Medications and the Older Adult

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Medications and the Older Adult
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Definitions
Young old adult ( 65 74 years ) Middle old
adult ( 75 84 years) Old old adult (85 years
up)
Frail old over 65 years and with debilitating
illness
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Pharmacotherapeutics Indications reasons why
drugs are prescribed

• the same as in any adult
• polypharmacy is common

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Pharmacokineticschanges that occur in the drug
as it moves in the body

• Absorption
• Increased pH
• Decreased absorptive surface
• Decreased blood flow
• Decreased motility

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• Distribution
• Increase in body fat
• Decreased body water and dehydration
• Reduced efficacy of blood brain barrier
• Polypharmacy
• Decreased serum albumin
• Increased glycoprotein

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Distribution (cont)
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• Metabolism
• Decreased liver size / function
• Decreased hepatic flow
• Reduced oxidisation

• Excretion
• Decreased renal function

Drug doses need to be lowered
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Pharmacodynamics Action of drug at cellular level

• Fewer receptor cells
• Reduced action of agonists
• Enhanced action of antagonists

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Adverse Effects

• more prone to toxic effects
• more prone to CNS side effects
• Paradoxical excitement may experience an effect
  that is the opposite of the intended effect

Difficult to distinguish between signs and
symptoms of aging versus side effect of drugs
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• Health Assessment
• Enquire about polypharmacy
• Assess body organs function
• Ability to read and open bottles

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Lifestyle, diet and habits

• Dietary patterns
• Level of activity
• Quality of life
• Financial costs
• Depression

Environment and Culture
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Intervention

• Promote compliance by providing
• memory aids
• Schedules
• Easy to open bottles

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• monitor for side effects
• Ensure safety
• Quality of life

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Dosage Metric Systems

• Measures of weight
• Gram abbreviated as g or gm
• Milligram abbreviated mg
• Microgram µg or mcg
• Kilogram abbreviated kg

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Dosage Metric Systems

• Measures of weight
• Gram abbreviated as g or gm
• Milligram abbreviated mg
• Microgram µg or mcg
• Kilogram abbreviated kg

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Changing grams to milligrams

• Convert 0.1g to mgs
• 1g 1000 mg
• 1g will yield a bigger number inmilligrams
• Therefore when converting grams to milligrams the
  answer should be greater than the original value
• Therefore to increase the value move the
  decimal point three places to the right
• Answer 0.1g 100mg

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Converting mg to grams

• Convert 0.1mg to g
• 1g 1000 mg
• 1mg is a value less then one gram
• Therefore when converting milligrams to grams the
  answer should be smaller than the original value
• Therefore to decrease the value move the
  decimal point three places to the left
• Answer 0.1mg 0.0001g

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• Whenever there is an order always transform
  the ordered dose to the same weigh as the supply
  dose before you proceed further

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Calculating oral doses
Desire X Stock Amount Have
Desire Physicians Order Have
strength per tablet Stock form in which
the tablet comes Amount amount to give
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Injections from Powders
Order 0.65g QID po
Label directions Add 2.5ml water for injection.
Shake well . Provides approx volume of 3.1mL
(325mg/ml) Note the manufacturer gives the
strength of the solution
Desire 0.65g Have 325 mg / ml Stock in every ml
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Desire 0.65g Have 325 mg / ml Stock in every ml
Convert 0.65g to mg 1g 1000 mg (
therefore answer should be bigger) 1000mg
Three zeros Therefore move decimal point three
spaces to the right 0.65g 650mgs
Desire X Stock Amount Have
650mg X 1ml 2mL 325mg
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• When mixing powders for injections, remember to
• Check the type of fluid to dissolve the
  powder
• The amount of fluid to add
• The strength of the solution made

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• Where to find information regarding
  reconstitution of the powder
• The label of the vial
• Package insert inside the vial
• Nursing Drug book
• Compendium of Pharmaceuticals and Specialities (
  CPS)

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Calculating drop rate per hour
Example 250 mL D5W IV at 25 ml/hr (IVI drop
factor 60 gtt / ml) How many drops per minute?
Number of ml per hour X Drop factor Number
of minutes
25ml X 60 gtt 25 gtt/ minute
60
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• Example 2
• 500ml Nacl for 24 hours (drop factor 60 gtt)
• Calculate how much mL you have to give in1 hour
• 500ml 24 hours Z ml 1 hour
• 24 Z 500mL
• Z 500ml 21ml
• 24
• Number of ml per hour X Drop factor
• Number of minutes
• 21 X 60 21 gtt / min
• 60

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Adding Medications to I.V.I s
Order 1000ml D5W with 20 mEq KCL IV over 12
hrs Available Vial of KCL 40 mEq/ 20 ml
Microdrip ( 20 gtt/ min)

• Calculate volume of KCL

Desire X Stock Amount Have
Add 10 ml KCL to Bag
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Order 1000ml D5W with 20 mEq KCL IV over 12
hrs Available Vial of KCL 40 mEq/ 20 ml
Microdrip ( 20 gtt/ min)

• Calculate how many ml per hour
• 1000ml 12 hrs Z ml 1 hr
• 12 Z 1000ml
• Z 1000ml 83 ml per hour
• 12

Number of ml per hour X Drop factor Number
of minutes
83 X 20 28 gtt / min 60
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