Exam 3: NURS5333/ NURS 5333 (Latest 2024/ 2025 Update) Family I | Qs & As| 100% Correct| Grade A (Verified Answers)

Exam 3: NURS5333/ NURS 5333 (Latest 2024/ 2025 Update) Family I | Qs & As| 100% Correct| Grade A (Verified Answers) Q: Four specific classifications of medications accounted for over two-thirds of these visits Answer: -That is warfarin, insulin, oral hypoglycemic medications, and oral anti-platelet medications. Q: They---- so there's excessive prescribing, and there's poor adherence in this population, as well. There's several reasons for the poor adherence. Some of it is they can't afford the medications Answer: have multiple drug therapy, Q: Prescribing RX for elders Answer: You have to have these patients return to the office frequently. Their regimen must be adhered to. The goals of treatment are to reduce the symptoms and improve the quality of life. Q: pharmacokinetic changes in older adults Answer: Q: Absorption. With aging, the GI tract does produce less acid and fewer parietal cells, but the change is too small to be clinically relevant. Frail, older adults don't have very much subcutaneous fat. Answer: However, the small change can become significant in the presence of certain drugs, such as proton pump inhibitors. Q: Absorption. With aging Answer: There's also decreased active transport of some drugs, so it can decrease bioavailability. The rate of absorption also slows with age. There's an increase in total body fat, and a decrease in subcutaneous fat. Q: Frail, older adults don't have very much subcutaneous fat to absorb RX such as? Answer: This decreases the absorption of transdermal drugs. This can be impor- tant if you're trying to manage pain with transdermal patches. -Delayed gastric emptying can also occur, and reduced splanchnic blood flow, also. Q: With Distribution Answer: There's also an increased percentage of body fat. Lipid-sol- uble drugs, such as benzodiazepines, have a higher tendency to accumulate in the adipose tissue, resulting in lower serum concentrations, but it also increases the duration of action, due to an increased half-life, because the drugs tend to hang around there in the adipose tissue. -lean muscle mass decreases about 20%, in total body water by 10-15%, causing changes in the distribution of many drugs Q: Pharmaceutical agents primarily distributed in lean body mass or body water reach higher serum concentrations in older adults Answer: -lean muscle mass decreases about 20%, in total body water by 10-15%, causing changes in the distribution of many drugs Q: Normal aging also results in a decrease by as much as 20% of serum albumin levels. Albumin is the primary drug-binding protein in the plasma.- Answer: The consequence of this lowered serum albumin level is fewer protein molecules available for binding to the drug, and higher levels of the free or unbound drug. Q: Metabolism of rx with elderly Answer: metabolism, this brings up the hepatic metabo- lism, and this declines with age. This is your CYP450 Q: Metabolism:decreases with age, causing a decrease with the drug clear- ance and an increased half-life. Answer: SO=This alters drug-drug interactions, as well. First-pass metabolism also decreases, and so drugs that undergo the first-pass me- tabolism have an increased bioavailability and decreased amounts of the prodrugs Q: Most drugs are eliminated through the kidney Answer: generally about a 50% decline in renal function. This decreases tubular secretion and decreases the renal clear- ance of drugs. Q: because of the decrease in kidney function, this is the most important cause of adverse drug reactions in the older adult population. Answer: -the decrease in kidney function, this is the most important cause of adverse drug reactions in the older adult population -examples of drug classes that there's evidence of age-related reduction in clear- ance include your antihypertensives, your fibrates, your sedatives and hypnotics, and your anxiolytic medications Q: Creatinine clearance is evaluated best with the Cockcroft-Gault Equation- Answer: Renal function needs to be assessed, what the best method? Q: Alterations in receptor properties may underlie sensitivity to some drugs such as -there's a reduction in the number of beta-receptors, and there's a reduction in the affinity of beta-receptors for beta-receptor blocking agents Answer: Drugs with more intense effects are warfarin and CNS depressants. Beta-blockers in the elderly are? Q: reduced thermoregulatory ability, and this increases hypothermia risk Answer: Has a direct effect on the phenothiazines, the VDCs, and the TCAs, and narcotics. Q: impaired baroreceptor function and altered fluids, which can cause Answer: postur- al hypotension with anti-hypertensives, and TCAs, and MAOIs, and antihistamines. Q: Adverse Drug Reactions are seven times more likely in the elderly: high risk for drug interactions, not only because of physiologic changes, but be- cause of the medication practices of both health care providers and patients- Answer: -non-adherence with drug therapy, either intentional or unintentional, and this is reported in up to 50% of older adults -Symptoms in older adults are often nonspecific, and they can just be dizziness or cognitive impairment.