Drug Dosage in Older Adults Quiz

Drug Dosage in Older Adults

• Drug ranges for older adults are not the same as those for younger and middle-aged adults. Start low and titrate slowly.

Physiologic Changes in Older Adults Affecting Drug Response

• Reduced Total Body Water & Lean Body Mass: Increased body fat alters drug distribution.
• Decreased Kidney Mass & Function: Lower glomerular filtration rate (GFR) and creatinine clearance affect drug excretion.
• Reduced Liver Mass & Function: Impacts drug metabolism.
• Disrupted Physiological Equilibrium: Potential for postural hypotension with blood pressure medications, gastrointestinal issues with NSAIDs, electrolyte imbalances with diuretics.

Increased Adverse Drug Effects in Older Adults

• Older adults experience more adverse effects from medications (prescription, over-the-counter, and supplements).

Absorption in Older Adults

• Decreased Gastrointestinal Motility: Slower emptying time.
• Reduced Surface Area: Less absorption capacity.
• Lower Gastric Acid: Use calcium citrate instead of calcium gluconate.
• Decreased Gastric Blood Flow: Reduced absorption.

Distribution in Older Adults

• Increased Drug Storage: Risk of drug toxicity.
• Reduced Water Content: Affects water-soluble drugs.
• Increased Body Fat, Reduced Muscle Mass: Lipid-soluble drugs are better absorbed.
• Lower Albumin: Increased free drug levels.

Metabolism in Older Adults

• Reduced Hepatic Metabolism: Longer half-life for drugs.
• Decreased First-Pass Effect: Less metabolism.
• Decreased Hepatic Blood Flow: Impacts drug metabolism.
• Reduced Cytochrome Enzymes: Reduced drug metabolism capacity.
• Check Liver Function Tests (LFTs).

Excretion in Older Adults

• Decreased Renal Excretion: Due to decreased kidney function.
• Reduced Kidney Size: Affects drug excretion.
• Reduced GFR: Impacts drug elimination.
• Normal Creatinine (Cr) Levels: Despite reduced kidney function, Cr may appear normal due to decreased muscle mass.

Pharmacodynamics in Older Adults

• Reduced Adrenergic Receptors: Impacts beta-blockers and beta-2 agonists.
• Decreased Compensatory Reflexes: Orthostatic hypotension.
• Changes in CNS and Cardiovascular System: Alters drug responses.
• Changes in Drug Receptor Numbers: Affects drug sensitivity.
• Changes in Drug Receptor Sensitivity: Reduced responsiveness to various drugs.
• Reduced Neurons and Connections: Impacts drug effects.
• More Permeable Blood-Brain Barrier (BBB).

Polypharmacy Risk Factors

• Advanced age, females, multiple healthcare providers, herbal/OTC use, multiple chronic diseases, and care transitions.

Polypharmacy

• Taking multiple unnecessary medications.

Polypharmacy Risks

• Increased risk of geriatric syndromes, mortality, and adverse reactions.

Beers Criteria

• A list of drugs potentially inappropriate for older adults.

Adverse Drug Events (ADEs)

• More frequent in older adults. Taking too many or too few medications.

Medication Adherence in Older Adults

• Challenges: Memory issues, reluctance to ask questions, lack of education, financial constraints, childproof containers, side effects, mobility limitations, dexterity issues.

Enhancing Medication Adherence in Older Adults (Nursing Interventions)

• Ensure all medications are dispensed from the same pharmacy.
• Daily follow-up with patients after prescriptions.

Health Teaching for Older Adults

• Adapt communication style to their hearing abilities.
• Limit distractions.
• Use large print and bright colors.
• Provide hearing aids and glasses.
• Review all medications at each visit.
• Complete "Vials of Life" (information for EMS).
• Have patients provide a list of all medications at appointments.
• Organize medications using simple dosing schedules.
• Encourage reporting of new symptoms and drug-related suspicions.

Substance Abuse (Definition)

• Recurrent alcohol or drug use causing health problems, disability, or failure to meet responsibilities.

Terms Avoiding Negative Connotations

• Avoiding language such as "abuse", "dependence", "addict", etc.

Substance Abuse Criteria

• Cravings, attempts to stop but failing, using larger amounts or for longer than intended, neglecting responsibilities or relationships, using even in hazardous settings.

Protective Factors for Substance Abuse

• Caregivers, self-esteem, safety, positive norms, and peer relationships.

Risk Factors for Substance Abuse

• Trauma, mental health conditions, child abuse, poverty, academic issues, peer substance abuse, and bullying.

Neurobiology of Drugs and Substance Abuse

• Drugs increase dopamine receptor availability, producing euphoria.
• Repeated use leads to downregulation of receptors and tolerance.

Reward Circuit

• Dopamine-rich brain circuit activated by pleasure.
• Drugs activate this circuit.

Epigenetics and Drugs

• Drug use can alter DNA, potentially impacting future generations.

Short-Term Effects of Alcohol Use Disorder

• Nausea, vomiting, headaches, slurred speech, impaired judgment, memory loss, hangovers, and blackouts.

Long-Term Effects of Alcohol Use

• Stomach issues, heart issues, brain damage, memory loss, immune system dysfunction, liver cirrhosis.

Alcohol Toxicity

• Body metabolizes alcohol at 10 g/hr. Symptoms include aspiration, asphyxiation, dehydration, seizures, hypothermia, brain damage. Treatment includes maintaining airway support and IV fluids.

Drug-Assisted Treatment for Alcohol Use Disorder

• Medications that induce negative effects when mixed with alcohol (e.g., disulfiram, acamprosate, naltrexone).

High-Risk Behaviors Associated with Alcohol Use Disorder

• Increased risk of accidents, suicide, and homicide.

Cannabis Mechanism of Action

• Crosses the blood-brain barrier and binds to cannabinoid receptors.

Cannabis Common Component

• Delta-9-tetrahydrocannabinol (THC).

Short-Term Effects of Cannabis Use

• Impaired short-term memory, learning, balance, coordination, difficulty responding to stimuli, increased heart rate, hallucinations, and panic attacks.

Long-Term Effects of Cannabis Use

• Lung damage from smoking, respiratory infections, cough, and exposure to cancer-causing compounds.

Medical Uses for Cannabis Legalization

• Glaucoma, headaches, cancer, multiple sclerosis, chemotherapy-induced nausea and vomiting, anorexia.

Cannabis Use During Pregnancy

• Potential for developmental problems in children (memory, problem-solving, attention issues).

Opioid Mechanism of Action

• Bind to opioid receptors in the brain.

Short-Term Effects of Opioid Use

• Euphoria, reduced pain, drowsiness, confusion, nausea, constipation (decreased gastric motility), and dose-dependent respiratory depression.

Opioid and SSRI Interactions

• Risk of serotonin syndrome.

Alcohol and Opioid Interactions

• Dangerously low heart rate and respiratory rate.

Opioid Overdose Signs and Symptoms

• Decreased bowel sounds, depressed mental status, decreased respiratory rate, decreased tidal volume, constricted pupils.

FDA Opioid Warnings

• Warnings for pregnant women and neonatal opioid withdrawal syndrome.

Vaping and Opioids

• Vaping can increase the severity of opioid-related symptoms.

Opioid Treatment Medications

• Naloxone, naltrexone, methadone, buprenorphine.

Naloxone Use

• Only reverses the effects of opioids.

Tobacco Mechanism of Action

• Crosses the blood-brain barrier and stimulates dopamine, norepinephrine, GABA, glutamate, and endorphins. Activating the reward circuit.

Tobacco Use Prevalence

• 50.6 Million adults currently use tobacco. Increased risk for vaping and cigarette initiation in 18-24 age group.

Short-Term Effects of Tobacco Use

• Increased blood pressure, heart rate, and respiratory rate.

Long-Term Effects of Tobacco Use

• Cancer, respiratory problems, heart issues, stroke, type 2 diabetes, stillbirth, miscarriage, and developmental problems in babies.

Cognitive Behavioral Therapy (CBT) for Tobacco Use

• Identifying negative thoughts and beliefs around tobacco use, understanding triggers, and developing coping strategies.

Electronic Cigarettes and Cigarette Cessation

• Electronic cigarettes are not a more effective means of cessation than traditional methods, despite potentially lower nicotine levels.

Nicotine Replacement Therapy

• Nicotine replacement products bind to CNS receptors, helping reduce withdrawal symptoms.

Bupropion for Nicotine Cessation

• Mimics nicotine to increase dopamine and norepinephrine in the brain.

Varenicline for Nicotine Cessation

• Stimulates dopamine, but with a black box warning for neuropsychiatric symptoms (hostility, agitation, depression, suicidal thoughts). Nurses should be aware and counsel patients. Safety during pregnancy and breastfeeding is unknown.

Dextromethorphan

• Psychoactive cough suppressant in high doses, causing euphoria, hallucinations, disassociation. Potentially harmful to the liver and cardiovascular system.

Promethazine-Codeine

• Cough suppressant, often inducing euphoria and relaxation.

Diphenhydramine

• Antihistamine that can induce narcotic-like high in high doses.

Anabolic Steroids Mechanism of Action

• Induce anabolic (muscle growth) and androgenic (sex characteristics) effects.

Anabolic Steroids Medical Use

• Treating low testosterone levels.

Short-Term Effects of Anabolic Steroid Use

• Headaches, yellowing of skin, fluid retention, acne, aggression, mood swings, delusions.

Long-Term Effects of Anabolic Steroid Use

• Kidney damage, liver damage, hypertension, enlarged heart, cholesterol abnormalities, reduced fertility, baldness, gynecomastia, and potential increased risk of prostate cancer.

Antidepressants and Anabolic Steroid Use

• Potential for suicidal ideation, warranting careful monitoring and consideration due to the use of anabolic steroids.

Substance Abuse and Surgical Patients (General Concerns)

• Drug interactions, greater risk of intubation, post-operative complications, and increased mortality risk.

Substance Abuse Screening Before Surgery

• Anticipate anesthesia adjustments, withdrawal symptoms, and drug interactions.

Substance Abuse Post-Operative Management

• Monitor for drug interactions, withdrawal symptoms (delirium tremens, seizures), and other complications.

Pain Management in Substance Abuse Patients Post-Surgery

• Address pain needs while considering drug interactions, potential withdrawal, and other adverse events. Prioritize patient safety while managing pain.

Common Abused Drugs Among Nurses

• Cannabis, cocaine, opioids, alcohol, and nicotine.

Medical Specialties with Highest Substance Abuse Rates

• Anesthesiology and Certified Registered Nurse Anesthetists (CRNAs).

Contributing Factors to Substance Abuse Among Nurses

• Stress from demanding workload, long shifts, emotional labor, and poor self-care.

Indicators of Substance Abuse in Nurses

• Performance deterioration, tardiness, absenteeism, poor judgment, medication errors, illogical documentation, changed appearance.

Treatment Programs for Nurses with Substance Abuse Disorders

• Provide treatment before disciplinary actions or license revocation.

Tobacco Use Assessment

• Assess smoking status, history, and willingness to quit, identifying the patient's locus of control and motivation.

Analysis of Tobacco Use Problems

• Address the patient's coping strategies to understand underlying motivations for continued use.

Planning for Tobacco Cessation

• Assist with developing strategies to regulate nicotine use, promoting self-management behaviors.

Nursing Interventions for Tobacco Use Cessation

• Maintain a list of slips and near-slips to understand patterns and maintain motivation. Help the patient problem solve, and actively work to avoid smoking environments.

Test your knowledge on the unique pharmacokinetics and pharmacodynamics affecting drug therapy in older adults. This quiz covers critical physiological changes that impact drug response, potential adverse effects, and important dosage considerations. Enhance your understanding of safe medication practices for the elderly.