Chapter 6 Drug Therapy for Geriatric Clients Chapter 6

Chapter 6

Drug Therapy for Geriatric Clients

Chapter 6

Drug Consumption p131 • Age ≥ 65 = increasing population growth

– Elderly are estimated to consume approximately 1/3 of all prescription drugs

– Estimate elderly use 3/4 of over-the-counter drugs– Polypharmacy

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Absorption p132• Diminishes with increased age • GI concerns

– Reduced stomach acid (HCl)– Villi are blunted – Prolonged gastric emptying rate– Blood flow to the intestines is reduced

• Atherosclerotic changes

– Reduced muscle tone in the stomach and intestines = decreased peristalsis

Absorption continued p 132

• Skin is thinner = faster topical absorption• IM absorption unpredictable due to changes

in peripheral circulation. Vasodilation, vasoconstriction.

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Distribution p133

• Total body water is decreased• Muscle atrophy• Fatty tissue increase• Protein binding capacity decreased

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Metabolism p133• Decline in amount of enzymes • Decrease in liver function• Causes are obscure; possibly due to:

– Reduced blood flow to the liver

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Elimination p133-134• Reduced glomerular filtration rate• Reduced tubular reabsorption and secretion• Decreased number of nephrons• More likely to experience drug toxicity

Drug Receptors p134• Internal drug receptors may change

– Results in diminished or greater responses to meds

– Close monitoring is required

Factors affecting drug action in elderly p134-139

• Memory loss• Sensory loss• Multiple disease states • Polypharmacy • Use of multiple pharmacies and physicians

Other Factors continuedp134-139

• Economic factors• Lack of education• Communication problems• Cultural considerations• Diet therapy

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Oral medications p137• Oral medication administration for geriatrics

– Position for administration: high Fowler’s– Assess ability to swallow– Speak clearly and slowly– Offer the most important medication first– Have plenty of liquid available– Do not rush the elderly client

Intramuscular Medications p137• Use ventrogluteal site• Avoid deltoid muscle• Avoid vastus lateralis because of loss of

muscle mass

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IV medications p137-138 • Assess rate of flow to prevent circulatory

overload.– Watch for respiratory distress– Moist respirations– Full bounding pulse– Distended neck veins– Edema

• Frequent toileting is necessary

Teaching geriatric patients p138• 95% live in the community• Nurse advocate…. Patient

autonomy• verbal and written

instructions• Short sessions in a well lit

area with few auditory distractions

• Self care skills are best taught by demonstration with return demonstration by patient.

Medication schedules p 138• Independence is facilitated

by setting up a medication schedule with meds labeled with purpose, color coded as necessary.

• Medication reminders: – Med alarms– Turn bottle upside down

after taking dose– Mark a checklist

• Store meds in cool dry place

Evaluation p139• Evaluate teaching/learning

– Communication: Does client understand?• Evaluate medication effects

– Drug action/side effects

Promoting Health p139• Prevent infections• Improve nutrition• Encourage exercise and activity• Facilitate social interaction• Promote restful sleep

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