What is POLYPHARMACY

&

how does it affect the OLDER ADULT?

~ The administration of many drugs together

~The older adult takes meds for chronic disease

& multiple illnesses

-have multiple health care providers

-often take pain, sleep, & laxitive OTC drugs

In the OLDER ADULT what needs to be

considered with drug doses,

& drug interactions?

~Doses need to be adjusted according to

-Weight

-adipose tissue

-lab results (serum protien, electrolytes, liver enzymes,BUN & creatinine)

~More chances of drug interactions

-Many providers

-More OTC drug use

~Must closely moniter effects of drugs because of declining organ function (esp. Lver & kidneys)

*ADVERSE REACTIONS & DRUG INTERACTIONS ARE 3-7 TIMES GREATER THAN THOSE FOR MIDDLE AGE & YOUNGER ADULTS*

~ declining organ function (Kidneys & Liver)

~ Weight changes

~ Changes in lab results (Liver enzymes, serum protien levels, electrolytes)

~ Adipose tissue

What are the physical changes in the

GI tract for the OLDER ADULT?

&

How do these changes effect drugs

within the older adult?

~Increased PH in gastric secreations

~ Alters the absorption of

weak acid drugs (ex asprin)

~Decrease in paristalsis

~slows GI emptying, allowing drugs

to remain in the GI tract longer

~Decreased motility

~Decreased first-pass-effect

What happens to the serum protien levels

in the OLDER ADULT?

&

How does this effect drug interaction within the body of an older adult?

~Due to decreased blood flow, there is fewer serum protein circulating in the blood stream

~Causes fewer protein binding sites

~with fewer binding sites drugs compete

~More likely to have drug interactions

~Creates an increase in free drugs

available to body tissues

What are the physical changes in the cardiac and circulatory systems of the OLDER ADULT?

&

how do these changes effect drug

interaction with the older adult?

~Cardiac output

~Decreased Blood flow

~Slows absorption rate of drugs

~decreases in circulating serum protiens,

resulting in fewer protein-binding sites

~delays transportation of drugs to the tissues

~Taking to many medications at different times

~Failure to understand purpose for drug

~impaired memory

~decreased mobility & dexterity

~visual & hearing disturbances

~side effects & adverse reactions

What are the physiologic changes of the

hepatic system in the OLDER ADULT?

&

How do these changes affect pharmacokinetics in the older adult?

~Decreased enzyme production & decrease in enzyme function

~Decrease in hepatic blood flow

~Decrease in total liver function

~Causes a reduction in drug metabolism

~leads to a longer 1/2 life of a drug

~can result in drug accumulation & toxicity

What are the physiologic changes in

Kidney & nephron function in the OLDER ADULTS?

&

How does this effect pharmacokinetics in the older adults?

~Reduced blood flow (due to reduced cardiac output)

~Decrease in functioning nephrons

~Decrease in the glomeruler filtration rate

~Leads to decrease &

incomplete drug excretion

~leads to possible drug toxicity

How is DISTRIBUTION effected in

the OLDER ADULT?

~Water-soluble drugs are more concentrated because of a decrease in total body water volume

~Fat-soluble drugs are stored & likely to accumulate because of an increase in the fat-to-water ratio

~Decrease in circulating serum protiene-binding sites leads to drugs competing for these sites

~Because of lack of protien sites, drug interactions are likely to result & increases the free drugs available to body tissues

How are drugs organized?

(2 classifications)

&

What are the classifications based on?

~Therapeutic Classification

~based on what the drug does clinically

(antidepressent, diuretics etc)

~Pharmacologic classification

~based on how the drug produces its effects

(at molecular, tissue, or body-system level)

How is DISTRIBUTION & EXCRETION

of drugs different in the OLDER ADULT?

&

What problems are caused?

~Decrease in hepatic enzyme production, hepatic blood flow, & total liver function, causing a reduction in drug metabolism

-leads to an increased 1/2 life of drug(s)

-can result in drugaccumulation

or even toxicity

~Decrease in renal blood flow & decrease GFR of 40-50%

-leads to decrease in drug excretion

What are the effects of

sedatives in the OLDER ADULT?

*SECOND MOST COMMON GROUP OF DRUGS PRESCRIBED OR TAKEN OTC*

~need low doses with short 1/2 life drugs

~watch for ATAXIA, MOTER IMPAIRMENT,

or SENSORY ALTERATIONS

What are the effects of diuretics &

antihypertensive drugs in the OLDER ADULT?

*BP tends to increase with age*

~Monitor for electrolytes, hyperglacimia,

hyperuricemia, postural hypotension, & dizziness

What are the effects of cardiac

glycosides (digoxin) in the OLDER ADULT?

~narrow therapeutic range

~doubled 1/2 life in adults over the age of 80

What are the effects of anticoagulents

in the OLDER ADULT?

~99% protein bound

~frequent labs to moniter for -prothrombin(PT)

~moniter for bleeding

What are the effects of antibacterials

in the OLDER ADULT?

~may have decreased host defenses

~may need reduced dose if renal drug clearance is decreased &/or has a prolonged 1/2 life

What to know about the use of Gastrointestinal

drugs  in the OLDER ADULT?

~ may use histamine blockers

With Laxitives

~monitor electrolytes and fluids

~may decrease absorption of other drugs because of increased GI motility

What are the effects of antidepressants

in the OLDER ADULT?

~normal dose should be 30-50% of middle age adult

~dose may be gradally increased according

to tolerance and desired therapeutic effects

~requires very close monitoring

What are the effects of narcotics &

analgesics in the OLDER ADULT?

~can cause dose-related adverse effects such as (hypertension, repiratory depression)

What are the effects of anti-inflammatory

drugs and the OLDER ADULT?

~NSAIDS accumulate more rapidly

~steroids can cause osteoporosis,

so increase calcium & vit. D intake

What are the nursing interventions to lesson

drug/aging issues in the OLDER ADULT?

~Take drug histories carefully

~prescribe drugs for specific indications

~start with small dose and adjust slow

~moniter serum protien blood levels

~know other drugs, OTCs, herbals, & vitamins PT is taking

~keep drug regimen simple

Why are small amounts of  VITAMINS

needed in the body?

~Necessary for normal metabolic functions

~promote tissue growth & repair

~maintains overall health

~Cannot be produced by human cells (except vit D)

~deficiency will result in disease

How are VITAMINS classified

&

what are there classifications?

~VITAMINS are classified by their solubility

 -fat soluble (A,D,K,& E)

-water soluble (B complex & C)

what to know about lipid-soluble

VITAMINS (A, D, K, & E)?

~must be injested with fats to be absorbed

~matabolized & excreted slowly

~excess stored in liver, adipose tissue, & some muscle

~can be removed from storage & used as needed

~excessive intake can lead to dangerously high levels

What are the purposes

of VITAMIN A?

~Needed for normal vision

~aids in formation of pigment

needed for night vision

~essential for bone growth & development

Where is VITAMIN A stored

&

What foods contain vitamine A?

~stored in the liver, kidneys & fat

~released slowly as needed

~CAROTENES, fruits & veggies, fish, dairy

~regulates calcium & phosphorus metabolism

~needed for calcium absorption

Where is VITAMIN D stored in the body

& and how is it excreted?

What foods can you find vitamine D in?

~ Absorbed in small intestine,

require bile salts for absorption

~Excreted in bile

~FOODS "FORTIFIED with VIT. D", YEAST, dairy, fish

What is the purpose of VITAMIN E?

&

What are the side effects of large doses?

~Antioxident properties

~prevention of macular degeneration

 ~Fatigue & breast tenderness

Where is VITAMIN E stored

& how is excreted?

what foods can you find vitamin E in?

~Stored in all tissues, espcially

liver, muscle, & fatty tissue

~75% excreted in bile

 ~OILS, NONHYDROGENATED MARGARINE, milk,grains, meats

What is the purpose of VITAMIN K &

what happens with a deficiency?

~needed to produce prothrombin & the clotting factors

~newborns need vitamin K immediatly after delivery

~antidote for oral anticoagulant overdose

~With definciency spontaneous hemorrhage may occure

-What is the most active form of VITAMIN K?

-Where is it stored &

-what foods contain VIT. K?

~K1 is the most active form

~stored primarily in the liver

~found in green leafy vegies, meats, eggs, dairy

What to know about WATER- SOLUBLE

VITAMINS (B complex C)

~absorbed with water in the digestive tract

~easily dissolved in body fluids

~EXCESS CAN NOT BE STORED(except for B6 pyridoxine)

~readily excreted, must ingest daily

~minimul protein binding occures

~not usually toxic

~Slower absorption of oral drugs

~Impaired circulation delays transportation of drugs to the tissues

~Drugs meatabolize more slowly & less completely

~Alteration in receptor properties may underlie altered sensitivety to some drugs

-reduction in #of beta receptors

-reduction in affinity of beta receptors

(beta-receptor blocking agents)

~Drugs excreted less completely

~1/2 life is prolonged

~Toxicity is more probable

What are  the 6 main

VITAMIN B complex's?

&

what is thier general fuction?

~act as coenzymes

1)B1 (thiamine)

2)B2 (riboflavin)

3)B3 (niacin)

4)B6 (pyridoxine)

5)B9 (folate)

6) B12 (choline)

~Functions of VITAMIN B1(Thiamin)

~Precurser of an enzyme needed for oxidation

of carbohydrate & alcohol metabolism

~alcholics often have thiamine definciency

VITAMINE B3(niacin)

~function

~foods found in

~Treatment of nutritional deficiency

in chronic alchoholism

~May lower cholesterol, triglycerides,

& free fatty acids

~synthesized from trytophan

~only water soluble vitamin stored

(stored in the liver)

VITAMIN B9 (folate)

~Functions

~essential for body growth, needed for DNA synthesis

& to prevent dissruption in cellular division

*Important during pregnancy*

~folic acid definciancy during pregnancy can affect development in the CNS in fetus

-neural tube defects

-spina bifida

-anencephaly

What are the PHARMODYNAMICS

of the OLDER ADULT?

~lack of affinity to receptor sites throughout the body

~age related changes in the CNS, in the #of receptors & the affinity of receptors to drugs decreases sensitivity to drug action in the older adult

~compensatory response to physiological changes is decreased

VITAMINE B12 (choline)

~Functions of

~what are the effects of deficiency

 ~signs & symptoms of deficiency

~Structural component of cell metabolism and ACH

~needed for normal hematopoisesis

~needed to maintain nervous system integrity

~Deficiency will lead to pernicious anemia

~sighns & symptoms of deficiency: Numbness, Tingling in lower extremities

VITAMIN C (ascorbic acid)

~functions

~foods vitamin C is found in

~poten antioxodant

~needed for building and maintaining strong tissues (wound healing)

~found in citrus fruits & green veggies

1) Iron

2) Copper

3) Zinc

4) Chromium

5) Selenium

Key points about IRON

purpose, absorption, defiencies, & foods

~Vital for Hgb regeneration & general metabolism

~Absorbed by small intestine

       -antacids & food slow absorption

       -more readily absorbed when ingested w/ vit. C

~deficiency causes anemia

~found in lean meat, egg yolks, & dried fruit

Key points about COPPER

purpose, toxicity, foods

~Needed for formation of RBCs & connective tissue

~cofactor of many enzymes

~functions in the production of NE & D (nerotransmitters)

~toxicity results in liver and nerve damage

~found in organ meats (liver), seafood, & legumes

Key points about ZINC

purpose & foods

~important in many enzyme reactions

~essential for normal growth & tissue repair, wound healing, taste, lactation & all stages of life

~do not take with antibiotics (wait 2 hours)

~found in oysters, & meat

Key points of CHROMIUM

Purpose & foods

~Helps normalize blood glucose levels by increasing the effects of insuline

~found in brewers yeast

Key points of SELENIUM

Purpose & foods

~cofactor for antioxident enzymes

~may have anticarcinogenic effects

~found in meats, seafood, liver, & dairy

What are the effects of

ABSORPTION in PEDIATRICS?

~Gastric PH is alkaline at birth, may not reach adult acidity until 1-3 years of age

~feeding methods impact infant absorption-breastfeeding

leads to longer GI transit times

~increased GI surface area -more absorptive area

Why are fluids required

&

what's important in fluid intake?

~good overall health require ECF & ICF fluids to remain within normal range

~THIRST IS THE MOST IMPORTANT FACTOR IN FLUID INTAKE

What is PLASMA OSMOLALITY

&

what is its importance?

~the concentration of a solution

~changes in ECF osmolality will effect ICF osmolality- this will cause problems with normal cell function & volume

In an ISOTONIC Solution....

~volume deficit

~Na & water are lost in equal proportions

~no change in osmolality

~a decrease in total volume of ECF

~loss of water is GREATER than Na

~decrease in ECF volume & an increase in osmolality

~water is drawn out of the cells

~causes excesive sweating

~Loss of NA is greater than the loss of water

~decrease in both volume & osmolality

~causes excessive loss of NA through kidneys

What is volume expansion

what does it result from &

what are the treatments?

~An increase in the total of body fluids

~results from overdose of therapeutic fluids

~associated with disease states such as

heart failure, or nephritis syndrom

~It is treated with diuretics, or

heart failure meds

What impacts DISTRIBUTION

in PEDIATRICS?

~Body fluid composition< in pediatrics -greater volume of fluids for distribution & less concentration of drug

-untill age 2, require higher dose of water-soluble

meds to achieve therapeutic levels

~body tissue composition, less body fats -require less fat-soluble meds

~the measure of solute particals

~allows for the flow of fluids in & out to maintain balance

~refers to the effect of fluid on cellular volume

~used primarily as a measurment of the

concentration in IV solutions

~Replace/mainatian fluids, electrolytes,

calories or nutrients

~Transfuse blood, or blood products

~Administer prescribed medications

What are the 2 major nursing responsibilities

in regards to IV infusions?

1) Understand why the therapy is needed & the potential outcomes expected to see in patient

2) Understand the fluid & electrolyte

balance of the patient

1) Crystalloids

2) Colloids

3) Blood & Blood products

4) Lipids

What is the main funtion of a

 CRYSTALLOID IV Infusion?

~Comony used for hydration

~Replacement & maintaince of fluid therapy

~Promote urin output

~CREATE osmotic pressure

~Contain electrolytes & other agents that mimic the ECF

~Will increase total volume in the body

What are the main functions of

COLLOID IV therapy?

~Plasma volume expanders

~Expand intravascular volume

~Contain protiens, starches & amino acids

~INCREASES osmotic pressure

~May cause intervascular fluid overload

~May decrease platelets & hct

What are the main components transfused in

BLOOD PRODUCT IV therapy?

~Whole blood (not used in anemia unless drastic case)

~Packed red blood cells

~Plasma

~Albumin

What are the main functions of

LIPID IV therapy?

~Fat emulsion soultion

~Helps balance nutritional needs

~Usually indicated when IV therapy is prolonged

What are the 5 Major ELECTROLYTES that

the human body requires?

1) Potassium

2) Sodium

3) Calcium

4) Magnesium

5) Chloride

What are the important funtions

ELECTROLYTES do in the body?

&

What are the main points to remember?

~Essential to nerve conduction & muscle contraction

~Maintained within a very narrow range

~positively or negatively charged inorganic molecules

POTASSIUM

-normal range

-hyperkalemic range

-hypokalmic range

~ 3.5 - 5.3 mEq/L

~ Greater than 5.3 mEq/L

~Lesser than 3.5 mEq/L

What are the functions of POTASSIUM

within the body?

~Transmission & conduction of nerve impulses

~Contraction of muscle (smooth, cardiac, & skeletal)

~enzyme action to change carbs to energy & amino acids to protien

~Regulates intracellular osmolality

What causes HYPOKALEMIA

(less than 3.5 mEq/L of potassium)

~Occures when cells are damaged, causing K+ to leak into intravascular fluid

~occures with strenuous muscle activity

~Occures with the use of loop diuretics

~Caused by overuse in laxitives, steroids,

or antibiotics

What causes HYPERKALEMIA

(more than 5.3 mEq/L of potassium)

~Usually results from renal deficiency

~Results in over administration of K+

What are the signs & symptoms of

HYPERKALEMIA?

(greater 5.3 of potassium)

~Oliguria

~Dyspnea

~Tachychardia then Bradycardia

~can be fatal if greater than 7mEq/L

What foods are high in

POTASSIUM?

~Banana

~Yams

~Coffee

SODIUM

-Normal range

-Hypoantremic range

-Hypertremic range

~135 - 145 mEq/L

~less than 135 mEq/L

~more than 145mEq/l

What are the primary functions of

SODIUM?

*PRIMARY EXTRACELLULAR ELECTROLYTE*

~Regulates body fluids

~MAINTAINS osmolality & water balance

~Transmision & conduction of nerve impulses

~Part of Na/K pump

~part of the acid base balance

Causes of HYPOTREMIA

(greater than 145 mEq/L of Sodium)

~Occures to excessive dilution of the plasma due to:

-surgery

-potent diuretics

-excessive sweating

Signs & symptoms of HYPOTREMIA

(sodium)

~Tachycardia

~HyPOtension

~muscle weakness

~lethargy

~confusion & Anxiety

Causes of HYPERTREMIA

(sodium)

~results from use of cortisone

~results from use of caugh medicines

~results from use of some antibiotics

Signs & Symptoms of

HYPERNATREMIA (sodium)

~Dry flushed skin

~elevated Temperature

~hyPERtension

CALCIUM

-normal range

-Hypocalcemic range

-Hypercalcemic range

~4.5 - 5.5 mEq/L

~ less than 4.5 mEq/L

~more than 5.5 mEq/L

What are the primary functions of

CALCIUM?

~FORMATION OF BONE & TEETH

~NORMAL NERVE & MUSCLE ACTIVITY

~BLOOD CLOTTING

~increases contractions in heart muscle

~MILK

~CHEESE

~SALMON

What causes HYPOCALCEMIA?

(calcium)

~Inadequet calcium intake

~Insufficient Vit. D intake

~hyPOparathyroidism

~multiple blood transfusions

~Phosphate preps

What are the signs & symptoms of

HYPOCALCEMIA (calcium)?

~TETANY SYMPTOMS

~bone deformities

~osteomalacia

~ostoporisis

What causes HYPERCALCEMIA

(calcium)?

~Excessive calcium intake

~bone tumors

~THIAZIDE DIURETICS

~Multiple fractures

What are the sighns & symptoms of

HYPERCALCEMIA (calcium)?

~CARDIAC ARRYTHMIAS

~constipation

~kidney stones

~flabby muscles

MAGNESIUM

-normal range

-Hypomagnesemic range

-Hypermagnesemic range

~ 1.5 - 2.5 mEq/L

~ less than 1.5 mEq/L

~ more than 2.5 mEq/L

What are the funtional properties

of MAGNESIUM?

~REQUIRED TO FORM PROTIENES

~Promotes the function of neuromuscular activity

~aids in bone formation

~Important mediater in neural transmission in the CNS

~promote contraction of the myocardium

~activate enzymes for CHO & protien metabolism

~responsible for Na & K across cell membranes

What impacts DISTRIBUTION

in PEDIATRICS?

~Protein binding capability

-Have less albumin creating fewer recpetor sites for binding & creating more free drugs

-need to have reduced doses to have

-Bilirubin can bind with protein sites

~Effectiveness of blood brain barrier

-BBB inmature, increases liklihood for tocicity

~Whole grains

~seafood

~P-Butter & nuts

What causes HYPOMAGNESEMIA

(magnesium)?

~Diuretics

~Some antibiotics

~Laxitives

~Steroids

What are the signs & symptoms of

HYPOMAGNESEMIA?

~Cardiac dysrhythmia

~hyper-excitability

~tachacardia

~muscle spasms

What causes HYPERMAGNESIUM

(magnesium) ?

~Excessive intake of:

-Mg

-laxitives

-milk of magnesia

-maalox

-mylanta

What are the signs & symptoms of

HYPERMAGNESEMIA?

~drwosiness

~Sedative CNS effect

~paralysis

~loss in DTRs

CHLORIDE

~normal range

~hypochloremia

~hyperchloremia

~ 95 - 108 mEq/L

~ less than 95 mEq/L

~ more 108 mEq/L

*MAIN ANION IN ECF*

~Major contributer in acid/base balance

~gastric juice acidity

~ECF osmolality

What foods can you find

CHLORIDE in?

~Table salt

~processed foods

What are the signs & symptoms

of HYPOCHLOREMIA?

~Tremors

~Twitching

~slow shallow breathing

What are the signs & symtoms of

HYPERCHLOREMIA?

~Deep rapid breathing

~weakness & lethargy

~ results in unconsciousness

PHOSPHORUS

~normal range

~hypophosatemia range

~hyperphostemiea range

~ 1.7 - 2.6 mEq/L

~ Less than 1.7 mEq/L

~ more than 2.6 mEq/L

What are the functions of

PHOSPHORUS in the human body?

*MAJOR ANION IN ICF*

~IMPORTANT COMPONENT OF DNA & RNA

~HELPS FILTER OUT WASTE IN KIDNEYS

~energy transfer in cells, fat storage

& other nutrient metabolism

~Protiene rich foods

-nuts

-meats

-legumes

-pork

~results from:

-diabetes

-starvation

-chrons disease

-alcoholism

What are the signs & symptoms of

HYPOPHOSPHATEMIA?

~bone pain & brittleness

~ Hyperflexia

~Hyperventilation

~dysphagia

What are the signs & symptoms of

HYPERPHOSPHATEMIA?

~hyperreflexia

~paralysis

How is METABOLISM impacted

in PEDIATRICS?

~Decreased levels of hepatic enzymes

-slower metabolism

-longer 1/2 life of drugs

~Higher metobolic rate

-May require higher doses

How is EXCRETION impacted

in PEDIATRICS?

~Primarily in the kidneys

              -Decreased renal blood flow

              -Decreased GFR

              -Reduced renal tubular function

~slower excretion may lead to accumulation or toxicity

~water is needed for effective excretion

What are the PHARACODYNAMICS

in PEDIATRICS?

~Onset, peak, duration of effect of a med

~Variabls impact drug pharmacodynamics

Nursing Implications in

the PEDIATRIC population

~Pediatric medication dosing

~client Identification

~adaptation of administration of drugs

~Routes of medications

SYMPATHETIC NERVOUS SYSTEM

changes within the body

~avtivated under conditions of stress

~Vasoconstriction

~Dialates the Bronchi

~Shunts blood AWAY from the skin & viscera

TO skeletal muscles

~Dialates the pupils for better vision

~Mobilizes stored energy from liver

Maine functions of the

ADRENERGIC SYSTEM (CNS)

~Regulation of cardiovascular system

            -maintain blood flow to brain

            -redistribution of blood

            -compensation for loss of blood

What are the 3 NEUROTRANSMITTERS

in the CNS?

1)Norepinephrine (NE)

2)Epinephrine (E)

3)Dopomine (N)

What are the functions of

ADRENERGIC drugs?

~Activate adrenergic recepteors (alphas & betas)

~Stimulates the SNS through these same receptors

~Mimics the sympothetic neurotransmitters (NE) & (E)

~act on 1 or more adrenergic receptor sites

located in the cells of muscles