Medications and Older Adults (Geropharmacology) PDF

Medications and older adults (Geropharmacology) Objectives: Describe the pharmacokinetics changes that occur as a result of normal changes with aging Describe potential PROBLEMS ASSOCIATED WITH DRUG THERAPY Identify medications that are used most common in later life Descr...

Medications and older adults (Geropharmacology) Objectives: Describe the pharmacokinetics changes that occur as a result of normal changes with aging Describe potential PROBLEMS ASSOCIATED WITH DRUG THERAPY Identify medications that are used most common in later life Describe medication and side effects of those more commonly used as psychotherapeutic agents Identify inappropriate drug use in gerontological nursing © Ma'en Aljezwi 1  Introduction Persons 65 years and above are the largest users of prescriptions and over the counter medications The most commonly prescribed are cardiovascular drugs Medications can both enhance and endanger the quality of life Older adults are at a greater risk for polypharmacy and adverse drug events © Ma'en Aljezwi 2  Pharmacokinetics Is the study of the movement and action of a drug in the body It determine the concertation of a drug in the body it includes: - Absorption - Distribution - Metabolism - Excretion © Ma'en Aljezwi 3  Absorption Is the transfer of drug from the route of administration to the blood The amount of time for absorption depend on: 1- rout of administration; 2- bioavailability; 3-the amount of drug that absorbed from the absorption surface Some drugs are give enterally (via a tube) to the stomach or intestine, but due to mechanical problems in the mouth they are give via a tube © Ma'en Aljezwi 4  Aging and absorption Diminished salivary secretions and esophageal motility may interfere with swallowing This could lead to erosions if adequate fluids are not taken Decreased acidity in the stomach will retard the action of acid- dependent drugs delayed stomach emptying may diminish the effect of short term drugs © Ma'en Aljezwi 5  Aging and absorption Some enteric coated drugs that are meant to bypass stomach acidity, may be delayed so long in older adults that their actions begins in the stomach slowed intestinal motility seen in aging can increase the time of contacting with the intestinal walls which may increase the drug absorption © Ma'en Aljezwi 6  Aging and absorption In normal aging both liver mass and blood flow are significantly decrease, resulting in decreasing metabolism rate for some medications Skin dryness may interfere with the absoprption of topical medications © Ma'en Aljezwi 7 © Ma'en Aljezwi 8  Distribution Circulatory disease such as peripheral vascular disease can affect drug distribution Lipophilic drugs pass through capillary membranes more easily than hydrophilic drugs resulting in a more rapid tissue distribution As the adipose tissue increase with age, the risk of drug accumulation in fat tissue increase and the risk of overdose increase © Ma'en Aljezwi 9  Distribution Some drugs are bound to protein distribution in a normally predictable percentage The elderly shows either no or a small change in plasma binding proteins Albumin may be significantly reduced in malnourished patients, so over dose could happen in theses patients © Ma'en Aljezwi 10  Metabolism Is the process wherein the chemical structure of the drug is converted to metabolites that are more easily used and excreted Some drugs needs to be metabolized first in the body to produce their therapeutic effect Studies have proven that there is no difference in drugs metabolism with age © Ma'en Aljezwi 11  Metabolism Several of metabolizing enzymes show genetic differences , there are people who are poor metabolizers, normal metabolizers and fast metabolizers A knowledge of the genome explodes, so does our ability to consider the possibility of what has come to be called “personalized medicine” © Ma'en Aljezwi 12  Excretion Drugs and their metabolites are excreted in sweat, saliva, and other secretions, but primarily from the kidneys Few drugs are eliminated through the lungs The glomerular filtration rate, renal plasma flow, tubular function and absorptive capacity declines with age © Ma'en Aljezwi 13  Excretion This leads to prolongation of half-life of drugs eliminated through the renal system More opportunities for accumulation and potential toxicity for other adverse events In this case the dose is calculated according to the creatinine clearance rate © Ma'en Aljezwi 14  Pharmacodynamics Physiological interactions between the drugs and the body Drugs bind to specific proteins in the body Drugs are usually similar in configuration to chemicals occurring naturally in the body Age can alter the response to medications especially anticholinergics, this results in unwanted side effects: constipation © Ma'en Aljezwi 15  Pharmacodynamics Age can alter the response to medications especially anticholinergics, this results in unwanted side effects: - Constipation - Dry mouth - Blurred vision - Dizziness - Urinary retention - Confusion © Ma'en Aljezwi 16  Issue in medications use Polypharmacy: - Use of multiple medications, or the use of multiple medications for the same problem - Either way is common among elderly - The risk of medication duplication increase - It is important to discontinue all drugs prescribed by other doctors if they are not necessary © Ma'en Aljezwi 17  Issue in medications use Drug interaction: the greater the number of medications a patient takes the grater the risk that one or more of them will interact They could have either a stronger or weaker effect compared to when they given alone Drug-supplement interaction Drug-food interaction Drug-drug interaction © Ma'en Aljezwi 18 Issue in medications use © Ma'en Aljezwi 19  Psychoactive drugs These drugs have a higher than usual risk for adverse events and must be used with care The nurse works with the patient to ensure that appropriate biomarkers are measured and to identify the behavioral markers (sadness, quality of sleep, ability to enjoy social activities © Ma'en Aljezwi 20  Antidepressants Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice for first line use in older adults Side effects for older adults are manageable and could resolve with time like dry mouth or sedation Sexual dysfunction resolve with discontinuation of drug © Ma'en Aljezwi 21  Antidepressants Serotonin and norepinephrine inhibitors may be preferred for those engaged in sexual activity Monoamine oxidase inhibitors and tricyclic antidepressants are no longer indicated in most cases © Ma'en Aljezwi 22  Anxiolytic agents They include benzodiazepines Their side effect include drowsiness, dizziness, ataxia, mild cognitive defects, and memory impairment Buspirone is a nonbenzodiazepine alternative, no effect is felt or observed by the nurse for 5- 7 days, therefore this drug should not be discontinued immediately © Ma'en Aljezwi 23  Mood stabilizers They are used to treat bipolar disorder Lithium was the first in this category Today anticonvulsant are used more commonly e.g. valporic acid and Lamotrigine The nurse should be proactive in ensuring that the serum concertation are monitored Lithium should be taken carefully, low salt diet could elevate its serum level, thiazide diuretics and NSAIDs elevate the serum level © Ma'en Aljezwi 24  Antipsychotics Are tranquilizing medications used primarily to treat psychoses and for bipolar disorders Their side effects include: - Malignant syndrome: the effect on thermoregulatory pathway, patients taking them cannot tolerate excess heat, even the small elevation in core temperature can cause liver damage, nurse should provide cool environment for elders all the time © Ma'en Aljezwi 25  Antipsychotics - Acute dystonia: abnormal involuntary movement consisting of slow and continues muscular contraction or spasm - Akathisia: compulsion to be in motion, a sense of restlessness, being unable to still, having an unrelenting desire to move - Parkinsonian syndrome: mimicking Parkinson disease, a bilateral tremor(in true Parkinson unilateral), may progress to rigidity and inability to move © Ma'en Aljezwi 26  Antipsychotics - Tardive Dyskinesia: irreversible movement disorder starts when the drug has been used continuously for at least three to six months, wormlike movement of the tongue, facial movement, blinking and frowning, slow maintained involuntary twisting of the limbs © Ma'en Aljezwi 27  Nursing health promotion Find out a support person who can manage the patient medication and teach him about it Minimize distraction and avoid competing with television or others demanding the patients time, make sure the person is comfortable and not hungry Provide teaching during the best time of the day for the person, when he or she is most engaged and energetic © Ma'en Aljezwi 28  Nursing health promotion Keep the education session short and succinct Ensure that you will be understood, make sure the elders have their glasses or hearing aids Reinforce teaching: by making the elder remember to take his medication by using the most appropriate strategy like a storage box or writing dates on medication bottles © Ma'en Aljezwi 29