1. Caring for Older Adults Holistically, 4th Edition Chapter Nineteen Pharmacology and Its Significance for Older Adults

2. Caring for Older Adults Holistically, 4th Edition Definitions  Pharmacology  Study of medications  Pharmacotherapeutics  Use of medications to treat disease  Pharmacodynamics  Effect of specific medications at the site of action

3. Caring for Older Adults Holistically, 4th Edition Definitions  Pharmacokinetics  How a medication moves through the body and is excreted  Half-life  Time required for half the medication to be excreted

4. Caring for Older Adults Holistically, 4th Edition Definitions  Protein binding  Binding properties of proteins  Proteins in blood are binding sites for many drugs  Adverse drug reactions  Unwanted side effects of medications

5. Caring for Older Adults Holistically, 4th Edition Aging Changes That Effect Pharmacotherapeutics  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

6. Caring for Older Adults Holistically, 4th Edition Aging Changes That Effect Pharmacotherapeutics  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

7. Caring for Older Adults Holistically, 4th Edition Aging Changes That Effect Pharmacotherapeutics  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

8. Caring for Older Adults Holistically, 4th Edition Aging Changes That Effect Pharmacotherapeutics  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

9. Caring for Older Adults Holistically, 4th Edition Aging Changes That Effect Pharmacotherapeutics  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

10. Caring for Older Adults Holistically, 4th Edition Aging Changes That Effect Pharmacotherapeutics  Financial concerns  Low incomes  Unable to afford medications  Poor diets that affect drug absorption and excretion

11. Caring for Older Adults Holistically, 4th Edition Pharmacokinetics  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

12. Caring for Older Adults Holistically, 4th Edition Pharmacokinetics  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

13. Caring for Older Adults Holistically, 4th Edition Pharmacokinetics  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

14. Caring for Older Adults Holistically, 4th Edition Pharmacology 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

15. Caring for Older Adults Holistically, 4th Edition Pharmacology Problems  Contraindicated  Take medications prescribed by several doctors  Multiple drug interactions, allergic reactions, problems with polypharmacy

16. Caring for Older Adults Holistically, 4th Edition Specific 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

17. Caring for Older Adults Holistically, 4th Edition Specific Drug Problems  Laxative abuse (cont.)  Inhibit absorption of medications from the intestine  Fluid and electrolyte imbalances  Alcohol abuse  Interferes with pharmacotherapeutics and alters nutritional status

18. Caring for Older Adults Holistically, 4th Edition Specific Drug Problems  Alcohol abuse (cont.)  Impaired memory and thinking decreases medication compliance  Alcohol increases or decreases effects of several drugs

19. Caring for Older Adults Holistically, 4th Edition Nursing Care of Older Adults Receiving Medications  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

20. Caring for Older Adults Holistically, 4th Edition Nursing Care of Older Adults Receiving Medications  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

21. Caring for Older Adults Holistically, 4th Edition Nursing Care of Older Adults Receiving Medications  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

22. Caring for Older Adults Holistically, 4th Edition Nursing Care of Older Adults Receiving Medications  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

23. Caring for Older Adults Holistically, 4th Edition Nursing Care of Older Adults Receiving Medications  Evaluation (cont.)  Evaluate appropriate blood levels  Adherence to regimen