Pharmacology and Older Adult NURS 1060 Exam 2 PDF

Pharmacology and the Older Adult NURS 1060: Exam 2 Outcome  Discusscritical thinking and clinical reasoning to provide quality patient care.  Describe quality improvement measures in healthcare micro and macro systems that impact patient care. Competency  Discuss...

Pharmacology and the Older Adult NURS 1060: Exam 2 Outcome  Discusscritical thinking and clinical reasoning to provide quality patient care.  Describe quality improvement measures in healthcare micro and macro systems that impact patient care. Competency  Discuss critical thinking and clinical judgment used to provide accurate and safe medication administration  Describequality improvement measures use to reduce medication errors. Concept  Clinical Decision Making: A process used to examine and determine the best actions to meet desired goals; requires anticipating, recognizing and organizing patient problems to respond with urgency and/or importance in a preferential order to avoid or minimize adverse changes in a patient’s condition.  Sensory/Perception: Factors contributing to receiving and interpreting internal and external stimuli through the five senses.  Development: The sequential physical and psychological capacities that allow complex adaptation to the environment. Unit Outcomes  Discuss pharmacokinetic changes in the older adult.  Discuss common causes of adverse drug reactions in the older adult.  Identify the purpose of the Beers list.  Identify factors that contribute to non- adherence in older adults with drug treatment plans  Identify measures to promote the older adult’s adherence with drug treatment plan. Older Adult Activity  Prepareto administer the order  Wear sunglasses and gloves  Open the roll of candy Older Adult Activity Orders  White 1 tablet oral every morning  Peach 1 tablet oral every morning  Blue 1 tablet oral every morning  Pink 1 tablet oral every morning   How did it go? Older Adult  Any challenges? Activity  Were you successful? Debrief  Did you feel safe?  Older adults Altered are more pharmacokinetic sensitive to drugs than s younger adults Older Adult and Multiple Chronic illnesses Pharmacolo gy Multiple-drugs daily  Goal of treatment: Reduce symptoms and improve quality of life Older Individualization of Adults treatment Must be monitored for desired and adverse responses.  Pharmacokinetic changes  Pharmacodynamic changes Drug Therapy  Adverse drug reactions and Challenges in interactions Older Adults  Compliance/adherence Examples of Pharmacokinetic Changes In the Older Adult   Delayed gastric emptying increases time for absorption Pharmacokinet  Increasein gastric pH ic Changes: (toward alkaline) delays absorption of acid drugs Absorption  Decreased blood flow to GI tract   Increased percentage of body fat  Decreased percentage of lean muscle mass Pharmacokinet  Decreased total body ic Changes: water  Distributed in smaller volume; drug Distribution concentration is increased and effects are more intense  Reduced serum albumin Protein Binding Drugs Albumin Most abundant extracellular protein. Manufactured in the liver daily Serum albumin test measures the amount of this protein in the clear Normal range is 3.5 – 5 g/dl liquid portion of the blood. Causes decreased protein binding of drugs and Reduced serum albumin increase in levels of free drugs   Hepatic metabolism declines with age.  Reduced hepatic blood flow, reduced liver Pharmacokinet mass, and decreased activity of hepatic ic Changes: enzymes occur. Therefore: Metabolism  Half-life of drugs increase  Response to drugs may be greater and/or last longer. Metabolism and Hepatic Function  Hepatic Function (Liver)  Serum Tests that measure hepatic enzymes  ALT normal 5 – 55 units/L  AST normal 5 -40 units/L   Renalfunction progressive decline  Reductions in renal Pharmacokinet blood flow, glomerular filtration rate (GFR), ic Changes: active tubular secretion, and number of nephrons Excretion  Riskof drug accumulation and toxicity Pharmacokinetic Changes: Excretion Renal Function  Renal function should be assessed with drugs that are eliminated primarily by the kidneys. 24 hour urine collection  OLDER ADULTS  Preferred test is creatinine clearance, not serum creatinine, because lean muscle mass (source of creatinine) declines in parallel with kidney function.  Creatinine levels may be normal even though kidney function is greatly reduced.  In practice, most providers order serum creatinine unless renal disease is suspected Serum Creatinine RANGE 0.5 - 1.2 mg/dl  How well are the kidneys working?  Creatinine is a chemical waste product of creatine. Creatine is a chemical made by the body and is used to supply energy mainly to muscles.  Creatinine is removed from the body entirely by the kidneys. If kidney function is not normal, often the creatinine level increases in the blood. This is because less creatinine is released through the urine. BUN (Blood Urea Nitrogen) RANGE 10-20mg/dl  Canbe used to assess levels of hydration or dehydration  HighBUN can indicate the kidneys are not working well. Case Study  Mr. Johnson is a 92-year-old male admitted to the medical-surgical unit for severe pneumonia, and the provider prescribed gentamicin antibiotic therapy.  Upon review of the order, you notice the initial dose is ordered at less than the standard recommended dose.  What is the rationale behind the decreased starting gentamicin dose for this patient? Adverse Drug Reactions and the Older Adult Adverse Drug Reactions (ADR)  More likely in the older adult  Maylead to hospital admissions, injuries, harm  Symptoms in older adult often not specific Common Causes of ADR in Older Adults  Altered Pharmacokinetics  Drug-Disease Interactions  Polypharmacy  Medication Mismanagement Adverse Drug Response Example Antihypertensive drugs cause orthostatic hypotension Falls Fracture or Subdural Hematoma  Created by Dr. Beers in 1991 with updates ongoing Includes Medication Classes Beers that should be avoided or used with caution in the Criteria older adult Beers Criteria Web Link Pharmacologic Compliance and the Older Adult Medication Nonadherence Possible Contributing Factors Cost and access Side effects Lake of perceived need Complex drug regimen Promoting Medication Adherence Clear, concise verbal and written instructions Simplified drug regimens Clearly labeled and easy-to-open containers Daily Reminders Patient Education Support System Monitor clinical response/plasma drug levels Regular Follow Up Monitor for drug-drug interactions Get generic form (if possible, often more affordable) Cost and access assistance Mail to home options 1060 Exam 2  Format: Multiple Choice or Select All That Apply (45 questions)  Time: 68 minutes (1.5 minutes per question)  *NextGen NCLEX question- not for points and clearly marked, extra time added for this question  Covers all 1060 content including:  Powerpoints from Lecture  Distribution  Metabolism and Excretion  Pharmacodynamics  Older Adult Considerations  In-class activities, study guides and homework