Caring for Older Adults Holistically, 4th Edition Chapter Nineteen Pharmacology and Its Significance...
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Transcript of Caring for Older Adults Holistically, 4th Edition Chapter Nineteen Pharmacology and Its Significance...
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Chapter NineteenChapter Nineteen
Pharmacology and ItsSignificance for
Older Adults
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
DefinitionsDefinitions
Pharmacology Study of medications
Pharmacotherapeutics Use of medications to treat disease
Pharmacodynamics Effect of specific medications at the site of action
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
DefinitionsDefinitions
Pharmacokinetics How a medication moves through the body and is
excreted Half-life
Time required for half the medication to be excreted
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
DefinitionsDefinitions
Protein binding Binding properties of proteins Proteins in blood are binding sites for many drugs
Adverse drug reactions Unwanted side effects of medications
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Aging Changes That Effect Aging Changes That Effect PharmacotherapeuticsPharmacotherapeutics Changes in vision
Difficulty distinguishing different colors of pills Reading directions in small print Sensitivity to glare makes it difficult to read labels Use larger print and nonshiny paper Medication boxes with days and times
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Aging Changes That Effect Aging Changes That Effect PharmacotherapeuticsPharmacotherapeutics Decreased hearing
Unable to hear or understand instructions Speak clearly and slowly Allow person to see your lips
Decrease taste acuity Inability to distinguish different tasting medications Throw away old pill bottles and containers
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Aging Changes That Effect Aging Changes That Effect PharmacotherapeuticsPharmacotherapeutics Change in touch and dexterity
Difficult to open bottles and packages Difficulty picking up pills Use flip-top bottles, remove pills from bubble wrap
packaging Cognitive factors
Difficulty remembering if medications were taken
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Aging Changes That Effect Aging Changes That Effect PharmacotherapeuticsPharmacotherapeutics Compliance factors
Make mistakes in taking drugs Forget to take medications Stop taking or alter schedule because of side
effects Allow for questions, work with person for highest
compliance
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Aging Changes That Effect Aging Changes That Effect PharmacotherapeuticsPharmacotherapeutics Polypharmacy and chronic health issues
Smallest number of drugs at lowest possible dose Adjust long-term drugs for aging process Often have multiple physicians prescribing Use multiple pharmacies Take multiple over-the-counter medications Medications prescribed for adverse effects of
other medications
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Aging Changes That Effect Aging Changes That Effect PharmacotherapeuticsPharmacotherapeutics Financial concerns
Low incomes Unable to afford medications Poor diets that affect drug absorption and excretion
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
PharmacokineticsPharmacokinetics
Normal aging and disease processes change pharmacokinetics Decreased stomach acid Decreased liver and kidney function
Decreased absorption Change in gastrointestinal mobility Change in gastrointestinal tract
Decrease in gastric pH and digestive enzymes
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
PharmacokineticsPharmacokinetics
Distribution Altered in older adults Leaner body mass, increased fat content
Increased absorption of fat-soluble medications Changes in cardiovascular system
Decreased blood flow to target areas Decreased plasma protein concentrations
Chronic dehydration
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
PharmacokineticsPharmacokinetics Metabolism
Decrease overall metabolism Decrease in body’s ability to transform drugs Drugs remain in system twice as long as in younger
adults Excretion
Altered filtration and decreased plasma volume
due to dehydration changes excretion Keeps drug in body longer, toxicity
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Pharmacology ProblemsPharmacology Problems
Misuse of medications Taking wrong drug for a problem
Overuse One pill works; two will be better
Underuse Take less medication to save money Forget to take due to short-term memory
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Pharmacology ProblemsPharmacology Problems
Contraindicated Take medications prescribed by several doctors Multiple drug interactions, allergic reactions,
problems with polypharmacy
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Specific Drug ProblemsSpecific Drug Problems
Antacid abuse High sodium content Increase the severity of renal and cardiovascular
disease Alter motility of gut—diarrhea or constipation
Laxative abuse Individual forgets he or she had bowel movement Damage to intestinal mucosa
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Specific Drug ProblemsSpecific Drug Problems
Laxative abuse (cont.) Inhibit absorption of medications from the
intestine Fluid and electrolyte imbalances
Alcohol abuse Interferes with pharmacotherapeutics and alters
nutritional status
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Specific Drug ProblemsSpecific Drug Problems
Alcohol abuse (cont.) Impaired memory and thinking decreases
medication compliance Alcohol increases or decreases effects of
several drugs
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nursing Care of Older Adults Receiving Nursing Care of Older Adults Receiving MedicationsMedications Follow nursing process when administering
medications to older adults Assessment
Obtain health history that includes prior medication usage
Assess social support network Assess understanding of medications Assess ability for compliance
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nursing Care of Older Adults Receiving Nursing Care of Older Adults Receiving MedicationsMedications Diagnosis
Identify nursing diagnoses that apply Planning
Teach older adult about medications Teach family member of friend at same time Plan schedule for medications that fits his or her lifestyle Encourage to carry list of all medications and their
dosages
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nursing Care of Older Adults Receiving Nursing Care of Older Adults Receiving MedicationsMedications Implementation
Oral medications Can the person swallow a pill, or is liquid form needed? Offer most important medication first Give plenty of water for swallowing
Parental medications Give in dorsogluteal or ventrogluteal sites Avoid injections into edematous areas
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nursing Care of Older Adults Receiving Nursing Care of Older Adults Receiving MedicationsMedications Implementation (cont.)
Intravenous therapy Monitor for fluid overload
Evaluation Do return demonstration on teaching Ask questions about the person’s home situation Ask about occurrence of side effects