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28 Cards in this Set
- Front
- Back
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Polypharmacy
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administration of many drugs together
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Reasons why polypharmacy is more common in older adults (4)
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1. Multiple health care providers
2. Herbal therapy 3. OTC drugs 4. Discontinued prescription drugs |
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Problems caused by poloypharmacy
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confusion, falls, malnutrition, renal and liver dysfunction, nonadherance
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Nursing interventions to prevent polypharmacy
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1)Explain that herbal drugs can cause adverse reactions when taken with prescription or OTC
2)Encourage elderly to use same pharmacy and give pharmacist a list of all drugs taken. |
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Effects of physiological changes on absorption
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(Oral) Drug absorp. is slowed d/t decrease in blood flow and GI motility
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Effects of physiological changes on distribution
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1)Increased circulation of free drug and increased chance of adverse reaction d/t loss of protein-binding sites for drugs
2)Higher concentration of water-soluble drugs d/t loss of body water. 3)Decrease in desired drug effect of lipid-soluble drugs d/t increase in body fat. |
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Effects of physiological changes on metabolism (biotransformation)
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1)Decreased hepatic blood flow by 40-45%, and decreased liver size.
2)Decrease liver metabolism and detoxification d/t decrease in enzyme function. This increases the risk of drug toxicity. |
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Effects of physiological changes on excretion
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1)Decreased cardiac output and blood to the liver and kidneys which causes dysfunction of these organs resulting in prolonged half-life and increased probability of drug toxicity.
2)Drug efficacy reduced |
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Factors contributing to adverse reactions in the elderly
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Loss of protein binding sites, decline in hepatic first-pass metabolism, prolonged half-life which all create a need for an increased time interval between doses.
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Why may the pharmacodynamic response be altered in the older adult?
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Lack of affinity to receptor sites which causes more or less drug sensitivity.
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What changes should be made to decrease the risk of drug toxicity?
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Lowering the dosage and increasing the time interval between doses.
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In the geriatric client, the compensatory response to physiological changes is __________ .
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decreased
(ex. admin of a vasodilator and sympathetic feedback being delayed and causing orthostatic hypotension) |
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What lab test are needed to assess kidney function?
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BUN (blood urea nitrogen) normal is 7-20 mg/dL (higher indicates poss. kidney disease)
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What pt. teaching info should be included when dealing with hypnotics?
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Teach client other ways to induce sleep that don't include medication (warm bath, music, warm fluids, avoiding caffeine)
Avoid alcohol, antidepressants, psychotic, and narcotic drugs. Severe resp. distress may occur. Advise client to take med. before bed-time. (Flurazepam works in 15-45 minutes) Void before bed to prevent sleep disruption. Check with healthcare provider about otc sleeping aids, and do not drive. |
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What are diuretics used to treat?
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Hypertension and CHF
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How do diuretics lower blood pressure?
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They promote fluid and sodium loss, which decreases fluid volume
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Diuretics that act on tubules closes to the glomeruli have the __________ natriuretic effect.
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Greatest (Lasix inhibits sodium and water reabsorption from loop of henle.
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What are the different types of diuretics?
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Thiazide and thiazide-like
Loop or high-ceiling Osmotic Carbonic anhydrase inhibitor Potassium-sparing |
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What diuretic types are frequently prescribed for hypertension and edema associated with HF?
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Thiazide, loop or high-ceiling, and potassium-sparing
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All diuretics are potassium-wasting. (T/F)
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False, potassium-sparing diuretics do not waste potassium
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What is the prototype loop-diuretic?
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Furosemide (Lasix)
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When is lasix used?
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Only when more conservative measures fail because of its potency.
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What are the normal dose ranges for lasix?
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Oral: 20-80 mg single dose/day, 20-40 mg/6-8 hrs. not exceeding 600mg/d
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What are common side effects of lasix?
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Electrolyte imbalances, nausea, diarrhea, vertigo, cramping, rash, headache, ecg changes, blurred vision, photosensitivity, and weakness
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Adverse reactions of lasix?
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Severe dehydration, and maked hypotension, renal failure, thrombocytopenia, and agranulocytosis.
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What electrolytes are lost with lasix usage?
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sodium, potassium, magnesium, and calcium
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What is the half-life of lasix?
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30-50 minutes
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Drug-Lab Interactions w/ Lasix
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Alcohol-orthostatic hypotension
Amingogycosides-ototoxicity Anticoagulants-hemorrhage Steroids- K+ loss Digoxin-Dig toxicity w/ K+ loss dysrhytmmias with K+ loss |
