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


DefinitionsDefinitions

Pharmacology Study of medications

Pharmacotherapeutics Use of medications to treat disease

Pharmacodynamics Effect of specific medications at the site of action



Pharmacokinetics How a medication moves through the body and is

excreted Half-life

Time required for half the medication to be excreted



Protein binding Binding properties of proteins Proteins in blood are binding sites for many drugs

Adverse drug reactions Unwanted side effects of medications


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


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


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


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


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


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


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


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


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


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


Pharmacology ProblemsPharmacology Problems

Contraindicated Take medications prescribed by several doctors Multiple drug interactions, allergic reactions,

problems with polypharmacy


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



Laxative abuse (cont.) Inhibit absorption of medications from the

intestine Fluid and electrolyte imbalances

Alcohol abuse Interferes with pharmacotherapeutics and alters

nutritional status



Alcohol abuse (cont.) Impaired memory and thinking decreases

medication compliance Alcohol increases or decreases effects of

several drugs


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


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


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


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


Nursing Care of Older Adults Receiving Nursing Care of Older Adults Receiving MedicationsMedications Evaluation (cont.)

Evaluate appropriate blood levels Adherence to regimen

caring for older adults holistically, 4th edition chapter nineteen pharmacology and its significance...

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