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Chapter 35
Safe Medication Use
Drugs Commonly Used by Older Adults
• Cardiovascular agents
• Antihypertensives
• Analgesics
• Antiarthritic agents
• Sedatives
• Tranquilizers
• Laxatives
• Antacids
Pharmacokinetics and Pharmacodynamics
• Pharmacokinetics
– The absorption, distribution, metabolism, and
excretion of drugs
• Pharmacodynamics
– The biologic and therapeutic effects of drugs at the
site of action or on the target organ
• Drugs behave differently in older adults.
• Careful dosage adjustment and monitoring are
needed.
Factors Altering the Absorption of Drugs
• Age-related changes
• Route of administration
• Concentration and solubility of drug
• Diseases and symptoms
Measures to Maximize the Absorption of
Drugs
• Encourage Exercise.
• Stimulate circulation and increase blood flow at the
absorption site.
• Prevent fluid volume deficit, hypothermia, and
hypotension.
• Avoid preparations that neutralize gastric secretions if a
low gastric pH is required for drug absorption.
Measures to Maximize the Absorption of
Drugs (cont.)
• Monitor drug–drug and drug–food interactions.
• Monitor drug-herb interactions.
• Use the most effective administration.
Drugs Having Increased Biological HalfLife
• Antibiotics
• Barbiturates
• Cimetidine
• Digoxin
• Salicylate
Conditions That Decrease Metabolism of
Drugs
• Dehydration
• Hyperthermia
• Immobility
• Liver disease
Risk of Adverse Reactions in Elders
• Symptoms can appear differently in older persons.
• A prolonged time may be required for an adverse
reaction to become apparent.
• Adverse reactions can be demonstrated after a drug has
been discontinued.
• Adverse reactions can develop to drugs that have been
used for a long period without problems.
Questions Nurses Should Ask About
Patient Medications
• Why is the drug ordered?
• Is the smallest possible dosage ordered?
• Is the patient allergic to the drug?
• Can this drug interact with other drugs, herbs, or
nutritional supplements that are being used?
• Are there any special instructions accompanying the
drug’s administration?
• Is the most effective route of administration being used?
Precautions in Drug Administration
• Do not crush enteric coated tablets.
• Assure suppositories have been melted, not expelled.
• Avoid cardiac overload from too rapid IV administration.
Older Adult’s Response to Drugs
• Increased myocardial sensitivity to anesthesias
• Increased central nervous system receptor sensitivity to
narcotics, alcohol, and bromides
Risk Factors for Medication Errors
• Multiple medications
• Cognitive impairment
• Visual and hearing deficits
• Arthritic or weak hands
• History of noncompliance with medical care
• Lack of knowledge about medications
• Limited finances
Risk Factors for Medication Errors (cont.)
• Illiteracy
• Lack of support system
• History of inappropriate self-medication
• Expired or borrowed medications in the home
Alternatives to Medications
• Lifestyle changes
• Diet modifications
• Regular exercise
• Effective stress management techniques
• Regular schedules for sleep, rest, and elimination
• Alternative therapies
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).