NURS 315 CHAPTER 15 QUESTIONS AND VERIFIED
ANSWERS GRADED A+
Beers criteria -list of drugs that carry high risk for older adults and criteria for
potentially inappropriate medication use in older adults
Polypharmacy-use of multiple medications (5 or more)
Polypharmacy and interactions •Due to high prevalence of health conditions, large use
of medications
•Polypharmacy occurs in 1/3 of older adults-more than ½ if we count OTC medications.
•Most common: cardiovascular agents, antihypertensive, analgesics, antiarthritic
agents, sedatives, tranquilizers, laxatives, and antacids
•Serious adverse effects can occur related to medication interactions
•Caffeine can have adverse effects on certain medications
Altered pharmacokinetics Aborption - Answer N.I: Possible measures to maximize
absorption: exercise ↑ circulation; heat & massage ↑ blood flow; preventing dehydration,
hypothermia, hypotension; interactions with other medications, use most effective route
Altered pharmacokinetics distribution - Answer Considerations with the older adult
•Changes in circulation
•Membrane permeability
•Body temperature
•Tissue structure
N.I.: Dehydration and hypoalbuminemia decrease drug distribution, may lead to toxicity
,Altered pharmacokinetics metabolism, detoxification, and excretion - Response
•Conditions that decrease the rate of metabolism of drugs: Dehydration, hyperthermia,
immobility, and liver disease --> must monitor carefully
•Biological half-life prolonged: must monitor drug elimination carefully
•Detoxification and conjugation of drugs impaired
•Renal system excretes drugs; impairment of renal function has significant
consequences
•Liver plays a role in the inactivation and elimination of drugs
Altered pharmacodynamics - Response •Biologic and therapeutic effects of drugs at the
site of action or on targeted organs
•Limited information in older population
Differences known to date
•Increased myocardial sensitivity to anesthesia
•Increased central nervous system receptor sensitivity to narcotics, alcohol, and
bromides
Risk increases when: - Response •People who take 5 or medicines
•People who take medications from more than provider
•Older adults
•People in the hospital (nih)
General factors regarding adverse reactions: - Answer •Signs and symptoms differ in
, older adults •Adverse reaction may take longer to become apparent •May be
demonstrated even after medication discontinued May develop suddenly, even after
long-term use
________ dysfunction is often an early adverse reaction - Answer Mental
Mental dysfunction for adverse reaction - Answer •Examples: codeine, digitalis,
methyldopa, phenobarbital, L-dopa, diazepam, various diuretics
•Medications that contribute to hypoglycemia, acidosis, fluid and electrolyte
imbalances, temperature elevations, increased intracranial pressure, decreased
cerebral circulation
•May only be slight alterations in mental status
•Must identify cause prior to treating condition; can place patient at risk for further
complications
What are the key medications of concern according to the Beers Criteria? - Answer
anticholinergics, tricyclic antidepressants, antipsychotics, barbiturates,
benzodiazepines
Safe and effective administration promote - Answer •The most common route to
administer drugs is oral --> Oral administration: problems can interfere with process
•Suppository form: due to lower body temperature may take longer to melt/dissolve
•Intramuscular and subcutaneous administration --> Immobile limb will reduce the rate
of absorption
•Intravenous administration --> Monitor for complications
Factors interfering with safe administration/compliance - Answer •Functional limitations
•Cognitive limitations
ANSWERS GRADED A+
Beers criteria -list of drugs that carry high risk for older adults and criteria for
potentially inappropriate medication use in older adults
Polypharmacy-use of multiple medications (5 or more)
Polypharmacy and interactions •Due to high prevalence of health conditions, large use
of medications
•Polypharmacy occurs in 1/3 of older adults-more than ½ if we count OTC medications.
•Most common: cardiovascular agents, antihypertensive, analgesics, antiarthritic
agents, sedatives, tranquilizers, laxatives, and antacids
•Serious adverse effects can occur related to medication interactions
•Caffeine can have adverse effects on certain medications
Altered pharmacokinetics Aborption - Answer N.I: Possible measures to maximize
absorption: exercise ↑ circulation; heat & massage ↑ blood flow; preventing dehydration,
hypothermia, hypotension; interactions with other medications, use most effective route
Altered pharmacokinetics distribution - Answer Considerations with the older adult
•Changes in circulation
•Membrane permeability
•Body temperature
•Tissue structure
N.I.: Dehydration and hypoalbuminemia decrease drug distribution, may lead to toxicity
,Altered pharmacokinetics metabolism, detoxification, and excretion - Response
•Conditions that decrease the rate of metabolism of drugs: Dehydration, hyperthermia,
immobility, and liver disease --> must monitor carefully
•Biological half-life prolonged: must monitor drug elimination carefully
•Detoxification and conjugation of drugs impaired
•Renal system excretes drugs; impairment of renal function has significant
consequences
•Liver plays a role in the inactivation and elimination of drugs
Altered pharmacodynamics - Response •Biologic and therapeutic effects of drugs at the
site of action or on targeted organs
•Limited information in older population
Differences known to date
•Increased myocardial sensitivity to anesthesia
•Increased central nervous system receptor sensitivity to narcotics, alcohol, and
bromides
Risk increases when: - Response •People who take 5 or medicines
•People who take medications from more than provider
•Older adults
•People in the hospital (nih)
General factors regarding adverse reactions: - Answer •Signs and symptoms differ in
, older adults •Adverse reaction may take longer to become apparent •May be
demonstrated even after medication discontinued May develop suddenly, even after
long-term use
________ dysfunction is often an early adverse reaction - Answer Mental
Mental dysfunction for adverse reaction - Answer •Examples: codeine, digitalis,
methyldopa, phenobarbital, L-dopa, diazepam, various diuretics
•Medications that contribute to hypoglycemia, acidosis, fluid and electrolyte
imbalances, temperature elevations, increased intracranial pressure, decreased
cerebral circulation
•May only be slight alterations in mental status
•Must identify cause prior to treating condition; can place patient at risk for further
complications
What are the key medications of concern according to the Beers Criteria? - Answer
anticholinergics, tricyclic antidepressants, antipsychotics, barbiturates,
benzodiazepines
Safe and effective administration promote - Answer •The most common route to
administer drugs is oral --> Oral administration: problems can interfere with process
•Suppository form: due to lower body temperature may take longer to melt/dissolve
•Intramuscular and subcutaneous administration --> Immobile limb will reduce the rate
of absorption
•Intravenous administration --> Monitor for complications
Factors interfering with safe administration/compliance - Answer •Functional limitations
•Cognitive limitations
