1. Chapter 6 Drug Therapy for Geriatric Clients Chapter 6

2. Drug Consumption p131 Age ≥ 65 = increasing population growth – Elderly are estimated to consume approximately 1/3 of all prescription drugs – Estimate elderly use 3/4 of over-the-counter drugs – Polypharmacy 6 - 2

3. Absorption p132 Diminishes with increased age GI concerns – Reduced stomach acid (HCl) – Villi are blunted – Prolonged gastric emptying rate – Blood flow to the intestines is reduced Atherosclerotic changes – Reduced muscle tone in the stomach and intestines = decreased peristalsis

4. Absorption continued p 132 Skin is thinner = faster topical absorption IM absorption unpredictable due to changes in peripheral circulation. Vasodilation, vasoconstriction.. 6 - 4

5. Distribution p133 Total body water is decreased Muscle atrophy Fatty tissue increase Protein binding capacity decreased 6 - 5

6. Metabolism p133 Decline in amount of enzymes Decrease in liver function Causes are obscure; possibly due to: – Reduced blood flow to the liver Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 6

7. Elimination p133-134 Reduced glomerular filtration rate Reduced tubular reabsorption and secretion Decreased number of nephrons More likely to experience drug toxicity

8. Drug Receptors p134 Internal drug receptors may change – Results in diminished or greater responses to meds – Close monitoring is required

9. Factors affecting drug action in elderly p134-139 Memory loss Sensory loss Multiple disease states Polypharmacy Use of multiple pharmacies and physicians

10. Other Factors continued p134-139 Economic factors Lack of education Communication problems Cultural considerations Diet therapy.

11. Oral medications p137 Oral medication administration for geriatrics – Position for administration: high Fowler’s – Assess ability to swallow – Speak clearly and slowly – Offer the most important medication first – Have plenty of liquid available – Do not rush the elderly client

12. Intramuscular Medications p137 Use ventrogluteal site Avoid deltoid muscle Avoid vastus lateralis because of loss of muscle mass.

13. IV medications p137-138 Assess rate of flow to prevent circulatory overload. – Watch for respiratory distress – Moist respirations – Full bounding pulse – Distended neck veins – Edema Frequent toileting is necessary

14. Teaching geriatric patients p138 95% live in the community Nurse advocate…. Patient autonomy verbal and written instructions Short sessions in a well lit area with few auditory distractions Self care skills are best taught by demonstration with return demonstration by patient.

15. Medication schedules p 138 Independence is facilitated by setting up a medication schedule with meds labeled with purpose, color coded as necessary. Medication reminders: – Med alarms – Turn bottle upside down after taking dose – Mark a checklist Store meds in cool dry place

16. Evaluation p139 Evaluate teaching/learning – Communication: Does client understand? Evaluate medication effects – Drug action/side effects

17. Promoting Health p139 Prevent infections Improve nutrition Encourage exercise and activity Facilitate social interaction Promote restful sleep.