Drug Therapy for Geriatric Clients PDF

SLIDES Ms.Virgina Varghese PREPARED BY Ms. Reshma P S PRESENTER COLLEGE / COHS CENTRE NURSING PROGRAM SEMESTER FALL 2024-2025 Drug therapy for Geriatric clients 1 Course Outcomes (From Course Specifications)...

SLIDES Ms.Virgina Varghese PREPARED BY Ms. Reshma P S PRESENTER COLLEGE / COHS CENTRE NURSING PROGRAM SEMESTER FALL 2024-2025 Drug therapy for Geriatric clients 1 Course Outcomes (From Course Specifications) A1 Describe the general principles of pharmacotherapeutic, pharmacokinetics, and pharmacodynamics in wellness promotion and illness prevention and treatment. A2 Explain principles of safe administration of medications B1 Demonstrate proficiency in applying the 10 rights of medication administration during the preparation and administration of medication therapy. B2 Apply the methods of healthcare documentation and professional communication related to medication therapy C1 Analyze the legal and ethical parameters of medication administration √ C2 Utilize the nursing process and teaching-learning principles in health promotion, self-care and management to assess, plan, set goals and administer medications to diverse individuals across the lifespan with basic pharmacological needs. D1 Demonstrate continued ability to calculate drug dosages safely and use of terminology associated with pharmacology D2 Generate a positive and flexible approach to lifelong learning 2 Drug therapy for Geriatric clients Introduction Drug use among the elderly is disproportionately high. The geriatric consume more drugs reasons for this intensive use of drugs include increased severity of illness, multiple pathologies, and excessive prescribing. The principal factors underlying these complications are (1) altered pharmacokinetics (secondary to organ system degeneration), (2) multiple and severe illnesses, (3) multiple-drug therapy, and (4) poor adherence Each patient must be monitored for desired and adverse responses, and the regimen must be adjusted accordingly  Pharmacokinetic Differences in the Geriatric Client ABSORPTION Reduced gastric acidity because of the gradual reduction in production of hydrochloric acid in the stomach that may affect the way tablets or capsules dissolve. Because many medications require an acidic pH to break down, they may pass through the digestive tract unchanged. Gastric emptying is slower, because there is a decline in motor tone and motor activity in the gastrointestinal tract with advancing age. The rate of passage of drugs through the lower gastrointestinal tract is also slowed because of decreased muscle tone and motor activity. The elderly have a tendency for constipation and consequent use of laxatives and bran foods, which may accelerate the movement of drugs through the gastrointestinal system and reduce absorption.  There is a general reduction in blood flow (diminished by 40%–50% by 65 years of age), causing blunting and flattening of villi in the intestinal tract, resulting in an overall decrease in absorptive surface area in the intestines. Topical absorption is faster because of thinner skin surface. Intramuscular absorption is more difficult to anticipate because the peripheral circulation is more affected by environmental changes. This can lead to variations in vasodilation and vasoconstriction, resulting in altered absorption. Distribution Total body water (TBW) content is decreased, resulting in diminished volume of distribution of some water-soluble medications. Total body fat content is increased, altering the distribution of fat-soluble medications, such as some sedatives and hypnotics. Drugs may be absorbed into fatty tissues and more slowly released into the bloodstream. Age-related loss of muscle tone due to atrophy alters distribution of some medications, especially those administered intramuscularly. There is a general decrease in protein-binding capability BIOTRANSFORMATION (METABOLISM) The levels of enzymes are decreased because of the decline in liver function with age. Liver blood flow is reduced by 0.5%–1.5% per year after the age of 25, thus, there is a decline in the body’s ability to transform active drugs into inactive metabolites. ELIMINATION Glomerular filtration rate is reduced by 40%–50%, because of the reduction of blood flow to the kidneys. Tubular secretion and reabsorption are decreased, because of decreased renal blood flow. The number of intact nephrons is decreased. The elderly are more likely to experience drug toxicity, because of accumulation of drugs Factors Related to Drug Problems in the Elderly 1. Sensory losses affect the elderly’s ability to manage medication programs accurately. 2. Loss of recent memory affects self-care. 3. Medication problems increase with the use of multiple pharmacies and physicians. 4. As the number of drugs taken increases, medication errors increase. 5. Use of nonprescription drugs, sharing medications, hoarding drugs, and dietary factors are all related to drug problems in the elderly. 6. Communication problems also lead to drug problems. PHARMACODYNAMIC CHANGES IN THE ELDERLY Alterations in receptor properties may underlie altered sensitivity to some drugs EX: The beta-adrenergic blocking agents (drugs used primarily for cardiac disorders) are less effective in the elderly than in younger adults Other drugs (warfarin, certain central nervous system depressants) produce effects that are more intense in the elderly, suggesting a possible increase in receptor number, receptor affinity, or both. Knowledge of pharmacodynamics changes in the elderly is restricted to a few families of drugs. ADVERSE DRUG REACTIONS AND DRUG INTERACTIONS Adverse drug reactions (ADRs) are 7 times more common in the elderly than in younger adults The majority of ADRs in the elderly are avoidable. Measures that can reduce their incidence include: Taking a thorough drug history, including over-the-counter medications Accounting for the pharmacokinetic and pharma codynamic changes that occur with aging Initiating therapy with low doses Monitoring clinical responses and plasma drug levels to provide a rational basis for dosage adjustment Employing the simplest regimen possible Monitoring for drug-drug interactions and iatrogenic illness Periodically reviewing the need for continued drug therapy, and discontinuing medications as appropriate Encouraging the patient to dispose of old medications Taking steps to promote adherence Promoting adherence Several measures can promote adherence, including: Simplifying the regimen so that the number of drugs and doses per day is as small as possible Explaining the treatment plan using clear, concise verbal and written instructions Choosing an appropriate dosage form (eg, a liquid formulation if the patient has difficulty swallowing) Labeling drug containers clearly, and avoiding containers that are difficult to open by patients with impaired dexterity (eg, those with arthritis) Suggesting the use of a calendar, diary, or pill counter to record drug administration Asking the patient if he or she has access to a pharmacy and can afford the medication Enlisting the aid of a friend, relative, or visiting healthcare professional Monitoring for therapeutic responses, adverse reactions, and plasma drug levels Drugs to Generally Avoid in the Elderly DRUG REASON ALTERNATIVE TREATMENT Analgesics Meperidine Not effective at usual doses, Moderate to severe pain: confusion morphine Antidepressants Amitriptyline Anticholinergic effects other antidepressants (constipation, urinary retention, blurred vision) Antihistamines Anticholinergic effects Second-generation Chlorpheniramine (constipation, urinary retention, antihistamines, such as cetirizine blurred vision) or loratadine Antihypertensive s Orthostatic hypotension, Thiazide diuretic, ACE inhibitor, Methyldopa depression beta-adrenergic blocker, calcium channel blocker Sedative- Hypnotics Physical dependence; compared zolpidem, zaleplon, eszopiclone Barbiturates with other hypnotics, higher risk of falls, confusion, cognitive NURSING CARE OF ELDERLY CLIENTS RECEIVING DRUG THERAPY Assessment 1. Obtain baseline measures on vital signs, height, and weight. 2. Take a history of allergies and current use of prescription and nonprescription drugs. 3. Also obtain information on disabilities, sensory functioning, client’s home environment, general financial concerns, and social support network. 4. Be certain that persons responsible for self-medication are able to open containers and do not have difficulty in getting prescriptions filled. Nursing Diagnoses Nursing Diagnoses Including but not limited to: Altered health maintenance related to inability to manage costs of drug therapy Risk for injury related to self-administration of medications Noncompliance related to drug regimes Deficient knowledge related to medication regime and administration Risk for injury related to idiosyncratic responses to medications due to physiologic changes of aging Planning/Goals Client will seek out help to manage costs of drug therapy. Client will not sustain injury from self-administration of medications. Client will demonstrate ability to safely administer medications to self. Client will communicate understanding of medication regime including dosage, adverse effects, signs and symptoms to report to his/her physician, and the importance of maintaining compliance with drug regime. Client will state the importance of taking medication as ordered. Client will not sustain injury from idiosyncratic responses to IMPLEMENTATION Administration of Drugs to the Elderly Follow the patient rights. When giving oral medications, position the client in an upright position. Use liquid dosage forms if the client has difficulty with tablets or capsules. Do not rush the client. Provide a sufficient amount of water or other liquid to ensure that the oral medication reaches the stomach. Avoid injection into muscles which have lost their mass. The ventrogluteal site is preferred in the elderly. Watch elderly clients receiving intravenous infusions for fluid overload Teaching Older People Be certain the older person is wearing his/her glasses and/or hearing aid, if these are used. Conduct all teaching sessions in an area with good lighting and minimal environmental distractions. Speak clearly and slowly with your voice pitched low so the client can hear. Always face the client when speaking. Keep teaching sessions brief, no longer than 15–20 minutes. Provide sufficient time for review, questions, and client demonstration. Use visual aids and reading materials that are attractive and have large print. Brightly colored aids may be useful in getting points across. Teach a family member, friend, or neighbor about the treatment Evaluation Client demonstrates understanding of need to seek assistance in managing costs of drug therapy. Client sustains no injury from self-administration of medications. Client can communicate understanding of medication regimen, including dosage, adverse effects, signs and symptoms to report to his/ her physician, and importance of maintaining compliant with drug therapy. Client demonstrates ability to safely administer medications to self. Client states the importance of taking medication as ordered. Client experiences no idiosyncratic responses to drug therapy.  References Broyles, B., Reiss, B., & Evans, M. (2012). Pharmacological aspects of nursing care. Nelson Education. Berman, A., Snyder, S. J., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T., & Park, T. (2010). Kozier and Erb's fundamentals of nursing (Vol. 1). Pearson Australia. Lehne, R. A. (2013). Pharmacology for nursing care. Elsevier Health Sciences. Thank You 21 21