Question | Answer |
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 |