Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

Pharmacology and Older Adults

6

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Explain the interaction between normal aging and responses to drug therapy in older people.

2. Identify principles of safe medication management with older persons in a variety of patient care settings.

3. Discuss measures to prevent and reduce polypharmacy in older patients.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

4. Describe assessments to monitor older patients for adverse drug effects and polypharmacy.

5. Apply principles of teaching and learning to promote compliance and adherence to the medication regimen.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

6. List nonpharmacological therapies that may be useful as alternatives to medications.

7. Discuss issues related to ensuring the safe use drug therapy by the older person.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Introduction

• Drug therapy in the older person presents many challenges in ensuring the appropriate use of medications.

• The nurse is in a pivotal position to use nursing assessments and nursing interventions to promote the appropriate use of medications.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Cultural Diversity and Medication Use

• Cultural diversity and ethnic background can affect the older person’s beliefs about health, illness, medications, and physiological response to medications.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Pharmacodynamic Alterations

• In addition to the alterations due to normal aging processes, older persons are more likely to have chronic pathological conditions that may affect responses to drugs.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Box 6-1 Definitions of Adverse Drug Reactions and Adverse Drug Events

Gerontological Nursing, Third EditionPatricia A. Tabloski

Adverse Drug Events of Concern in Older Persons

• Side effects including amnesia, depression, nausea, vomiting, lethargy, confusion, and visual disturbances occur more often in older persons than in younger patients.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Box 6-2 Heuristic for Remembering Anticholinergic Effects

Gerontological Nursing, Third EditionPatricia A. Tabloski

Box 6-4 Warning Signs of NSAID-Induced Gastric Irritation

Gerontological Nursing, Third EditionPatricia A. Tabloski

Adverse Effects of Interactions

• When multiple medications are used, there is a greater chance of drug-drug interactions, ADEs, and ADRs.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Promoting Medication Effectiveness and Safety

• The nurse has a pivotal role in ensuring that a person’s drug therapy is both effective for the person’s condition and to prevent, detect, or to intervene as early as possible if the person develops adverse drug effects.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Promoting Medication Effectiveness and Safety

• The “five rights” of medication administration:– Right patient– Right drug– Right dose– Right route– Right time

Gerontological Nursing, Third EditionPatricia A. Tabloski

Potentially Inappropriate Drugs

• Some drugs are considered to be inappropriate to use for older persons because of their adverse effects.

• “Beers list”• The nurse can use the list as a basis of

questioning the prescribing clinician about the appropriateness of a drug being used in a particular patient.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Appropriate Use of Psychotropics

• The use of psychotropic drugs in older persons, especially those in institutional settings, is of concern due to potential use of these drugs for less than optimal therapeutic reasons.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Medication Management

• The nurse has a major role in promoting the safe and effective management of medications.

• This includes the correct storage, preparation, and administration.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Medication Management

• The nurse can be instrumental in promoting compliance and appropriate management of drug therapy by older patients or their caregivers in the home.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Assessing Older Patients’ Appropriate Use of Medications

• Assessment of drug effects is a nursing responsibility.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Financial Considerations in Medication Use

• Financial pressures may result in people taking dangerous actions related to prescription drugs.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Medicare Part D

• Medicare part D went into effect and has assisted many with their drug costs.

Gerontological Nursing, Third EditionPatricia A. Tabloski

Patient and Family Teaching

• Educating patients and families is critical so that nurses can interpret scientific data and individualize the nursing care plan.