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22 Cards in this Set
- Front
- Back
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Sedatives/Hypnotics
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Before theses drugs are used, evaluate factors contributing to insomnia. Adjusting environmental lighting or temperature, controlling noise, eliminating caffeine, increasing physical activity, relieving pain, giving a back rub, and controlling symptoms of disease can improve sleep and eliminate the need for a sedative.
Carefully monitor pts who are using sedatives as they are at higher risk for falls and fractures Be alert to interactions: o Sedatives and hypnotics can increased the effects of oral anticoagulants, antihistamines, and analgesics, and decrease the effects of cortisone and cortisone-like drugs. o The effects of sedatives and hypnotics can be increased by alcohol, antihistamines, and phenothiazines. Teach proper medication administration. Monitor for S/E |
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Laxatives
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Nonpharmalogical measures to promote bowel elimination should be used before resorting to laxatives.
Types of laxatives: o Bulk formers – absorb fluid in the intestines and create extra bulk, which distends the intestines and increases peristalsis. They usually take 12-24hr to take effect. They need to be mixed with large amounts of water. Do not use if pt has intestinal obstruction. o Stool softeners – collect fluid in the stool which makes the mass softer and easier to move. They do not affect peristalsis. They take effect in 24-48hrs. o Hyperosmolars – pull fluid into the colon, causing bowel distention which increases peristalsis. Take effect 1-3hrs. Contraindicated when there is a risk for fecal impaction. o Stimulants – irritate the smooth muscle of the intestines and pull fluid into the colon, causing peristalsis. They take effect in 6-10hrs. Can cause intestinal cramps and excessive fluid evacuation. o Lubricants – coat fecal material to facilitate passage. They take effect in 6-8hr. Not recommended for older adults. Recognizing that it is a common geriatric risk, assist older adults in preventing constipation. When pts complain of constipation, assess carefully before suggesting or administering a laxative. Reinforce to older adults and their caregivers that laxatives, although popular, are drugs and can cause S/E and interact with other drugs. Good fluid intake must accompany the use of bulk forming laxatives and stool softners to prevent the accumulation of stool leading to bowel obstruction. Be alert to interactions: o Laxatives can reduce the effectiveness of many oral medications by increasing the speed of their passage through the GI system. o Chronic mineral oil use can deplete the body’s fat-soluble vitamins (Vitamins A, D, E, and K). |
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Diuretics
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Types:
o Thiazides: inhibit sodium reabsorption in the cortical diluting site of the ascending loop of Henle and increase the excretion of chloride and potassium. o Loop diuretics: inhibit reabsorption of sodium and chloride at the proximal portion of the ascending loop of Henle. Lasix (furosemide). o Potassium-sparing diuretics: antagonize aldosterone in the distal tubule, causing water and sodium, but not potassium, to be excreted. (spironolactone). Monitor for electrolyte imbalances and correct them promptly. Plan an administration schedule that interferes least with the pts schedule. Morning administration is usually preferable. Monitor I/O, and assure adequate fluid intake. Teach pts and their caregivers to recognize and promptly report signs of fluid and electrolyte balance: dry oral cavity, confusion, thirst, weakness, lethargy, drowsiness, restlessness, muscle cramps, muscular fatigue, hypotension, reduced urinary output, slow pulse, and GI disturbances. Because of postural hypotension, careful attention should be paid to preventing falls. Latent diabetes sometimes can be manifested during thiazide diuretic therapy. Monitor hearing in pts receiving loop diuretics as these drugs can cause transient ototoxicity. Diuretics can worsen existing liver disease, renal disease, gout and pancreatitis, and raise blood glucose in diabetics. Careful monitoring of pts with these conditions is essential. Ensure serum electrolytes, glucose, and BUN are evaluated periodically. Be alert to interactions: o Diuretics can increase the effects of antihypertensives and decrease the effects of allopurinol, digoxin, oral anticoagulants, antidiabetic agents and probenecid. o The effects of diuretics can be increased by analgesics and barbiturates; diuretics’ effects can be decreased by cholestyramine and large quantities of aspirin (administer these drugs at least 1 hr before). |
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Analgesics
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Assess the symptom of pain carefully for its underlying cause. Improving or eliminating the cause of the pain may make the use of an analegesic unnecessary.
Explore nonpharmacologic means to manage pain, such as relaxation exercises, massages, warm soaks, and diversional activities. If nonpharmalogical means of pain control are unsuccessful, begin with the weakest type and dose of analgesic and gradually increase so that the patient's response can be evaluated. Administer analgesics regularly to maintain a constant blood level. Observe for signs of infection other than fever in patients who are taking aspirin or acetaminophen as the antipyretic effect of these drugs can mask fevers associated with infection. Because bleeding and delayed clotting times can result from long-term aspirin use, observe for signs of anemia, bleeding, and altered hemoglobin and ptt. Note signs of salicylate toxicity, which include dizziness, vomiting, tinnitus, hearing loss, sweating, fever, confusion, burning in the mouth and throat, convulsions, and coma. Hypoglycemic reactions can occur when persons with diabetes combine aspirin with sulfonylureas. Use narcotics very carefully in older adults. If there has been a known or suspected overdosage of any drug from this group, refer the patient for emergency help at once, even if no symptoms are present. Signs of poisoning may not appear for several days, although liver damage may be occuring. |
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Antacids
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During assessments, ask specifically about the use of antacids. Some patients may not consider OTC antacids medications of concern and may omit them when reporting their medication history
Ensure that patients who have used antacids frequently or over a long period of time have been evaluated for the underlying cause of their problem Avoid administering other medications within 2 hours of administration of an antacid, unless otherwise ordered, to prevent antacid from interfering with drug absorption Monitor bowel elimination. Constipation can result from the use of aluminum hydroxide and calcium antacids; diarrhea can occur when magnesium hydroxide combinations are used. Advise patients who are on sodium-restricted diets to avoid using sodium bicarbonate as an antacid |
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Antianxiety (Anxiolytics)
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Ensure that approaches other then medications have been attempted prior to having an antianxiety drug prescribed. Even if these measures were tried and ineffective previously, they should be tried again
Advise patients to change positions slowly and to avoid operating a car or machinery that requires mental alertness and fast responses These drugs can be constipating, so instruct patients to incorporate foods in the diet that can promote bowel elimination. Monitor bowel elimination Monitor nutritional status and weight to assure food intake is not jepardized by possible lethargy or GI upset Advise caution in grapefruit consumption; this fruit can increase the concentration of these drugs Advise patients that several days of administration may be necessary before clinical effects from the medication are noted and that the effects could continue several days after the drug is discontinued Avoid alcohol when these drugs are used and limit caffeine |
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Antibiotics
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Ensure that cultures are obtained when an infection is suspected or present; different antibiotics are effective for different infections
Administer antibiotics on a regular schedule to maintain a constant blood level. Reinforce to patients that they should not skip doses. Consider developing a medicaation chart or calendar to assist the older patient in remembering to administer the drugs Observe for signs of superinfections, which can develop with long-term use of antibiotics |
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Anticoagulants
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Ensure that patients using anticoagulants have their PT/international normalization ratio (INR) monitored; discuss the recommended frequency with the physician
Age-adjusted dosages may be prescribed; consult with the physician Administer anticoagulants at the same time each day to maintain a constant blood level Observe for signs of bleeding: teach patients to observe for these signs Educate patients about the need to be careful about diet. A large intake of vitamin K rich foods (asparagus, bacon, beef liver, cabbage, fish, cauliflower, green leafy vegetables) can reduce the effectiveness of anticoagulants. Mango and papaya can increase INR. High doses of vitamin E can increase bleeding risk. Many herbs interact with anticoagulants. Advise patients to refrain from taking herbal products until they have reviewed them with their health care provider Keep vitamin K readily available as an antidote when patients are receiving anticoagulants Advise patients to avoid using aspirin as it can interfere with platelet aggregation and cause bleeding. 3 g or more of salicylates - a level that could be reached by persons who use aspirin for arthritic pain - are sufficient to cause hemorrhage in older adults |
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Anticonvulsants
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Observe for and inquire about possible side effects from these drugs, including change in bowel habits, abnormal bruising, bleedings, pallor, weakness, jaundice, muscle and joint pain, nausea, vomiting, anorexia, dizziness (increases risk of falls), blurred vision, diplopia, confusion, agitation, slurred speech, hallucinations, arrhythmias, hypotension, sleep disturbances, tinnitus, urinary retention, and glycosuria
As these drugs can depress psychomotor activity, ensure patients have adequate physical activity Ensure periodic evaluations of blood levels are done for drugs for which this is required and/or available (e.g., carbamazepine, phenytoin, phenobarbital, primidone, valproic acid) Be aware that these drugs can worsen any exisiting liver or kidney disease Anticonvulsants should not be discontinued abruptly Advise patients to avoid grapefruit and grapefruit juice when taking these drugs as it increases the risk of toxicity Anticonvulsants can aggravate existing glaucoma, coronary artery disease, or prostate disease, Patients with these conditions require close monitoring Some anticonvulsants can cause photosensitivity |
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Antidepressants
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Assess factors contributing to depression. In some situations, obtaining financial aid, receiving greif counseling, joining a group, and other actions can improve the cause of the depression and reduce or eliminate the need for the drug
Explore the use of other therapies in addition to antidepressants to improve mood Ensure that the lowest effective dosage of the drug is used to reduce the risk of adverse effects Advise patients that several weeks of therapy commonly is required before improvement is noted Monitor the plasma level of the drug. Be aware that dosage adjustment may be needed Observe for, ask about, and report side effects, including diaphoresis, urinary retention, indigestion, constipation, hypotension, blurred vision, difficulty voiding, increased appetite, weight gain, photosensitivity, and fluctuating blood glucose levels The dizziness, drowsiness, and confusion that can occur in older adults can increase the risk of falls, so special precautions are needed Dryness of the mouth can be an uncomfortable side effect of these drugs. Advise patients to use sugarless mints, ice chips, or a saliva substitute to improve this symptom. Monitor oral health closely because dry mouth increases risk of dental disease Some antidepressants need to be discontinued gradually, so advise patients not to abruptly stop taking the drugs Observe patients for a worsening of depression symptoms or suicidal thinking or behavior; bring these findings to the physicians attention immediately |
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Antidiabetic Drugs
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Teach individuals with diabetes and their caregivers about the proper use and storage of medications, and recognition of hypo- and hyper- glycemia. Reinforce that all insulins or oral antidiabetic drugs are not interchangable
Ensure that people with diabetes wear or carry identification to alert others of their diagnosis in the event they are found unconscious or confused For patients using insulin, examine injection sites regularly. Local redness, swelling, pain, and nodule development at the injection site can indicate insulin allergy. A sunken area at the infection site can be caused by atrophy and hypertrophy associated with insulin lipodystrophy - a harmless although unattractive condition Report conditions that could alter antidiabetic drug requirements, such as fever, severe trauma, prolonged diarrhea or vomiting, altered thyroid function, or heart, kidney or liver disease Advise patients to avoid drinking alcohol as this can lead to a significant drop in blood sugar |
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Antihypertensive
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Assess blood pressure carefully. Obtain readings with the patient in lying, sitting, and standing positions
Help patients in learning and using nonpharmacologic measures to reduce blood pressure, such as weigh reduction, restriction of sodium and alcohol intake, moderate aerobic exercise, and stress management techniques Monitor patients closely when therapy is initiated. Some antihypertensives can cause significant hypotension initially. Advise patients to change positions slowly to prevent falls Ensure that patients obtain lab work as ordered. Monitoring of serum potassium is especially important when patients are receiving ACE inhibitors with potassium or potassium-sparing diuretics Monitor patients for side effects Reinforce to patients the importance of adhering to treatment even when symptoms are absent Some antihypertensives should not be abruptly discontinued. Advise patients to check with their physicians before discontinuing these drugs |
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Anti-inflammatory, Nonsteroidal (NSAIDs)
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NSAIDs have a narrowed therapeutic window, and toxic levels accumulate much easier and at lower doses in older adults. Closely observe for and aask about side effects, such as GI symptoms, impaired hearing, and indications of CNS disturbances. Be aware that older adults are at higher risk of developing delirium as a side effect to these drugs
Ensure blood evaluations are done regularly Administer these drugs with food or a glass of milk, unless contraindicated, to reduce GI irritation If patients are using aspirin for cardioprotective effects and are started on NSAID, review this with the physician or pharmacist as some NSAIDs (ibuprofen) can reduce the cardiac benefit of aspirin Prolonged use of indomethacin, meclofenamate, piroxicam, and tolmetin can cause CNS effects (headache, dizziness, drowsiness, confusion) When reviewing patients drugs, note if these drugs have been used for an extended time and review this with the physician and pharmacist |
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Antipsychotics
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Ensure that patients receive a thorough physical and mental health evaluation before any antipsychotic drug is prescribed
Whenever possible, attempt to use other interventions to address symptoms prior to using antipsychotics Antipsychotics should be used for the treatment of specific disorders and not as a means of managing behavior. Using antipsychotics to control behaviors alone can be viewed as chemically restraining patients Drugs have a longer biological half-life in the older adults; assure the lowest possible dosage is initially used Older adults are more sensitive to the anticholinergic effects of these medications: dry mouth, constipation, urinary retention, blurred vision, insomnia, restlessness, fever, confusion, disorientation, hallucinations, agitation, picking behavior. They also are a greater risk for developing extrapyramidal symptoms: tardive dyskinesia, parkinsonism, akinesia, dystonia. Observe and report these symptoms promptly. Patients taking antipsychotics are at high risk for falls due to the hypotensive and sedative effects. Implement fall prevention measures for these individuals. Constipation is a common side effect of antipsychotics. Advise patients to include fiber and other foods in diet that promote regular bowel movement and monitor bowel elimination. Men with prostatic hypertrophy may develop urinary hesitance and retention when using antipsychotics. Advise patients and caregivers to monitor urinary symptoms and report changes promptly. Gradual weaning rather than abrupt withdrawal from these drugs is recommended. Response to these drugs can vary in older adults, necessitating close monitoring. |
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Cholesterol-Lowering Drugs
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Assist patients in implementing dietary and lifestyle modifications to help reduce cholesterol levels
Ensure that patients receive liver functions and other necessary tests as ordered Monitor for interactions and follow precautions for each category of cholesterol-lowering drugs as discussed above |
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Cognitive Enhancing Drugs
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Evaluate patients mental status, cognition, and activities of daily living prior to initiation of therapy and periodically thereafter during prolonged treatment. Monitor for signs and symptoms of GI bleed. Ensure that patients using tacrine have regular liver function tests.
Recommend that patients on these drugs be reevaluated as their underlying disorder progresses Cholinesterase inhibitors can affect cardiac conduction in patients with existing conduction disorders or who are using medications that affect heart rate. Review potential risks with the physician and pharmacist. Avoid abrupt discontinuation of these drugs Tacrine is best taken on an empty stomach. Galantamine is best taken with food. Be alert to interactions with: anticholinergics, aspirin (high doses used for arthritis), cholinergic drugs, long-term use of NSAIDs, cholinesterase inhibitors, carbamazepine, dexamethasone, phenobarbital, phenytoin, and rifampin |
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Digoxin
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Check and/or instruct patients and their caregivers to check pulse for rate, rhythm, and regularity prior to administering digoxin.
The usual biological half-life of these drugs can be extended in older adults, increasing their risk of digitalis toxicity. Signs of toxicity include: bradycardia, diarrhea, anorexia, nausea, vomiting, abdominal pain, delirium, agitation, hallucinations, headache, restlessness, insomnia, nightmares, asphasia, ataxia, muscle weakness and pain, cardiac arrhythmias, high serum drug levels (although toxicity can occur in the presence of normal serum levels). Promptly report any signs of possible toxicity. Hypokalemia makes patients more susceptible to toxicity so make sure that the patient consumes potassium-rich foods and that serum potassium is evaluated regularly. Be alert to interactions: can be increased by alprazolam, amphotericin, benzodiazepines, carvedilol, cyclosporine, erythromycin, ethacrynic acid, fluoxetine, guanethidine, ibuprofen, indomethacin phenytoin, propranolol, quinidine, tetracyclines, tolbutamide, trazodone, trimethoprim, verapamil. Can be decreased by antacide, cholestyramine, kaolin-pectin, laxatives, neomycin, Phenobarbital, phenylbutazone & rifampin. toxicity increases cortisone, diuretics, parenteral calcium reserpine, thyroid preparations. |
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Inappropriate Drugs to Use in Older Adults
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Idomethacin
Pentazocine Muscle relaxants & antispasmodics: methocarbamol, carispprdol, chlorzoxazone, metaxalone, cyclobenzaprine, and oxybutynin Amitriptyline, chlordiazepoxide-amitriptyline, and perphenazine-amitriptyline Doxepin Meprobamate Short-acting benzodiazepines in specific doses that are greater than: 3 mg for lorazepam, 60 mg for oxazepam, 2 mg for alprazolam, 15 mg fr temazepam, and 0.25 mg for triazolam Long-acting benzodiasepines: chloridiazepoxide, chlordiazepoxide-amitriptyline, clidinium-chlordiazepoxide, diazepam, quazepam, halazepam, and clorazepate Disopyramide Methyldopa and methyldopa-hydrochlorothiazide Gastrointestinal antispasmodic drugs: dicyclomine, hyoscyamine, propantheline, belladonna alkaloids, and clindinium-chlordiazepoxide Anticholinergics and antihistamines: chlorpheniramine, diphenhydramine, hydroxyzine, cyproheptadine, promethazine, tripelennamine, dexchlorpheniramine Diphenhydramine All barbiturates Meperidine Ticlopidine Ketorolac Amphetamines and anorexic agents Long-term use of full-dosage, longer half-life non-COX-selective NSAIDs Fluoxetine (daily doses) Long-term use of stimulant laxatives Mineral oil Amiodarone Orphenadrine Guanethidine Guanadrel Nitrofurantoin Methyltestosterone Thioridazine Mesoridazine Short-acting nifedipine Desiccated thyroid |
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Tips for Safe Drug Use: Teaching Tool
Keep a current list of all of the following that you use: |
prescription drugs
OTC drugs vitamins, minerals, and other nutritional supplements herbal and homeopathic remedies and show this to your health care providers |
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Tips for Safe Drug Use: Teaching Tool
For each drug, herb, homeopathic remedy, or nutritional supplement that your use, know (and, if possiblem have this information written down) the dosage: |
administration schedule
administration instructions (take on full or empty stomach, take only if symptom is present, discontinue after x days) purpose usual side effects adverse effects that you should bring to the attention of your health care provider precautions (when you should not take it, interactions with food, other drugs or substances) storage instructions where purchased/obtained |
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Tips for Safe Drug Use: Teaching Tool
Learn as much as you can about the drugs you are taking by: |
reading the literature that comes with the drug
consumer drug reference books that are available at your local library or bookstore |
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Tips for Safe Drug Use: Teaching Tool
Other information |
Recognize that your drug dosage may be different from someone else's dosage who is taking the same drug
Be aware that you can develop adverse effects to drugs that you have taken for years without problems. Review your symptoms with your health care provider Try to reduce the drugs you are using. Discuss with your health care provider improvements in your symptoms or other changes that could cause a drug to no longer be needed, Periodically review your drug dosages with your health care provider to see if any changes in your body's function could lead to reduced dosages Try to manage new symptoms naturally rather than with drugs Do not take new drugs without consulting your health care provider |
