Objective 7: Safe Medication Administration & Older Adults PDF

OBJECTIVE 7: SAFE MEDICATION ADMINISTRATION & OLDER ADULTS MEDICATION USE & OLDER ADULTS Largest consumers of prescription & over the counter (OTC) medications. Challenges: polypharmacy, expense, adherence, absorption & elimination. Many older persons use complementary alternative medicine (CAM)....

OBJECTIVE 7: SAFE MEDICATION ADMINISTRATION & OLDER ADULTS MEDICATION USE & OLDER ADULTS Largest consumers of prescription & over the counter (OTC) medications. Challenges: polypharmacy, expense, adherence, absorption & elimination. Many older persons use complementary alternative medicine (CAM). Medication use is influenced by • Beliefs (perception of the need for meds), understanding about illness. • Functional & cognitive status. • Severity of illness S/S. MEDICATION USE: TRENDS/ISSUES Older clients are becoming more aware/ knowledgeable of new meds (advertised on TV & elsewhere). Challenges with coordinating care between specialists. Pharmacists taking active role in educating clients. Medication costs often exceed income of older adults. PHARMACOKINETICS The movement of a drug into the body from the point of drug administration, considering absorption, distribution, metabolism & excretion. Includes: • • • • Absorption Distribution Metabolism Excretion PHARMACOKINETICS: ABSORPTION The route is important e.g. oral (PO) vs Intravenous (IV) Age related changes in stomach related to pH & which affects absorption. motility Bioavailability: how much drug that is available to be absorbed in the blood. PO route maybe 70% is available, IV – 100% available. The drug them exert changes or acts on target tissues. PHARMACOKINETICS: DISTRIBUTION The drug is transported to target organ to exert effect. The action of the drug depends on the availability of plasma protein (albumin), percentage of drug that binds to the protein, and the amount of free drug circulating. DISTRIBUTION Many older adults have an increase in body fat, decrease in lean body mass & total body water. Dehydration & decrease in serum albumin can increase serum levels of medications. *These changes may extend & possibly elevate the med effect. PHARMACOKINETICS: METABOLISM Biotransformation is the process where the body changes the composition (chemical structure) of the drug. • Medications are changed to metabolites and in this form they can still exert the effect of the drug. • *Need to be in this form to be excreted. The rate of metabolism is impacted by age-related changes in the liver which is the primary site of metabolism of medications. Liver mass is decreased in older persons, and circulation to the liver is reduced. • *Because of age-related changes in the liver, metabolism of drugs is slower resulting in older adults being more at risk for Adverse Drug Effects (ADR). PHARMACOKINETICS: EXCRETION Medications are excreted via sweat & saliva other body fluids. Major organ involved with excretion is the kidneys. Due to age related changes (recall glomerular filtration rate decreases, kidney shrinks), it takes longer for drugs to be excreted. Half life (how long the drug stays in the body) is increased as a result. * Because of age-related changes in the kidney, older adults are more at risk for adverse effects & potential toxicity. PHARMACODYNAMICS The interaction between a medication and the body. With age there is an altered & or unreliable response to medications. e.g. increased sensitivity to many drugs (e.g. benzodiazepines [Ativan, Valium], anti-cholinergic meds & others). POLYPHARMACY The use of multiple medications, use of meds that are contraindicated or potentially inappropriate. Common issue with older adults. Contributes to morbidity & mortality. Can be accidental by the older person. POLYPHARMACY: TWO CONCERNS Increase risk for drug interactions Increase risk for adverse drug events ADVERSE DRUG REACTIONS (ADR) Often due to inappropriate use of certain drugs. May occur when starting doses are too high. Insufficient monitoring of blood levels increases likelihood. Decreased Fluid intake or volume depletion are contributing factors. Drug can induce delirium e.g. (antipsychotics, anti-cholinergics) Common ADRs include lethargy & confusion. 50% of prescription drugs react with alcohol Common medication: acetaminophen (Tylenol) taken regularly can lead to liver failure in the older person. TOXICITY Can occur when concentration of drug in the blood circulation exceeds the level needed for therapeutic effect. Toxic responses are most life threatening of ADRs. See Table 14-3 in the text -Meds Considered Inappropriate for Older Adults. SAFE MEDICATION ADMINISTRATION Medications prescribed to older adults should……. ‘Start low and go slow’….to determine therapeutic level (or intended response) ISSUES/PATTERNS OF MED USE IN OLDER ADULTS 1. Polypharmacy 2. Self- prescribing- e.g. taking left-over meds; sharing meds, use of OTC drugs. 3. Using herbal/natural remedies. 4. Non-compliance- e.g. not finishing prescription; not following instruction. 5. Non-adherence … ….? Due to memory? Due to literacy level? MEDICATION ASSESSMENT First step is comprehensive assessment of all older persons taking medication. ‘Brown Bag approach’- ask client to bring all meds & other products that they are taken. Ask the client what med is taken for & when it is taken? What is their understanding? Assess their comprehension, mental status & ability to function (? Risk for ADR). Does the client understand the reason for taking the medication? Sensory function? Is the medication effective? Is there ongoing teaching & follow-up required? Who is responsible for administering Meds? Are the Rights of med. administration being followed? RIGHTS OF MEDICATION ADMINISTRATION TPR – triple ‘D’s’ D – Right Drug T - Right Time P – Right Patient R – Right Route, Reason D – Right Dose D – Right Documentation New *Right to Refuse MEDICATION ADMINISTRATION CONSIDERATIONS How much assistance does the client need: • Can the client open the med. cap, & break a med. in half (if indicated)? • Does the client have difficulty in swallowing (dysphagia)? If so, they may need liquid form. • Are reminders to take medications needed? Goals • To manage a schedule for taking meds. • To understand instructions. • To be able to read labels. • To be able to open & dispense medication. • To report anything unusual e.g. bruising. • To have an ongoing rapport with care-provider. PATIENT EDUCATION CONSIDERATIONS 1. Key Persons: Who manages medications? 2. Environment – is it conducive to taking meds without distractions? e.g. radio. 3. Timing – what is the best time of day to take certain meds? 4. Communication - what is the level of comprehension; memory? Encourage questions. 5. Reinforce teaching. 6. Evaluate teaching: have client repeat back info. 7. Avoid Med interactions: obtain meds from same pharmacy, educate about recognizing s/s of ADRs. INTERVENTIONS TO PROMOTE ADHERENCE Memory aids to prompt. Calendars / visual reminders. Easy to open containers. Pill containers labeled with times and days of week. Journal / log when meds taken. Blister-pack dispensing. Regular check-in.