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.

Outlines

00:00

🎙️ Introduction to Geriatric Pharmacology

In this episode of the Straight A Nursing Podcast, Nurse Moe introduces the topic of geriatric pharmacology, discussing the unique considerations needed when administering medication to the elderly. She acknowledges a listener's success in passing the NCLEX and emphasizes the importance of understanding how aging affects drug absorption, distribution, metabolism, and excretion. The episode promises to delve into pharmacokinetics, the concept of 'start low and go slow,' and the complexities introduced by multiple diseases and polypharmacy in the elderly.

05:01

👵 Age-Related Changes in Drug Absorption

This paragraph explores how the aging process impacts the absorption of drugs. It discusses conflicting research findings on the reliability of intramuscular administration due to variable absorption in the elderly. The general consensus is that while there are some changes, absorption may not be the most significant factor. The paragraph also covers gastrointestinal changes in the elderly, such as altered gastric emptying, decreased intestinal surface area, and increased gastric pH, and how these can affect the absorption of specific medications like levodopa, digoxin, and calcium carbonate. The benefits of transdermal drug administration for the elderly are highlighted, including steady drug release and ease of use.

10:05

💊 Distribution and Metabolism in Elderly Patients

The discussion moves on to the distribution of drugs within the body, noting that as body water decreases and body fat increases with age, the distribution of lipophilic drugs is affected. Examples of such drugs are provided, and the potential for increased half-life and prolonged effects are explained. The paragraph also addresses the impact of decreased serum albumin on drug binding, which can lead to higher levels of unbound drugs and increased risk of adverse effects. Metabolism is then covered, focusing on the liver's role in drug metabolism and the first-pass effect, which is reduced in the elderly, often necessitating lower doses of medication.

15:07

🚰 The Impact of Aging on Drug Excretion

This section delves into the excretion or elimination of drugs, with a focus on the renal system's role. It explains how creatinine clearance and glomerular filtration rate decline with age, affecting the kidneys' ability to eliminate drugs. Medications that rely heavily on renal clearance, such as morphine, metformin, and certain diuretics, require careful dosing considerations in the elderly. The importance of starting with lower doses and the concept of deprescribing to enhance medication safety are emphasized.

20:09

🧠 Pharmacodynamics and the Elderly

The paragraph discusses pharmacodynamics, particularly the increased sensitivity of elderly individuals to the central nervous system effects of medications, especially those with cognitive impairments. It uses diphenhydramine as an example, highlighting the potential for acute confusion and other adverse effects in the elderly. The BEERS list is introduced, noting drugs that are potentially inappropriate for older adults due to heightened risks, such as anticholinergics, ACE inhibitors, Warfarin, and benzodiazepines.

25:11

📋 Improving Medication Adherence in the Elderly

This paragraph focuses on strategies to improve medication adherence and safety among the elderly. It discusses the challenges faced by the elderly in adhering to medication regimens, including cognitive decline and swallowing difficulties. Nurse-led interventions are suggested, such as patient education, the use of medication management tools, and regular assessment of medications. The importance of deprescribing to reduce polypharmacy and its associated risks is reiterated.

📝 Conclusion and Study Resources

The final paragraph wraps up the episode with a quick summary of key points, emphasizing the importance of adjusting medication dosages for the elderly and the role of deprescribing. It introduces a new members-only podcast, 'Straight A Nursing Study Sesh,' which offers in-depth study materials, including pod quizzes, drills, case studies, and power hour sessions. Interested listeners are directed to a website for more information and to access these study resources.

Keywords

💡Geriatric Pharmacology

Geriatric pharmacology is the study of how aging affects drug action and the unique considerations needed for medication administration in the elderly. It is a key theme in the video, as it discusses the impact of age-related physiological changes on drug absorption, distribution, metabolism, and excretion. The script emphasizes the importance of understanding these changes to ensure safe and effective medication use in older adults.

💡Pharmacokinetics

Pharmacokinetics refers to the process of how a drug moves through the body, including absorption, distribution, metabolism, and excretion. In the video, it is highlighted as a crucial concept for understanding the differences in medication administration in the elderly, where age-related changes can affect each of these stages, often necessitating lower dosages and a 'start low and go slow' approach.

💡Polypharmacy

Polypharmacy is the use of multiple medications by a single patient, which is common in the elderly population due to multiple health conditions. The script discusses how polypharmacy can lead to increased risk of adverse drug interactions and effects, emphasizing the need for careful medication management in older adults.

💡Deprescribing

Deprescribing is the process of reducing or eliminating unnecessary medications in a patient's regimen, particularly important in geriatric care to enhance medication safety and adherence. The script mentions deprescribing as a strategy to combat the high pharmacological risks associated with polypharmacy in the elderly.

💡Pharmacodynamics

Pharmacodynamics is the study of the effects of drugs on the body, including their mechanism of action and the relationship between drug concentration and effect. The video points out that elderly individuals are often more sensitive to the central nervous system effects of medications, which is a key aspect of pharmacodynamics.

💡Beers List

The Beers List, or Beers Criteria, is a set of guidelines that identifies potentially inappropriate medications for use in older adults due to their risk of adverse effects. The script uses the Beers List as an example of how certain medications, such as diphenhydramine and benzodiazepines, are flagged for their risks in the elderly population.

💡Absorption

Absorption in pharmacology is the process by which a drug moves from the site of administration into the bloodstream. The video script discusses how age-related changes in the gastrointestinal tract can affect drug absorption, with examples such as altered gastric emptying and increased gastric pH affecting certain medications.

💡Distribution

Distribution refers to the transfer of a drug from the bloodstream to the tissues where it can exert its effect. The script explains that as people age, changes in body composition, such as decreased total body water and increased body fat, can affect the distribution of drugs, particularly lipophilic ones, leading to increased half-life and potential toxicity.

💡Metabolism

Metabolism in the context of pharmacology is the process by which the body chemically transforms drugs into more or less active compounds, typically preparing them for excretion. The video mentions that metabolic activity and the first-pass effect are reduced in the elderly, which can affect the efficacy of medications that rely on hepatic metabolism.

💡Excretion

Excretion, or elimination, is the process by which drugs are removed from the body, primarily through the kidneys. The script notes that renal function declines with age, affecting the excretion of many drugs, and highlights the need to adjust dosages for medications that rely heavily on renal clearance.

💡Medication Adherence

Medication adherence refers to the extent to which patients take their medications as prescribed. The video discusses challenges in medication adherence among the elderly, such as difficulty swallowing pills, cognitive decline, and complicated regimens, and suggests nurse-led interventions to improve adherence and safety.

Highlights

Introduction to the topic of geriatric pharmacology and medication administration considerations.

Congratulation to Rebecca for passing the NCLEX, emphasizing the podcast's role in her success.

The concept that pharmacology is not 'one size fits all', especially in the elderly.

Explanation of pharmacokinetics and its four pillars: absorption, distribution, metabolism, and excretion.

The importance of starting medication dosages low and increasing slowly in elderly patients.

Discussion on the complexities of pharmacology in the elderly, including polypharmacy.

Impact of aging on drug absorption, including changes in the gastrointestinal tract.

Examples of drugs affected by decreased gastric emptying and active transport in the elderly.

The benefits of transdermal drug administration for the elderly.

How age-related changes in the body affect drug distribution and the impact on lipophilic drugs.

The role of plasma proteins in drug binding and the risks associated with decreased serum albumin in the elderly.

An overview of how the liver's metabolic activity and first-pass effect change with age.

The significance of renal function decline with age and its effect on drug excretion.

Introduction to pharmacodynamics and increased sensitivity to CNS effects in the elderly.

The Beers List and its purpose in identifying potentially inappropriate medications for older adults.

The practice of deprescribing to enhance medication safety in the elderly.

Challenges in medication adherence among the elderly and factors affecting it.

Nurse-led interventions to improve medication adherence and safety in geriatric patients.

Announcement of a new members-only podcast for nursing students focusing on study sessions.

Upcoming podcast episode on newborn assessment and the Apgar score.

Transcripts

[Music]

well hello there again everyone this is

Nurse Moe and welcome back to the

straight a nursing podcast this is

episode 157 and today we are talking

about some considerations with geriatric

pharmacology and medication

administration so before we dive into

this really interesting topic I do want

to take a moment for our listener shout

out and this one goes out to Rebecca so

Rebecca says I wanted to thank you just

past my NCLEX in 75 questions you were

integral in that success Rebecca I mean

I'm sorry nurse Rebecca congratulations

that is amazing I cannot wait to hear

about all the amazing things that you do

so please reach out touch base send us

an email let us know where you land and

how you're loving your new job

so I have a big news flash for you guys

pharmacology is not one size fits all

okay if you have already listened to the

episode on pediatric pharmacology you

definitely understand this concept so

now we're going to look at the other end

of the spectrum

to discuss how aging affects medication

administration pharmacological

considerations in the elderly and then

at the end we'll be doing some of those

pod quiz questions that you love so much

and I have an exciting announcement

about that as well

so recall that pharmacokinetics is

essentially what the body does to a drug

after it's administered so the four

pillars of pharmacokinetics are

absorption

distribution

metabolism and excretion you may also

hear elimination so adme absorption

distribution metabolism excretion

today we'll be talking about the

age-related changes that occur in each

of these pillars so the short version is

that many times drug dosages will need

to be lower in the elderly so the name

of the game is start low and go slow and

after we get through this episode you'll

understand why so complexities of

pharmacology and the elderly it's often

compounded you guys by the presence of

multiple disease conditions leading to

polypharmacy and we're going to talk

about that some more as well so let's

dive down into the details

absorption what is absorption it is the

process of the drug basically moving

from the site where it was administered

into the bloodstream so it can you know

get to where it needs to go and do what

it needs to do

so as I was researching this for you

guys I was really surprised to see there

is a lot of conflicting information out

there about how aging affects drug

absorption some of the materials

suggested that intramuscular route is

really unreliable because the absorption

can be so variable and then other

studies said not so much so the general

consensus is that yes there are some

changes in absorption but may not be the

biggest factor for the elderly patient

but I do want to look at po medications

because there are some things that we

need to talk about with that the general

differences in the GI tract of the

elderly is changes to gastric MTM time

decreased small bowel surface area and

increases in gastric pH but again most

cases the absorption of drugs is not

significantly different that's what the

studies are saying right now but there

are definitely differences in how long

it takes for the drugs to have an effect

but let's talk a little bit about some

prime examples of how the GI tract is

different in the elderly and how it

could be affected as far as

pharmacokinetics go

so decreased gastric emptying

can lead to altered absorption of some

drugs such as levodopa and digoxin so

that would be two prime examples of

drugs where decreased gastric emptying

does affect the absorption

and then decreased active transport can

lead to a decrease in the transport of

vitamins and electrolytes

and then that decreased intestinal

surface area that I mentioned a moment

ago leads to a general decrease in drug

absorption for some medications again

digoxin is another really great example

of this

and then that increased gastric pH can

affect medications that do rely on a

specific pH level so one example is

calcium carbonate which does need a more

acidic environment for optimal

absorption so for this reason elderly

patients are sometimes prescribed

calcium citrate instead because it

dissolves more easily in higher gastric

pH levels

another very key thing about the pH is

with enteric coated tablets so this

enteric coating is utilized for the

purpose of extended release you remember

that you never Crush an enteric coated

tablet right the coding is designed to

remain intact in that low PH environment

of the stomach in that very acidic

environment of the stomach and then

begin to dissolve in the higher pH

environment of the small intestines so

in the elderly where gastric pH can be

higher these medications could have an

early release causing adverse GI effects

or alterations in absorption

one other route that I think we should

talk about very briefly is the

transdermal route

transdermally delivered medications are

actually typically considered really

beneficial for the elderly because of

that steady rate of administration and

ease of use so some examples include

fentanyl

nitroglycerin estradiol

mean I had to pause there for a minute

and see if I could say that one and

Scopolamine so some of the advantages of

transdermal Administration are they

circumvent hepatic first pass metabolism

which we'll talk about in a moment there

are decreased adverse GI effects and

higher likelihood of compliance and more

consistent drug concentrations

though the skin absolutely changes with

age Studies have shown that these

changes in lipid structure and hydration

really only affect medications with

strongly

hydrophilic properties so in general if

dose alterations are needed in the

elderly it's not typically due to

alterations in absorption it's typically

due to age-related cardiovascular renal

and hepatic changes which will all make

so much more sense as we get into the

other pillars of pharmacokinetics

so the next pillar that we need to talk

about is distribution

so distribution is that process of

transferring a drug from the bloodstream

to the tissues where it can exert its

effect

so as we age total body water decreases

while body fat increases the

distribution of Highly lipophilic drugs

is therefore increased so some great

examples of this are risperidone

atorvastatin

ciprofloxacin

azithromycin and Propofol

so what does this mean for your patient

lipophilic drugs may have an increased

Half-Life when body fat is higher

leading to increased levels and

prolonged effects of these types of

medications

and then distribution is also affected

by the presence or the absence of plasma

proteins as we age or even as we're

malnourished serum albumin decreases and

you guys know a lot of times aging and

malnourishment can go hand in hand

so this decrease in serum albumin leads

to changes in the bindings of some

medications so if you're elderly patient

also has malnutrition then they are very

high risk for alterations and the

bindings of some medications and this

can lead to higher levels of Unbound

drugs like Warfarin and phenytoin and

this in turn can lead to Serious adverse

effects and toxicity

and then metabolism is that third pillar

so in general metabolism is the process

that drugs go through that makes them

either more or less active though

generally metabolism makes drugs less

active because that's how they're

designed there are some that actually

need to be metabolized to become active

but that's pretty rare the process of

metabolism converts the compound from

its original state which is that active

state in general and converts it into

something else which is less active and

then excreted from the body so a key

player in metabolism is the liver not

only does the liver metabolize many many

medications it is also responsible for

something called the first pass effect

so when you take a medication by mouth

it is absorbed through the intestinal

mucosa and then enters hepatic

circulation and taken straight to the

liver for metabolism even before it gets

to the heart for circulation

in some cases the first pass effect can

reduce the medication's efficacy by up

to 90 percent when you compare it to IV

Administration so this explains why IV

doses are sometimes so so much smaller

than po doses so a fantastic example of

this is midazolam

looking at the pediatric dose for

midazolam IV it's

.025 to .05 milligrams per kilogram and

we're you know if we're using it for

something like procedural sedation

versus

po 0.25 to 0.5 milligrams per kilogram

so if that child weighs 30 kilograms

that low end dose for an IV midazolam

would be 0.75 milligrams versus

7.5 milligrams po so you can see how po

doses can sometimes be so much larger

and that's because of first pass

metabolism

so in early patients metabolic activity

is reduced and so is that first pass

effect so for these reasons decreased

doses are often needed in your elderly

patients some examples of medications

that rely on hepatic metabolism and will

require scrutiny or Ibuprofen

diltiazem

Warfarin and levodopa remember the name

of the game start low and go slow

and then that final pillar of

pharmacokinetics is excretion you may

also hear it called elimination and this

part involves how the drug is

essentially removed from the body the

key player here is the renal system and

aging definitely has a significant

impact here

so after about age 40 which it does not

seem that old to me creatinine clearance

starts to decline along with GFR and

tubular function the result is that many

drugs have reduced elimination by the

kidneys so any medication that relies

heavily on renal clearance will need to

be scrutinized for proper dosing so some

great examples of these drugs are

morphine metformin

Gentamicin Gabapentin there's digoxin

again and diuretics like furosemide and

spironolactone again what's the name of

the game start low and go slow

Okay so we've talked about

pharmacokinetics let's talk now a little

bit about pharmacodynamics

the key takeaway here is that elderly

individuals will be more sensitive to

the central nervous system effects of

medications

especially if they have underlying

cognitive impairment

so take diphenhydramine for example

elderly patients are more sensitive to

the CNS effects of diphenhydramine which

is an anticholinergic so one of the main

adverse effects the elderly can have

with diphenhydramine is acute confusion

and it can be very very pronounced they

are also likely to be more strongly

experiencing the adverse effects such as

dizziness urinary retention blurred

vision and tachycardia

so be very careful or even wary of

giving diphenhydramine to your elderly

patient and you might want to talk with

the MD about Alternatives when they are

available

So speaking of diphenhydramine brings us

to the next thing we need to talk about

and that is the beers list so you may

hear

something called a Beer's drug and

that's a pretty common term you'll hear

when you're learning about elderly and

the pharmacology and no it does not mean

that the drug comes with an ice cold

bottle and a wedge of lime okay beers

drugs are those that are marked as

potentially inappropriate for use in

older adults

the goal with the beers list and that's

b-e-e-r-s the goal with the beers list

is to increase medication safety with

this special population that is

absolutely prone to polypharmacy

diphenhydramine and other

anticholinergics are on this list due to

that high risk for cognitive decline in

the elderly

other medications include ACE inhibitors

because of the risk for hyperkalemia

Warfarin due to the increased risk of

bleeding and benzodiazepines for the

increased risk of Falls now it doesn't

mean we don't use these medications in

the elderly because I'm sure you've seen

a lot of elderly patients on Warfarin or

an Ace inhibitor but they have to be

scrutinized very carefully there are

quite a few medications on the beers

list and I will include a link to some

additions and updates in the episode

notes they're also in your Davis drug

guide if you happen to use that

reference

one of the highest pharmacologic risks

for the elderly is polypharmacy like

I've mentioned before and with that

heightened risk for adverse interactions

and effects so we have something called

deprescribing and the practice of

deprescribing involves that practitioner

evaluating the patient's medical

condition and current pharmacologic

regimen to remove as many medications as

possible

the process of removing medications it's

not as cut and dried as just stopping

them all together the practitioner and

the patient must work together in a lot

of cases to taper or withdraw as

appropriate with ongoing monitoring

conducted as it is needed so some

studies show that deprescribing leads to

a fewer medications overall which tends

to improve medication adherence

B improving or preserving cognitive

function

C reducing fall risk and D reducing risk

for hospitalization and even death

so deprescribing is something you may

hear about and it is basically the

opposite of prescribing

okay some special considerations with

your geriatric patients so things to

think about

adherence can be challenging in the

elderly population for a variety of

factors so a 1998 study showed that

adherence to pharmacologic regimens

varies based on the drug dosage itself

the form that the drug comes in its cost

physician patient communication and

insurance coverage

complicated regimens and cognitive

decline also play a very key role here

and then we have to look at swallowing

difficulty many elderly patients have

difficulty swallowing so may even avoid

taking pills or avoid taking them in

their original form so let's say you

have a patient who can't swallow pills

so they Crush everything and then they

add it to you know you have to add it to

applesauce or some pudding have you guys

ever tasted a pill that's been crushed

and you try to disguise it in Pudding it

doesn't taste like pudding okay it's

very very bitter tasting and could cause

a decreased medication adherence

patients may not also understand that

they should not Crush extended release

or enteric coated tablets leading to

Serious adverse effects and even

toxicity

and then medications that require very

close monitoring such as Warfarin may be

utilized in appropriately in patients

who maybe don't have the resources for

regular visits to the lab or visits to

the doctor's office

so what can the nurse do to help improve

medication adherence and safety amongst

this patient population so a 2017

systematic review

showed some basic General guidelines

that are nurse-led interventions and

these include lots of patient education

right that's always a component as you

are teaching make sure a that you're

teaching the appropriate person if the

individual you're teaching has severe

dementia you're not teaching the

appropriate person teach the caregiver

the family members whoever it may be and

utilize the teach back method where you

have them teach it back to you that's a

great way to really know okay they got

it

also providing written easy to follow

instructions and written easy to follow

schedules it's not enough just to have

it on the pill bottle have it written

out large print easy to see put it right

there next to the location where they

keep their medications

also the utilization of medication

management tools such as electronic pill

dispensers is really great or simply

those pill organizers that separated out

by day of the week or AM and PM

you can even have reminders via

telephone or electronic devices there

are several apps created specifically

for this purpose

and of course if you are a home health

nurse a visiting nurse assessing all

medications with each home visit and

then when the patient comes into the

inpatient setting or the outpatient

setting like at a clinic or a doctor's

office

so there you have it you guys your basic

guide to pharmacology and the elderly

patient now if you're looking for just

the very basic info let's do a quick too

long didn't read I guess this would be a

too long didn't listen and that is

physiologic changes associated with

aging lead to alterations and absorption

distribution metabolism and excretion of

medications though absorption not as

much a factor as the others the name of

the game is to start low and go slow

the beers list Flags medications that

may be inappropriate for the elderly and

the goal of deprescribing is to enhance

medication safety and adherence in the

elderly and nurse driven interventions

can improve medication adherence and

safety okay you guys who is up for a few

pod quiz questions

if you've never done a pod quiz before I

ask a question I pause for a little bit

give you time to answer and then tell

you the answer basically we are doing

flash cards with our ears and if you

enjoy this format then stay to the end

because I'm going to tell you how you

can get way more pod quizzes in your

life okay so here we go

what are the four pillars of

pharmacokinetics

absorption distribution

metabolism and excretion very good

what is the process of transferring a

drug from the bloodstream into the

tissues

foreign

what is the process drugs go through to

make the drug more or less active and

ready for excretion

that is metabolism

what is the process of the drug moving

from the site of administration into the

bloodstream

that is absorption excellent work

what is the process of removing the drug

from the body

that is excretion you may also hear it

called elimination

what is the key organ in medication

excretion or elimination

that's the kidneys what is the key organ

in metabolism

the liver great job and what is one of

the highest pharmacologic risks for the

elderly

that is polypharmacy and to combat that

we do

deprescribing very very good okay so if

you guys like doing pod quiz questions

and you kind of got a feel for how

beneficial that might be to review

things that you've learned in class or

from listening to this podcast then

you're going to love my new members only

podcast called straight a nursing study

sesh so in this podcast we do a lot of

pod quizzes and not just four or five an

entire episode that dives into a topic

and pod quizzes you on it and then in

addition to that we have drills where we

do recognize there are some things in

nursing school that you need to memorize

for instance if you memorize the blood

flow pathway through the heart and you

know that thing forwards and backwards

then you can apply that to the much

broader concepts of heart failure and

Val of disorders so in drills we drill

things into your head so that when you

do need to memorize something we get it

in there where it belongs and then we

have case studies which is basically

making clinical decisions evaluating

scenario as we go through a patient

situation and then the power hour

sessions are those deep dives into more

extensive Concepts so there's one in

there right now on blood pressure

regulation and it is just amazing and it

comes with a study guide some of the

episodes do come with study guides this

study guide is awesome you guys so I

want you to get your hands on all of

that so you can learn more by going to

straight a nursingstudent.com forward

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study Dash Sash and all the information

is there there's a bunch of FAQ at the

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straightynursingstudent.com forward

slash study Dash sesh okay next week you

guys where are the nursing students that

are heading into or in their OB or mom

and baby or whatever they call it at

your school clinical rotation because

we're diving into newborn assessment

specifically the apgar score so I'll see

you back here next week to talk about

that bye for now

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