Term
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Definition
| Plant-based products with medicinal properties; must consider pharmacokinetics/pharmacodynamics; interact w/other meds; Not FDA regualted; risk of adverse effects w/ certain conditions |
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Term
| What are the 3 concepts of homeopathy and who created them? |
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Definition
| According to Hahnemann, 1) The law of similars or "like cures like"- homeopathy treats an illness by stimulating they body's self-healing abilities thru the use of a small amt of a substance similar to what caused the illness (Ex- quinine causes malaria and cures it) 2)The more a substance is diluted, the more potent it is; treatments are diluted then shaken vigorously to increase potency. 3)The illnesses are highly individualized and so treatment might be individualized; based on this practitioners focus on treating the person not the disease, spend much time interviewing and assessing patients before prescribing a homeopathic remedy. |
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Term
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Definition
| regulated by the FDA, OTC remedies, treatment from an HCP, precautions |
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Term
| How does change in renal function affect actions of bioactive substances in the body? |
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Definition
| Diminished renal function --> Effect on concentration of bioactive substances; decreased clearance of water-soluble medications; consider medications w/a narrow therapeutic range |
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Term
| How does change in hepatic blood flow affect actions of bioactive substances in the body? |
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Definition
| Diminished hepatic blood flow --> serum concentration of meds affected by liver metabolism; volume of distribution also affected |
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Term
| How do changes in the function of Cytochrome P-450 system affect the actions of bioactive substances in the body? |
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Definition
| Slower function of Cytochrome P-450 system --> Enzymes responsible for metabolism of meds; clearance of meds is delayed in older adults |
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Term
| How does change in total body water, proportion of body fat to lean body mass and serum albumin levels affect actions of bioactive substances in the body? |
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Definition
| decrease in total body water, increase in proportion of body fat to lean body mass and decreased serum albumin levels --> higher serum concentrations (w/agents distributed primarily in body water or lean body mass), lower serum (fat-soluble substances), prolonged duration (fat-soluble substances), age related changes in receptor sensitivity can influence pharmacodynamics and cause older adults to be more or less sensitive to particular substances. |
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Term
| What are some age-related homeostatic mechanisms changes in older adults that affect the actions of bioactive substances? |
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Definition
| receptor sensitivity in the brain, thermoregulation, fluid regulation, baroreceptor control of BP, body size and gender |
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Term
| What are some age-related homeostatic mechanisms changes in older adults that affect the actions of bioactive substances? |
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Definition
| receptor sensitivity in the brain, thermoregulation, fluid regulation, baroreceptor control of BP |
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Term
| How do body size and gender affect actions of bioactive substances? |
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Definition
| Gender is a factor with any age; body size can affect therapeutic and adverse effects so doses need to be adjusted for those who are small or lost weight or are losing weight. this is important for older adults losing muscle mass or have decreased renal function. |
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Term
| Which of the following statements is true about age-related changes affecting the action of medications in the older adult? A.Renal changes may affect the concentrations of medications in the body. B.Liver metabolism of medications is increased in older adults. C.Water-soluble substances have a less intense effect in the older adult. D.Fat-soluble substances may have a decreased duration of action. |
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Definition
Answer:Renal changes may affect the concentrations of medications in the body.
Rationale: Age-related declines in glomerular filtration rates may affect the concentrations of bioactive substances. Diminished renal function can decrease the clearance of water-soluble medications and the consequences will be greater on substances, like digoxin, that readily reach toxic levels because they have a narrow therapeutic index. |
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Term
| List some risk factors that affect bioactive substances |
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Definition
| Attitudes of the older adult; level of knowledge; socioeconomic issues; HCPs; myths |
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Term
Which of the following risk factors may have a negative effect on bioactive substances and the older adult?
A.Appropriate prescribing practices
B.Increased prevalence of chronic conditions
C.Knowledge of medications
D.Avoidance of over-the-counter preparations |
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Definition
Answer: B. Increased prevalence of chronic conditions
Rationale: The increased prevalence of chronic conditions in older adults adds to their vulnerability to medication–disease interactions. Pathologic conditions not only influence the action of substances in the body, but also contribute to nonadherence, especially in combination with functional limitations. |
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Term
| What are some myths and misunderstandings that behaviors are based on? |
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Definition
| 1-"Medications are a 'quick fix' for symptoms" 2-"OTCs are all safe" 3- prescribing patterns of health care practitioners 4- nurses should always consider the beliefs of the older adult related to treatment of illness and disease. |
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Term
| Beers criteria about anticholinergic drugs (includes drugs with anticholinergic properties) |
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Definition
| Are inappropriate because of toxicity and serious side effects (e.g.: seizures, delirium, agitation, hallucinations, cardiac arrhythmias, cognitive impairment, urinary retention) |
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Term
| Beers criteria about Tricyclic antidepressants |
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Definition
| inappropriate not only because of anticholinergic effects, but because of their increased volume of distribution and slowed metabolism, which are particular concerns for older adults with cardiac conditions |
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Term
| Beers criteria about antipsychotic medications |
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Definition
| can produce extrapyramidal and anticholinergic effects, as well as tardive dyskinesia, even with low doses and short-term use. |
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Term
| Beers criteria about barbiturates |
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Definition
| inappropriate, except as anticonvulsants, because their high protein-binding capacity can lead to accumulation and toxicity. |
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Term
| Beers criteria about Benzodiazepines |
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Definition
| esp those that have been on he market the longest (ex: diazepam, chlordizepoxide, flurazepam) have a high risk for accumulation and toxicity because of their prolonged half-life in older adults |
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Term
Which of the following medications is inappropriate for use in the older adult population according to the Beers criteria?
A.Nonsteroidal anti-inflammatory drugs B.Anticonvulsants
C.Opioid analgesics
D.Anticholinergic drugs |
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Definition
Answer: D. Anticholinergic drugs
Rationale: The Beers criteria identify medications that are inappropriate for use in the older adult population because they are ineffective or have poor safety profiles. Anticholinergic drugs and drugs with anticholinergic properties are inappropriate because of toxicity and serious side effects such as seizures, delirium, agitation, hallucinations, cardiac arrhythmias, cognitive impairment, and urinary retention. |
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Term
| Polypharmacy and its effects |
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Definition
| Polypharm- refers to the use of multiple medications often from multiple sources; community residing older adults in the US take on average 3-9 meds at a time, 12% take more than 10; can lead to drug interactions and adverse medication effects; one study found that use of 4 or more meds is a significant independent risk factor for increased mortality, even when illness severity, level of functioning, and other factors were considered. |
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Term
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Definition
| major intent: to substantially improve drug coverage for older adults and Medicare-eligible people with disabilities, with particular provisions for low-income Medicare beneficiaries; analysis after 1st 6 mo. showed that those w/lowest incomes were worse off with the new program |
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Term
| Concerns with Medicare part D |
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Definition
| the program fails to address the rapid and significant increase in the cost of drugs that has been occurring during the past 10 yrs. comparative analysis in 2006 show that the lowest negotiated price for each of the 20 drugs most commonly prescribed under the plan was an avg of 58% higher than the lowest price negotiated by the VA. |
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Term
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Definition
| how the drug is absorbed, distributed, metabolized, and excreted |
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Term
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Definition
| how the body is affected by the drug at the cellular level and in relation to the target organ |
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Term
| Elimination half-time or serum half-time |
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Definition
| the time required to decrease the drug concentration by one half of its original value |
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Term
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Definition
| measures the volume of blood from which the medication is eliminated per unit of time |
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Term
| Describe effects of med-to-med interactions |
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Definition
| use of mult. meeds w/increased prevalence of mult. chronic conditions --> potential for drug interactions and adverse side effects; need for medication monitoring: barriers in older adult population |
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Term
Mrs. N. is prescribed a complex medication regimen for the chronic condition of diabetes mellitus. In addition to the prescribed regimen, another factor for nonadherence may include:
A. Living with her daughter
B. Knowledge of the medications
C. Adverse effects of the medication
D. Cognitive wellness |
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Definition
C. Adverse effects of the medication
Rationale: Medication nonadherence refers to medication-taking patterns that differ from the prescribed pattern, including missed doses, failure to fill prescriptions, or medications taken too frequently or at inappropriate times. Factors that contribute to nonadherence include depression, isolated living situation, financial considerations, disease category, adverse medication effects, complex medication regimen, and inadequate understanding of the medication regimen. |
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Term
Which of the following mechanisms may affect medications by altering absorption in the stomach?
A. Increased transit time
B. Competitive binding of molecules
C. Increased stomach secretions
D. Decreased time to reach peak serum levels |
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Definition
B. Competitive binding of molecules
Rationale: A common way that nutrients affect medications is by altering absorption in the stomach by delayed transit time or slowed gastric emptying, competitive binding of molecules, and diminished stomach secretions. |
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Term
| What are effects of taking medications with alcohol consumption? |
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Definition
| CNS depression, HCP don't always accurately assess an older adult's alcohol consumption; OTC preparations may have alcohol as an ingredient; older adults more susceptible to interactions between alcohol and meds; increased risk for adverse effects |
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