ADEs
adverse drug eventsan umbrella term that encompasses the two subcategories of adverse drug reactions and medication errors
ADE's have also been linked to increased risk for
falls and auto accidentsfunctional decline changes in cognition (delirium)death poor adherence and poor quality of life
Geropharmacology
the study of how older adults respond to medication-older adults normally have some changes in the body function and are more than likely to have at least one disease process than a younger person
Factors that increase the risk for medication related problems
-drug testing method -several health care providers -recent hospitalization -physical changes related to aging -use of otc, or herbs -knowledge -financial concern -cognitive and sensory changes
Pharmacokinetics
The process by which drugs are absorbed, distributed within the body, metabolized, and excreted.
drug absortion altered because
causes decreased gastric acidity, peristalis and blood flow. This places older ppl a risk for drug to become toxic
first pass effect
-The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.
Drug Distrubution
movement of drug between the blood and various tissues of the body
Drug Distribution- Water soluble drugs
tend to remain in higher concentration in the blood stream because their is less total body water water drugs like: gentamicin, histamine, receptors blockers, and lithium
drug distribution- Fat Soluable drugs
drugs become trapped in the fatty tissue because of decreased muscle mass and increased adipose tissue -blood test may be lowerfat drugs- phenpbarbital & benzodiazepines
Protein bound drugs
-a decrease in hemoglobin and the plasma protein albumin results in fewer available sites for these drugs -
The half life of a drug can last longer in the
older person
drug excretion
aging kidneys are less effective at removing waste products including the by products of the medications. -as the kidneys become less effective in the excretion of drugs more drugs remain in the circulation, leading to elevated drugs levels and s/s of the drug
creatine clearance test provide a more effective measure of kidneys then the
Serum creatine level
Medications such as ________ are more than likely to reach toxic levels because of poor renal excretion
aminoglycosides digoxin lithium procainamide cimetidinenicotine and alcohol
Pharmacodynamics
The study of what the drug does to the body-ex: sildenafil citrate (viagra) started put as a cardiac drug to reduce hypertension & angina but because of it's side effects it's not used for that purpose
a major problem is multiple doctors and each doctor is
prescribing a different medication
Beers Criteria
A list of medications that are generally considered inappropriate when given to elderly people-ppl over 65-making sure older adults are given safe and approiate medications considering their -age -other meds -exsisting conditions -over 50 medications are listed in the BEERs criteria
6 basic guideline to protect older adults, doctors and anyone else who can prescribe medications
1. start low and go slow 2. start one drug and stop 2 3. dont use a drug if the side effects are worse than the disease 4. use as few drugs as possible and try to use other approches besides drugs5.frequently access patients response 6. consider drug holidays
Cognitive changes
-Lack of the literacy skills needed to read the label and directions -inabilty to understand and comply with directions -inability to make correct judgements about medications -may not recognize that they have to take a medication
sensory changes/ Vision
-Can they read the label -are they able to see it -can the patient see good enough to take the right amount. -see what patients vision is like and help them make adjustments if needed
Smart for medication assesment
Schedule Monitor Adherence Review Teach
Alcohol has a sedative effect so he should not be taken with other drugs that have a sedative effects
Alcohol has a sedative effect so he should not be taken with other drugs that have a sedative effects
Saving money
-some patients use old drugs to save money -sometimes do not throw away drugs incase something happens and they need it in future
Assessment
-asses older adult before giving meds -monitor the older adult to determine if the medication is working -watch for any signs of overdose -observe for any changes in medical condition
C.A.R.E
Caution/compliance adjustreview regimen regular educate
Mission statements
-defines purpose -states vision -states values
mangement vs leadership
-organization of all care required of patients in a health care settings for a specific period -leadership is how a person empowers and develops a team to meet and exceed patients and instituational outcomes
autocratic/ authoritarian leader
-make decision alone -total authority -have full power -they don't care about the employees opinion -
Democratic/ participative leader
includes one or more ppl making the decision -ppl feel involved, they feel apart of the solution -makes final decision making auhority -
Laisses-faire or delegative leader
-allows ppl to make their own decision -leader is still responsible that is made -allows greater freedom and responsibilty for the ppl -however you will need competent ppl around you or nothing will get done
Charismatic Leader
-leads by creating energy ppl like -leader well liked and inspires ppl -appeals to ppls emotional side -gives job to the ppl that can do it
Servant leader
-works for the ppl -will do the work for you
Combinations of styles leader
a leader that can have a few leading styles
Core areas
-motivate team members to accomplish goals -communicate assertively -problem solve effectly -build a team of coopertaive workers -manage stress effectively
4 I's of Transformation leadership
-idealized influence -inspirational motivation -intellectual stimulation -indivisualized consideration