessitates medication dosage adjustments in the older adult patient with decreased renal blood flow?
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Which action would be taken for an older adult with impaired memory in regard to their drug regimen?
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Which effect of aging occurs on the renal excretion of drugs?
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A patient who presents with severe gastric pain is diagnosed with peptic ulcer disease caused by a Helicobacter pylori infection. The nurse learns the patient does not have health insurance and is most concerned with planning care to prevent which occurrence?
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The home health nurse observes that the patient has taken the medication prescribed for before breakfast at bedtime each night. When asked about the timing of the medication, the patient states, 'I know the medication is due before breakfast; I just always forget.' Which intervention by the nurse is most appropriate?
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Study Notes
Beta Blockers and Chronic Kidney Disease
- Sotalol is contraindicated in stages 4 and 5 of chronic kidney disease.
- Atenolol, Bisoprolol, and Nadolol require dosage adjustments in advanced stages of kidney disease.
Antibiotics and Chronic Kidney Disease
- Gentamicin, an aminoglycoside, necessitates dosage adjustments due to renal excretion.
- Most antibiotics, except cloxacillin, clindamycin, metronidazole, erythromycin, and azithromycin, require dosage modifications in chronic kidney disease.
Orthostatic Hypotension in Older Adults
- Blunting of compensatory reflexes is a primary factor causing orthostatic hypotension.
- Older adults show decreased sensitivity in adrenergic receptors and reduced response to beta blockers and beta-2 agonists.
Medications and Stage 4 Chronic Kidney Disease
- Propranolol can be prescribed in stage 4 chronic kidney disease without dosage adjustment; other options like allopurinol, digoxin, and colchicine require adjustments.
CNS Drug Side Effects in Older Adults
- Increased central nervous system drug side effects in older adults are mainly due to a more permeable blood-brain barrier.
- Other changes like decreased renal excretion and blunted compensatory reflexes do not directly lead to increased CNS side effects.
Role of Pharmacists
- Pharmacists are crucial for reviewing medication regimens to ensure appropriateness and mitigate polypharmacy risks among older adults.
- Encouragement for patients to use a single pharmacy helps the pharmacist monitor therapy effectively.
Memory Aids for Medication Adherence
- Use of pill organizers with alarms can help older adults with cognitive impairment remember to take medications.
- Educational tools should be accessible and include various formats like videos and pamphlets.
Pharmacokinetics in Older Adults
- Decreased renal blood flow impacts drug excretion, necessitating dosage adjustments.
- Aging results in decreased hepatic clearance due to reduced liver size and blood flow.
Impact of Aging on Drug Toxicity
- Physiological changes from aging, including reduced renal function, lead to increased risks of drug toxicity even within recommended dosage ranges.
- The guideline to “start low and go slow” helps manage the risk of toxicity in older patients.
Drug Adherence
- Cornerstones for ensuring medication adherence among older adults include thorough patient education and simplified drug regimens.
- Close monitoring by healthcare professionals aids in adherence but is not the sole solution.
Financial Concerns and Medication Adherence
- Patients without health insurance are at high risk for nonadherence due to the inability to afford medications.
- It's essential to consider the economic barriers when planning care for these patients.
Aging and Renal Excretion
- Renal excretion of drugs decreases with age due to declining glomerular filtration rate (GFR), making careful medication management essential.
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Description
Test your knowledge on drug therapy specifically tailored for older adults as discussed in Chapter 7. This quiz covers various medications and their implications in geriatric patients. Ensure you understand the critical aspects of pharmacology in older populations.
