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Geri - Pharmacology

Epidemiology - Elders consume 31% of prescribed drugs - More chronic problems - More multisystem disorders
Why older adults respond differently to drugs - Altered Absorption, Distribution, Metabolism, Excretion - Incr Side effects & Sensitivity
Pharmakinetics: Absorption (why its slower) -Drug goes GI tract->blood -Decr intestinal blood flow -More time for gastric emptying -Less mucosal cell absorbing area -Decr gastric acid affects ionization & drug solubility -Poor absorption, need higher dose -Adverse reactions
Pharmakinetics: Absorption (what can incr effect) -Transdermal -Subcut -Intramuscular
Pharmakinetics: Distribution - Determines drug concentration - Body wt, less water & ms mass, Higher fat % - Drug accumulates in fat -> prolonging action & toxicity
Path of drug in the body Drug passes through liver, changed to enzymes, enters circulation, binds to protein in blood or cells, infiltrates target organ
Pharmakinetics: Metabolism - Determines duration drug is in body - Elderly liver decreases metabolic rate - Decr metabolism may cause toxic drug buildup
Pharmakinetics: Excretion - Urine, perspiration, feces Renal excretion diminishes by 35-50%: - Decr GFR - Longer drug half-life - Steady state reached later - Accumulation → toxicity
Pharmacodynamics: Body’s response to drug - Fewer receptors at site of action - Decr ability of receptors to respond - Less ability of body to produce counter-regulatory response to return to homeostasis
Medication Mishaps - Multiple providers - pt Visual, cognitive impairments - Cant afford drugs - Takes too much or too little - Functional illiteracy - Prefers natural or OTC alternative - Few package inserts give geriatric dose
Drug noncompliance - Older & younger adults equally compliant - Cost - Weakness: hands, swallowing - Impaired vision, hearing - Need clear, simple, explicit instructions
Nutrition - All drugs affect nutritional status bc all drugs affect metabolism - Depressed appetite, nausea, diarrhea - Metabolism: May change intestinal flora, May interfere with nutrient absorption & use - Often require vitamins & minerals
OTC meds - Elderly: OTC & Rx drugs - All have risks - Label cant make therapeutic claim - Polypharmacy incr: pain, colds, heartburn, fever, allergy, constipation, cough, insomnia, diarrhea, nausea - Symptoms can mask more serious condition: indigestion -> ang
Nutraceutical agent food providing health benefit
Functional food modified food providing health benefit
Herbs botanicals = phytomedicines
Extract concentrated preparation
Tincture herb in solution
Juice fresh plants macerated
Tea extracts from which infusions (steep in water or oil) are made
Adverse drug reactions (8) - Postural hypotension - Fatigue & weakness - Depression, Fluid depletion - Dehydration - Confusion - Movement disorders - Incontinence - Dizziness
Postural Hypotensives (9) - Tranquilizers: insomnia, psychosis - Narcotics: pain - Antiparkinsonians - Sedative-Hypnotics: insomnia, anxiety - Antidepressants - Antiarrhythmics - Antihypertensives - Diuretics - Nitrates: angina
Fluid volume depletion - Usually caused by diuretics - Fatigue
Causes of fatigue & weakness (6) - Beta-blockers: slow heart, reduce blood flow - Diuretics dehydrate, decr cardiac output - Vasodilators - Digitalis (cardiac med) - Antihypertensives - Oral hypoglycemics
Meds as falls risk Meta-analysis of 29 studies 1996-2004: - Psychotropics, especially benzodiazepines (sedative) - Antidepressants - Antipsychotics - Antiepileptics
Incontinence - Drugs that depress cerebral function - Stress incontinence: leak during activity- antipsychotics - Bladder relaxants & urge incontinence: anticholinergics
Risks of incontinence (8) - Cardiac abnormalities - Hallucination - Mouth dryness - Fatigue - Dysphagia - Difficult urination - Confusion - Ataxia
Dizziness - Counteracts balance exercise program - Antihypertensives - CV antilipemics: lipid lowering - Sedatives-Hypnotics - Analgesics
Alcohol: Risk factors & presentation Risk factors: - Male, Caucasian, family Hx Presentation: - Inappropriate behavior, late, smells
Alcohol: CAGE - Cut down on drinking - Annoyed by criticism - Guilty about drinking - Eye opener
Created by: neej