Ch. 5 - Pharmacology and Adults & Geriatrics
What phenomenon is primarily responsible for the changes in pharmacokinetics that accompany the aging process? a. Decreased function of vital organs b. Hemodynamic changes c. Changes in concentration and decision-making ability d. Increased prevalence of chronic diseases
a. Decreased function of vital organs Rationale: Aging results in physiologic changes that affect the absorption, distribution, metabolism, and excretion of medications. The most relevant physiologic change is the decreased function of vital organs needed for the pharmacokinetic processes. None of the other suggested options present such a degree of change.
What factors contribute to the decrease in absorption that accompanies aging? Select all that apply. a. Decreased gastric emptying b. Decreased blood flow in the GI tract c. Increased GI motility d. Decreased surface area of the GI tract e. Decreased gastric pH
a. Decreased gastric emptying b. Decreased blood flow in the GI tract d. Decreased surface area of the GI tract Rationale: In older adults, changes in the GI tract include decreased gastric acidity, with an increase in the gastric pH, and delayed absorption or lack of absorption of medications that require this decreased pH. Other changes in the GI tract responsible for affecting drug absorption in older adults are decreased blood flow and decreased surface area to support absorption. Motility is slower, not faster, in older adults.
The nurse is caring for an older adult client who has been prescribed multiple medications. How can the nurse best work with the care team to prevent polypharmacy-related issues? a. Ensure that each of the client's medications is genuinely necessary and discontinue those that are not. b. Ensure that the client's medications are administered at varied times throughout the day to reduce adverse effects. c. Teach the client the importance of having all prescriptions filled at one pharmacy. d. Encourage the client to taper down the dosages of medications once symptoms abate.
a. Ensure that each of the client's medications is genuinely necessary and discontinue those that are not. Rationale: Polypharmacy is a common phenomenon among older adults, and it can be mitigated by discontinuing medications that can potentially interact or that may not be unequivocally necessary. Changing the timing of administration or relying on one drug store do not adequately address polypharmacy. Clients should never be encouraged to unilaterally reduce their medication dosages.
Race is a variable that is known to influence what aspect of pharmacokinetics in older adults? a. Metabolism b. Absorption c. Administration route d. Distribution
a. Metabolism Rationale: Some responses to drug therapy are genetically determined and may differ in various ethnic and racial populations. Clients of Asian descent can metabolize and excrete medications more quickly than White or Black clients. As a result, circulating levels of medication are higher in the latter populations. None of the other aspects of pharmacokinetics is impacted as dramatically. Administration route is not an aspect of pharmacokinetics.
An older adult client taking a diuretic for hypertension has had two falls in the period of a week. The primary health care provider's willingness to consider discontinuation of the medication demonstrates a consideration of what safety-related issue? a. Risk-to-benefit ratio b. Changing pharmacodynamics in older adults c. Beers criteria d. Consequences of polypharmacy
a. Risk-to-benefit ratio Rationale: The presence of two falls while taking a drug that can cause orthostatic hypotension represents a serious risk that likely exceeds the therapeutic benefit of this drug. This scenario does not involve the administration of multiple drugs (polypharmacy) or pharmacodynamics. Diuretics are not included on the Beers list.
The child of an older adult client states that the client has developed a rash on the upper torso and has been taking diphenhydramine hydrochloride to relieve the associated pruritus. What question should the nurse ask the client to assess for the presence a. ''Have you fallen since starting the medication?'' b. ''Have you been having any difficulty urinating?'' c. ''Have you noticed a decrease in your appetite lately?'' d. ''Do you have a history of liver failure?''
b. ''Have you been having any difficulty urinating?'' Rationale: Diphenhydramine hydrochloride is included on the Beers list due to the risk of urinary retention among older adults. None of the other options are relevant to this medication
The ability of older adults to adequately distribute drugs that are ingested is highly dependent on serum levels of what factor? a. Blood urea nitrogen b. Albumin c. Sodium d. Creatinine
b. Albumin Rationale: Many medications require serum albumin to bind, transport, and distribute the medication to the target organ. In the event that the amount of serum albumin is insufficient, the amount of free drug rises and the effect of the drug is more intense. Distribution is not directly dependent on levels of sodium, creatinine, and BUN.
To reduce older adults' risk of experiencing adverse drug effects or interactions, what action should the nurse prioritize? a. Encourage clients to taper down their dosages until they sense the reemergence of symptoms. b. Assess clients' use of herbal remedies and over-the-counter (OTC) medications. c. Assess the degree to which clients understand the indications for their medications. d. Encourage clients to seek a second opinion whenever prescribed a new drug.
b. Assess clients' use of herbal remedies and over-the-counter (OTC) medications. Rationale: To prevent adverse effects, the nurse should assess clients' health history and list of medications, including prescription medications, over-the-counter medications, and herbal supplements. Clients should never be encouraged to adjust their drug dosages. A second opinion is not always necessary and may not reduce the risk of adverse effects. Assessing clients' understanding of their medications is important, but this action may or may not directly reduce the risk of adverse effects.
An older adult client intends to supplement a prescribed anti-inflammatory with a herbal remedy that a neighbor strongly recommended. What action should the nurse encourage the client to take before initiating that plan? a. Asking for more information about this particular supplement b. Checking with the health care provider before taking the supplement c. Beginning with low, slow dosing of the supplement d. Doing personal research before beginning to use the supplement
b. Checking with the health care provider before taking the supplement Rationale: To prevent potentially adverse effects, clients must be urged to liaise with their health care providers before adding over-the-counter medications or supplements to their medication regimens. None of the other options provide as well for the client's safety and avoidance of adverse effects.
The nurse should caution an older adult client against using diphenhydramine hydrochloride because of what increased risk? a. Fevers b. Confusion c. Diarrhea d. Excitability
b. Confusion Rationale: Diphenhydramine hydrochloride should be avoided by older clients since it is included on the Beers list because of the risk of confusion. This medication is not known to have the risks associated with other options.
When conducting health promotion education with older adults, the nurse should encourage what intervention to help reduce their risks of altered drug responses? a. Increasing fluid intake b. Regular use of multivitamins c. Frequent physical activity d. A low-fat, high-protein diet
c. Frequent physical activity Rationale: The more physically active older adults are, the less likely they will experience altered drug responses. The other listed measures are conducive to health, but they may not affect the risks of altered drug responses among older adults.
The client's admission blood work indicates a low creatinine clearance rate (CrCl). A low CrCl may have what implication for the client's pharmacotherapy? a. The client may require higher doses to achieve therapeutic effect. b. The client may require small, frequent doses of a drug. c. The client may require lower-than-normal doses of a drug. d. The client may require oral, rather than IV, drug administration.
c. The client may require lower-than-normal doses of a drug. Rationale: Low CrCl implies diminished excretion, necessitating lower doses of many drugs. Alternative routes and timing do not compensate for this physiologic change.
An older adult client has presented with signs and symptoms that are suggestive of a urinary tract infection. Which prescribed medication would alert the nurse to the client's increased risk of nephrotoxicity? a. Ciprofloxacin b. Cephalexin c. Trimethoprim-sulfamethoxazole d. Nitrofurantoin
d. Nitrofurantoin Rationale: Nitrofurantoin has been linked with renal toxicity in older adults. None of the other medications are associated with nephrotoxicity.
