Term
| What are the physiologic changes associated with geriatrics? |
|
Definition
DECREASED EVERYTHING!
except therapeutic effect in increased because they cannot metabolize the drug as well |
|
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Term
|
Definition
| The prescription, administration, or use of more medications than clinically indicated in a given patient |
|
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Term
| How are pharmacokinetics effected? |
|
Definition
-Decrease in absorption
-Decreased protein in blood, so more free drug available for distribution.
-Decrease in metabolism of the drugs due to decrease in hepatic enzyme production which can lead to toxicity because of increased half life
-Decreased excretion because decreased renal blood flow. Drug toxicity |
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Term
| What drugs are not recommended for use in older clients? |
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Definition
-Analgesics except Morphine
-Tricyclic Antidepressants use SSRI's instead
-1st generation antihistamines use 2nd instead
-Antispasmodics
-Muscle relaxants
-Sedatives use short acting benzos instead
- |
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Term
| What hypnotics are approved for geriatrics? |
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Definition
| Low doses of benzodiazepines with short or intermediate half lives. |
|
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Term
| What hypnotic should geriatrics avoid? |
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Definition
|
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Term
| What hyptnoics are recommended for older adults? |
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Definition
-Temazepam (Restoril)
-Triazolam (Halicon)
-Estazolam |
|
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Term
| What diuretics and hypertensives are approved for older adults? |
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Definition
CCB, ACE inhibitors, A II blockers
Reduced dose of hydrochlorothiazide.
Higher dose can cause electrolyte imbalance |
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Term
| What happens to half life of cardiac glycoside Digoxin in older adults? |
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Definition
| Half life is increased to 70 hours. |
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Term
| What is important to note about Warfarin in old people? |
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Definition
| Drug ia 99% protein bound and old people have less serum protein so there is an increased bleeding risk for older adults |
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Term
| What is antibacterials are safe for old people? |
|
Definition
-Penicillins
-Cephalosporins
-Tetracyclines
-Sulfanomides
Adjust dose based on renal fxn and the half-life of each drug |
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Term
| What GI drugs are safe for older adults with peptic ulcers? |
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Definition
-Histamine (H2) blockers
-Sucralfate
Tagament is NOT suggested for older people |
|
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Term
| What GI drugs are safe for older adults with constipation? |
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Definition
| Laxatives are safe but should not be overused in fear of electrolyte and fluid imbalance |
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Term
| How is the dose of antidepressants changed for older adutls? |
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Definition
| 30%-50% of what a normal dosage is |
|
|
Term
| What antidepressants are safe for old people? |
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Definition
-Tricyclic but they do cause anticholinergic effects
- Fluoxetine (Prozac)
NO MAOIS |
|
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Term
| What is considered with old people and narcotic analgesics? |
|
Definition
-Dose related adverse rxns
-Hypotension and respiratory depression may occur |
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Term
| What does A.C.C.E.P.T. stand for? |
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Definition
A - Accepts phyiscal chagnes
C - Conducts a life review
C - Confusion that is ACUTE may be indicative of med rxn, infection, fluid and electrolyte imbalance
E - Ego integrity vs. despair
P - prep for death
T - the past time is spent reminiscing over life |
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Term
| What is G.E.R.I.A.T.R.I.C stand for? |
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Definition
G - gerontology organized around FANCAPES
E - eval for abuse/anxiety
R - risk for falls
I - interdisciplinary collaboration
A - assess skin integrity, plan to prevent breakdown
T - teach fam and client
R - Report (SBAR)
I - impact of infection, fluid and electrolyte imbalance etc.
C - Confusion (acute) present |
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Term
| What does FANCAPES stand for? |
|
Definition
F - Fluid
A - Aeration
N - Nutrition
C - Communication/Cognition
A - Activity/Ability
P - Pain/Polypharmacy
E - Elimination
S - Skin/Spirituality/Social Support/Sleep |
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Term
| What are special considerations when teaching geriatrics? |
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Definition
-senses need to be as sharp as possible
+clean glasses
+fxn hearing aids in place
-Speak in tones they can hear
-Face them
-Treat w/ respect
-Use large print and bright colors
-Rvw meds each visit
-Encourage a schedule
-W/ confusion, suspect medications
-Encourage to report if new drug is not improving condition
-Avoid elder speak |
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Term
| What are common causes for med errors in the elderly? |
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Definition
| Poor eyesight, forgetfulness, OTC drug use, using other RX meds, lack of financial resources, lack of understanding of importance of med, failure to understand instructions, refusal to take med because of side effects |
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Term
| How many medications does a 70 y.o take on average? |
|
Definition
|
|
Term
| How many meds do 85+ take? |
|
Definition
|
|
Term
T or F?
FREQUENCY OF ADVERSE DRUG REACTIONS INCREASES AS THE NUMBER OF RX DRUGS INCREASES |
|
Definition
|
|
Term
| What is essential in education of medication compliance? |
|
Definition
-Emphasize meds are essential
-Attempt to reduce meds that are not essential
-Screen med use using a standard assessment tool
-Assess alcohol use
-Encourage the use of written med reminder systems/med planners
-Monitor drug dosage strength (elderly
-Encourage the use of one pharmacy
-Work with health care providers and pharmacy to establish routine drug profiles on all older adult patients
-Advocate for low income Rxs prescription plans |
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Term
| What is the pathology of parkinson's disease? |
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Definition
Chronic neurologic disorder
Degeneration of dopaminergic neurons
Imbalance of the neurotransmitters
Less dopamine
Too much acetylcholine |
|
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Term
|
Definition
| an inhibitory neurotransmitter |
|
|
Term
|
Definition
| an excitatory neurotransmitter |
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|
Term
| What does dopamine normally do? What's different in parkinson's |
|
Definition
| normally maintains control of acetylcholine and inhibits its excitatory response. There is a degeneration of dopamine neurons so there is an imbalance between the 2. |
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Term
| What happens with less dopamine? |
|
Definition
| acetylcholine is unopposed, causing excitation and stimulation of neurons that release gamma-aminobutyric acid (GABA). |
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Term
| What happens with more GABA? |
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Definition
| symptomatic movement disorders occur. |
|
|
Term
| What are the risk factors for parkinson's disease? |
|
Definition
Over 60
Male
Family history of PD
Exposure to environmental toxins
Caucasian
Head trauma |
|
|
Term
| What are the 4 main MOTOR symptoms of Parkinson's? |
|
Definition
-Shaking/tremor at rest
-Slowness of movement (bradykinesia)
-Stiffness or rigidity of the arms/legs/trunk
-Trouble w/ balance and falls |
|
|
Term
| How is Parkinson's diagnosed? |
|
Definition
-Detailed H&P
-Detailed history or current and past meds
-Neurological exam that assesses the agility of arms, legs, muscle tone, gait and balance.
-United Parkinson's Disease Rating Scale |
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|
Term
| What is the #1 way to diagnose Parkinson's? |
|
Definition
| Response to medications that imitate or stimulate the production of Dopamine |
|
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Term
| What drugs treat parkinson's? |
|
Definition
-Anticholinergics
-Dopaminergics
-Dopamine agonists
-MAO-B inhbitiors
-COMT inhibitors |
|
|
Term
| How do anticholinergics treat Parkinson's? |
|
Definition
-Block cholinergic receptors
-Takes competition AWAY |
|
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Term
| How do dopaminergics treat Parkinson's? |
|
Definition
-Convert to dopamine
-Carbidopa/Levodopa (Sinemet)
-CARBIDOPA is the CAR that delivers Levadopa |
|
|
Term
| How do dopamine agonsists treat Parkinson's? |
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Definition
| Stimulate dopamine receptors |
|
|
Term
| How do MAO-B inhibitors treat Parkinson's? |
|
Definition
| Inhibit MAO-B enzyme that interferes with dopamine |
|
|
Term
| How do COMT inhibitors treat Parkinson's? |
|
Definition
| Inhibit COMT enzyme that inactivates dopamine |
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|
Term
| What is the action of Carbidopa-Levodopa? |
|
Definition
converted to dopamine
Increases mobility |
|
|
Term
| What is the half-life of C-L? What does that mean? |
|
Definition
| Short half life so it must be taken 3-4 hours a day. |
|
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Term
| What are the side effects of C-L (Sinemet)? Dopaminergic |
|
Definition
Fatigue, insomnia
Dry mouth
Blurred vision
Orthostatic hypotension, palpitations, dysrhythmias
Urinary retention
Nausea, vomiting
Dyskinesia, psychosis, severe depression |
|
|
Term
| Are dopaminergics anticholinergic? |
|
Definition
|
|
Term
| How do anticholinergics treat Parkinson's? |
|
Definition
| They are parasympatholytics that inhibit the release of acetylcholine. They are said to treat drug-induced parkinsonism (pseudoparkinsonism). |
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|
Term
| What is the action of Trihexyphenidyl HCl (Artane)? |
|
Definition
| inhibit release of acetylcholine |
|
|
Term
| What is the therapeutic effect of Trihexyphenidyl HCl (Artane)? |
|
Definition
| Decrease tremors and rigidity |
|
|
Term
| What is another parasympatholytic? |
|
Definition
|
|
Term
| What nursing interventions are r/t anticholinergics? |
|
Definition
Monitor vital signs for increased heart rate
Monitor urine output for early detection of urinary retention.
Increase fluid intake (not in CHF), fiber, and exercise to avoid constipation.
Observe for involuntary movements.
Advise client to avoid alcohol, cigarettes, caffeine, and aspirin to decrease gastric acidity.
Encourage client to relieve dry mouth with ice chips, hard candy, or sugarless chewing gum.
Suggest use of sunglasses for photophobia. |
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Term
| What are the drug interactions r/t Carbidopa-Levodopa (Sinemet)? DOPAMINERGIC |
|
Definition
Decreased effect w/:
Anticholinergics
Phenytoin
Tricyclic antidepressants
MAO inhibitors
Benzodiazepines
Phenothiazines
Vitamin B6 |
|
|
Term
| What does PARK DARK stand for? |
|
Definition
P - Pill rolling
A - About to fall
R - Rigidity
K - Kan't swallow (Drool)
D - Dopamine/L-Dopa/Sinemet
A - Artane - Improves Rigidity
R - Restrict Coffee
K - Keep tremors down with antihistamines |
|
|
Term
| What is the pathopysiology of Alzheimer's disease? |
|
Definition
Neuritic plaques form
Neurofibrillary tangles are in neurons outside neurons and in cerebral cortex.
Cholinergic neurotransmitter abnormality |
|
|
Term
| What is Alzheimer's a deficiency of? |
|
Definition
| Degeneration of cholinergic neuron and deficiency of acetylcholine |
|
|
Term
| Which gender is more affected by Alzheimer's? |
|
Definition
|
|
Term
| What are the risk factors for Alzheimer's? |
|
Definition
-Age
-Genetics
-Fam History |
|
|
Term
| What can prevent Alzheimer's? |
|
Definition
-Head trauma
-What's good for your heart is good for your head |
|
|
Term
| What are the symptoms of Alzheimer's? |
|
Definition
Memory loss that disrupts daily
Challenges in planning or solving problems
Difficulty completing familiar tasks
Confusion with time or place
Trouble understanding visual images and spatial relationships
New problems with words in speaking or writing
Misplacing things and losing the ability to retrace steps
Decreased or poor judgment
Withdrawal from work or social activities
Changes in mood and personality |
|
|
Term
| What is the Slow House of Alzheimer's? |
|
Definition
-Lost and Wandering
-Safety and Confinement
-Confusion and Decision Difficulty
-Incontinence |
|
|
Term
| What are the characteristics of Alzheimer's? |
|
Definition
Loss of memory, logical thinking, judgment
Time disorientation
Personality changes
Hyperactivity
Tendency to wander
Inability to express oneself
Later hostility, paranoia |
|
|
Term
| How is Alzheimer's diagnosed? |
|
Definition
-Thorough medical history
-Mental status testing
-Physical and neurological exam
-Tests to rule out other causes of dementia-like symptoms |
|
|
Term
| What are the 2 FDA approved drugs to treat Alzheimer's? |
|
Definition
-Cholinesterase Inhibitors (ARICEPT, COGNEX)
-Memantine (Namenda) |
|
|
Term
| How to the cholinesterase inhibitors work? |
|
Definition
| Breaks down and blocks ACh |
|
|
Term
| What does Memenda (Namenda) treat? |
|
Definition
| to treat the cognitive symptoms (memory loss, confusion, and problems with thinking and reasoning) of Alzheimer's disease. |
|
|
Term
| What is non-FDA approved treatment of Alzheimer's? |
|
Definition
|
|
Term
| What is the drug action of Donepril (Aricept)? Acetylcholinesterase Inhibitors |
|
Definition
| Allow more acetylcholine in neuron receptors |
|
|
Term
| What is the therapeutic effect of Donepril (Aricept)? |
|
Definition
| Increase cognitive function |
|
|
Term
| What is Donepril (Aricept) used for? |
|
Definition
| Mild-moderate alzheimer's |
|
|
Term
| What are the side effects of Donepril (Aricept)? Acetylcholinesterase Inhibitors |
|
Definition
Headache, dizziness
Depression
GI distress
Dehydration, dry mouth, constipation
Blurred vision
Insomnia
Hypertension, hypotension, dysrhythmias
Hepatotoxicity |
|
|
Term
| What are the nursing interventions r/t acetylcholinesterase inhibitors? |
|
Definition
Nursing interventions
Monitor vital signs.
Maintain consistency in care.
Monitor behavioral changes.
Safety
Provide safety when wandering.
Arise slowly to avoid dizziness.
Monitor for GI bleeding.
Inform family of support groups. |
|
|
Term
| Summary of pathophys of Parkinson: |
|
Definition
Not enough dopamine
Too much AcH
Shaking, pill rolling, shuffling gait, flat affect
Carbadopa-Levadopa |
|
|
Term
| Summary of pathophys of Alzheimer's: |
|
Definition
Not enough AcH
Memory, cognitive impairment
Namenda, Exelon, Aricept etc. |
|
|
Term
| What laboratory values may be altered in a client who is taking carbidopa/levodopa? |
|
Definition
|
|
Term
| Which comment to the nurse indicates more teaching is needed for a client taking carbidopa/levodopa? |
|
Definition
A. “I know I need to take this drug once a day.”
Drug has a short half-life and must be taken 3-4 times a day. |
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