Considerations in Geriatric Pharmacology: Episode 157 | Straight A Nursing

Summary

In this episode of the Straight A Nursing Podcast, Nurse Moe delves into geriatric pharmacology, focusing on how aging affects medication absorption, distribution, metabolism, and excretion. She emphasizes that drug dosages often need to be lower in the elderly due to these changes. The episode also covers the challenges of polypharmacy, the Beers list for potentially inappropriate medications in older adults, and the importance of deprescribing. Nurse-driven interventions for improving medication adherence in the elderly are also discussed, with practical tips for nurses to enhance patient care.

Takeaways

• 📚 Aging affects pharmacokinetics, requiring lower drug dosages; start low and go slow.
• 💊 Geriatric patients face changes in drug absorption due to factors like decreased gastric emptying and increased gastric pH.
• 🩺 Transdermal medications are often preferred for the elderly due to consistent drug concentrations and ease of use.
• 🧠 Aging alters drug distribution, especially for lipophilic drugs, leading to prolonged effects and potential toxicity.
• 🍎 Decreased serum albumin in the elderly can lead to higher levels of unbound drugs, increasing the risk of adverse effects.
• 🛡️ Reduced liver function in elderly patients affects drug metabolism, often requiring lower doses to prevent toxicity.
• 🚰 Renal function decline in older adults reduces drug excretion, necessitating careful dosage adjustments for certain medications.
• ❗ The Beers list identifies drugs potentially inappropriate for older adults, emphasizing the importance of medication safety.
• 📉 Deprescribing aims to reduce polypharmacy risks in the elderly, improving cognitive function, fall risk, and overall safety.
• 📝 Nurses can improve medication adherence in elderly patients through education, written instructions, and the use of medication management tools.

Q & A

What is the main topic of episode 157 of the Straight A Nursing Podcast?

The main topic of episode 157 is considerations with geriatric pharmacology and medication administration.

What does the acronym 'ADME' stand for in pharmacokinetics?

ADME stands for Absorption, Distribution, Metabolism, and Excretion, which are the four pillars of pharmacokinetics.

Why is the principle of 'start low and go slow' important when administering medication to the elderly?

The principle of 'start low and go slow' is important because many times drug dosages need to be lower in the elderly due to age-related changes in pharmacokinetics.

What are some factors that can affect drug absorption in the elderly?

Factors affecting drug absorption in the elderly include changes in gastric emptying, active transport, intestinal surface area, and gastric pH.

Why might transdermal medication delivery be beneficial for the elderly?

Transdermal medication delivery is beneficial for the elderly because it provides a steady rate of administration, is easy to use, and circumvents hepatic first-pass metabolism.

How does aging affect the distribution of highly lipophilic drugs?

Aging increases body fat and decreases total body water, which can lead to an increased distribution and half-life of highly lipophilic drugs, potentially causing increased levels and prolonged effects.

What is the significance of the 'Beers List' in geriatric pharmacology?

The Beers List identifies medications that are potentially inappropriate for use in older adults due to risks of adverse effects and aims to increase medication safety in this population.

What is the process of 'deprescribing' and why is it important for elderly patients?

Deprescribing is the process of evaluating and removing unnecessary or inappropriate medications from a patient's regimen to enhance medication safety, improve adherence, and reduce risks of adverse effects.

How can nurses improve medication adherence and safety among elderly patients?

Nurses can improve medication adherence and safety by providing patient education, using the teach-back method, providing written instructions and schedules, utilizing medication management tools, and assessing all medications during home visits.

What are some examples of nurse-led interventions to enhance medication adherence in the elderly?

Examples of nurse-led interventions include teaching the appropriate person, using the teach-back method, providing written instructions, using medication management tools like pill organizers or electronic dispensers, and setting reminders via telephone or electronic devices.