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Pharmacologic aspects of aging

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  • Toxicology - the study of the adverse effects of chemicals on living organisms
  • polypharmacy: the administration of multiple medications at the same time; common in older persons with several chronic illnesses
  • Phenytoin acts as anticonvulsant for epilepsy Phenothiazines Any of a group of drugs derived from this compound and used as tranquilizers in the treatment of psychiatric disorders, such as schizophrenia
  • The actions of the drug on the body are termed pharmacodynamic
  • Perfusion – delivery of nutrients through arterial blood to capillary
  • With advanced age, body weight, total body water, lean body mass, and plasma albumin (protein) all decrease, while body fat increases. Consequently, agents that are highly protein-bound have fewer binding sites and higher pharmacologic activity, whereas fat-soluble agents have more binding sites, and therefore enhanced storage and delayed elimination.
  • Diabetic neuropathy - neuropathic disorders that are associated with diabetes mellitus; complication of diabetes causing damage to the nerves Osteoarthritis  is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. Parkinson's disease  (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells
  • Passive exercise:  This type is for people who cannot actively participate in exercise. No effort is required from them. The therapist moves their limbs
  • Proprioceptors are specialized sensory receptors on nerve endings found in muscles, tendons, joints, and the inner ear. These receptors relay information about motion or position and make us aware of our own body position and movement in space. Proprioceptors detect subtle changes in movement, position, tension, and force, within the body.
  • Impulsive behavior - action initiated without due consideration or thought as to the costs, results, or consequences
  • Polyuria - excessive or abnormally large production and/or passage of urine
  • fecal impaction  is a solid, immobile bulk of human feces that can develop in the rectum as a result of chronic constipation
  • Anticholinergics are a class of medications that inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells Alpha -blockers are useful in the treatment of primary hypertension calcium channel blockers  (CCBs) are a class of drugs and natural substances that disrupt the calcium (Ca2+) conduction of calcium channels
  • An  indwelling urinary catheter  is one that is left in place in the bladder.
  • Pneumocystis carinii pneumonia - caused by the yeast-like fungus found in the lungs of people Kaposis Sarcoma – tumor in skin Wasting syndrome – Cachexia loss of body mass that cannot be reversed nutritionally: even if the affected patient eats more HIV encephalopathy - AIDS dementia complex - infection and latter impairment of the neural cells by HIV
  • Transcript

    • 1. PHARMACOLOGIC ASPECTS OF AGING
    • 2. What is Pharmacology?
      • from Greek  pharmakon , "drug"; and  logia meaning study
      • study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function
      • It encompasses drug composition and properties, interactions, toxicology, therapy, and medical applications and antipathogenic capabilities
    • 3. How Does it Affect the Older People
      • Medications have improved the health and well-being of older people by alleviating symptoms of
        • discomfort
        • treating chronic illnesses
        • curing infectious processes.
      • Problems commonly occur, however, because of medication interactions, multiple medication effects, multiple medication use ( polypharmacy), and noncompliance
    • 4. Medications Given to Elders, if not Monitored Properly can
      • Depress appetite
      • cause nausea and vomiting
      • irritate the stomach
      • Cause constipation or diarrhea
      • decrease absorption of nutrients
      • alter electrolyte balance and carbohydrate and fat metabolism.
    • 5. Examples
      • antacids, which produce thiamine(Vit B1) deficiency
      • cathartics, which act as laxative
      • antibiotics and phenytoin, which reduce utilization of folic acid
      • phenothiazines, estrogens, and corticosteroids, which increase food intake and cause weight gain
    • 6. Altered Pharmacokinetics
      • Pharmacokinetics is the study of the actions of medications in the body, including the processes of absorption, distribution, metabolism, and excretion.
    • 7.  
    • 8.
      • Changeability in those processes in older people is caused, in part, by a reduced capacity of the liver and kidneys to metabolize and excrete the medications and by lowered efficiency of the circulatory and nervous systems in coping with the effect of certain medications.
    • 9. Nursing Implications
      • Medications removed from the body primarily by renal excretion remain in the body for a longer time in people with decreased renal function.
      • Medications with a narrow safety margin (eg, digitalis glycosides) must be administered cautiously.
    • 10.
      • A decline in cardiac output may decrease the delivery rate to the target organ or storage tissue.
      • The circulatory and central nervous systems of older people are less able to cope with the effects of certain medications, even when blood levels are normal.
    • 11.
      • Unusual responses to medications may manifest as toxic reactions and complications.
      • As a result of a slowing metabolism, medication levels may increase in the tissues and plasma, leading to prolonged medication action.
    • 12.
      • Many elderly people have multiple medical problems that require treatment with one or more medications.
      • The possibility of interactions between medications is further magnified if the older person is also taking one or more over-the-counter medications.
    • 13.
      • A high-fiber diet and the use of psyllium (Metamucil) or other laxatives may accelerate gastrointestinal transport and reduce absorption of medications taken concurrently.
      • If, for any reason, a patient is not dependable about taking medication, the nurse must be sure that the pill or capsule is actually swallowed and not retained between the cheeks and the gums or teeth.
    • 14. Teaching Self Administration of Medication
      • Considerations:
        • requires asking the patient questions
        • requesting return demonstrations to ensure that learning has occurred
        • Sensory and memory losses, as well as decreased manual dexterity, can affect the patient’s ability to carry out instructions properly
        • Need assistance from significant other/caregiver.
    • 15. Steps
      • Explain the action, side effects, and dosage of each medication.
      • Write out the medication schedule.
      • Suggest the use of a multiple-day, multiple-dose medication dispenser to help patients adhere to the medication schedule
    • 16.
      • Destroy old, unused medications.
      • Review the medication schedule periodically.
      • Discourage the use of over-the-counter medications and herbal agents without consulting a health professional.
      • Encourage the patient to take all medications, including over-the-counter medications, with him or her regularly when visiting the primary health care provider.
    • 17. GERIATRIC SYNDROMES: MULTIPLE PROBLEMS WITH MULTIPLE ETIOLOGIC FACTORS
    • 18. What are these Syndromes?
      • Impaired Mobility
      • Dizziness
      • Falls and Falling
      • Urinary Incontinence
      • AIDS
    • 19.
      • These syndromes happen because old people are frail.
      • The term “frail” is used to describe those elders who are at highest risk for adverse health outcomes or geriatric syndromes.
      • Early intervention can prevent further complications and help to maximize the quality of life for many older people
    • 20.
      • Frail people are those who are most vulnerable to significant problems because they meet one or more of the following conditions:
        • Being unable to perform IADLs or ADLs independently
        • Suffering from multiple chronic diseases
    • 21. Impaired Mobility
      • Impaired Physical Mobility
        • subject with a physiological defect or deficiency regardless of its cause, nature or extent that renders the person unable to move about without assistive devices that limit the person's functional ability to ambulate, climb, descend, sit or rise or to perform any related function
    • 22.
      • Common causes
        • Parkinson’s disease
        • Diabetic neuropathy
        • Cardiovascular compromise
        • Osteoarthritis
        • Osteoporosis
        • Sensory deficits
    • 23.
      • Elderly patients should be encouraged to stay as active as possible to avoid the downward spiral of immobility
      • During illness, bed rest should be kept at minimum as it may lead to deconditioning and other complications.
    • 24.
      • If bed rest is unavoidable, patient should perform range of motion and strengthening exercises with the unaffected extremities.
      • Nurse should perform passive RoM Exercises on the affected extremities.
      • Frequent position changes help offset the hazards of immobility.
    • 25. Dizziness
      • Painless and lightheadedness discomfort.
      • Older people frequently seek help for dizziness, which presents a particular challenge because there are so many possible internal and external causes
    • 26.
      • It is further complicated because of an inability to differentiate between:
        • true dizziness (a sensation of disorientation in relation to position)
        • vertigo (a spinning sensation)
    • 27. Causes of Dizziness
      • Minor b uild up of ear wax can result in
        • loss of balance
        • subsequent fall and injury
      • Severe Dysfunction of:
        • Cerebral Cortex
        • Cerebellum
        • Brain stem
        • Proprioceptive receptors
        • Vestibular system
    • 28. Where are Proprioceptors Found?
      • Muscle spindles (stretch receptors) . These are the primary proprioceptors in the muscle that are sensitive to changes in muscle length .
      • The golgi tendon organ . This proprioceptor in the tendon near the end of the muscle fiber is sensitive to changes in muscle tension .
      • The pacinian corpuscle . This proprioceptor is responsible for detecting changes in pain and pressure within the body
    • 29. Falls and Falling
      • Major cause of trauma in the elderly, falls are not often fatal but do threaten health and the quality of life
      • Falling is a common and preventable source of mortality and morbidity in older adults
    • 30. Risk Factors that contribute to Falling
      • Visual changes or impairment
        • loss of depth perception
        • loss of visual acuity
        • difficulty in light accommodation
      • Neurologic changes
        • loss of balance
        • Dizziness
        • loss of position sense
        • delayed reaction time
    • 31. Cont.
      • Cognitive changes
        • include confusion
        • loss of judgment
        • Impulsive behavior
      • Musculoskeletal changes
        • altered posture stability like osteoporosis, stroke and Parkinson’s disease
        • decreased muscle strength or muscle weakness
    • 32.
      • Some studies showed that elderly people who fall experience a greater decline in their ability to perform ADLs or Activities of Daily Living.
      • The most common fracture occurring from a fall is hip fracture resulting from the combined osteoporosis and the condition or situation that provoked the fall.
    • 33. Forms of Restraints Used in Institutionalized Elderly People
      • Physical Modalities
        • Geriatric Chairs
        • Lap Belts
        • Vest, Waist, Jacket Restraints
      • Chemical Modalities
        • Medication
      • NOTE: May precipitate injuries than they were meant to prevent.
    • 34.
      • Documented injuries and deaths resulting from these restraints include
        • Strangulation
        • Vascular and neurologic damage
        • Pressure ulcers
        • Skin tears
        • Fractures
        • increased confusion
        • Significant emotional trauma
    • 35. Rehabilitative strategies to prevent Fall
      • therapeutic exercise
      • wearing proper footwear
      • utilizing appropriate ambulation devices
    • 36. Environmental Strategies to Prevent Falling
      • Maintain an appropriate bed height. 
      • Equip the individual's bed with a transfer bar to support safe transfers. 
      • Install toilet grab bars to support toilet transfers.
      • Provide a bedside commode to support safe toileting activities
    • 37. Urinary Incontinence
      • The unplanned loss of urine.
      • Affects up to 50% of community-residing older adults and approximately 75% to 85% of nursing home residents.
      • Normal urination requires intact neural control, intact anatomic structures, mobility, and awareness of need to urinate.
    • 38.
      • Other measures that help prevent episodes of incontinence include having quick access to toilet facilities and wearing clothing that can be unfastened easily.
    • 39. Types of UI
      • Transient Incontinence
      • Urge incontinence
      • Stress incontinence
      • Overflow incontinence
      • Functional incontinence
      • Mixed incontinence
    • 40. Transient
      • Transient incontinence  is characterized by the sudden onset of potentially reversible symptoms or medical conditions.
      • The patients may be suffering from delirium, urinary tract infection, atrophic vaginitis, psychological problem (such as depression), endocrine disorder, impaired immobility and/or stool impaction. It may be due to drugs such as diuretics and sedatives.
    • 41. Attributed Transient UI Causes
      • According to Brunner and Suddhart’s Med. And Surg. Textbook
      • D elirium and dehydration;
      • R estricted mobility and restraints;
      • I nflammation, infection, and impaction;
      • P olyuria
    • 42. Attributed Transient Causes
      • According to Agency for Health Care Research and Quality (AHRQ)
        • D elirium
        • I nfection
        • A trophy
        • P harmaceuticals
        • P sychological
        • E ndocrine or excess urine output
        • R estricted mobility
        • S tool impaction
    • 43. Urge Incontinence
      • Associated with a strong urge to void.
      • Caused by overactive detrusor muscle that contracts prematurely, referred to as detrusor instability
      • Involuntary bladder contraction caused by inflammation or irritation within the bladder.
      • Uncontrollable contractions can also occur when the brain centre that inhibits bladder contractions is impaired by neurologic conditions such as stroke, Parkinson’s disease or dementia
    • 44. Stress Urinary Incontinence (SUI)
      • Also known as effort incontinence
      • Essentially due to insufficient strength of the pelvic floor muscles. It is the loss of small amounts of urine associated with coughing, laughing, sneezing, exercising or other movements that increase intra-abdominal pressure and thus increase pressure on the bladder
    • 45. Overflow Incontinence
      • involuntary loss of urine resulting from an over-distended bladder.
      • may be caused by an inactive or acontractile detrusor, or bladder outlet or urethral obstruction.
      • In men, it is often related to enlarged prostate and impacted feces.
    • 46. Functional Incontinence
      • is the involuntary urine loss caused by factors outside the lower urinary tract such as impairment of physical or cognitive functioning, or both.
      • It is important to note that immobile and cognitively impaired individuals may also have other types and causes of UI
    • 47. Mixed Incontinence
      • is a combination of both stress and urge incontinence. It is most common in older women.
    • 48. Strategies for Continence Promotion and Management of UI
      • Factors to be considered
        • Communication
        • odor control
        • skin care
        • regulation of fluid balance
        • Physical environment like poor lighting
        • review of the person’s medication as there are drugs that may contribute to UI
    • 49. Common Drug Causes of Incontinence  
      • Anticholinergics
      • Alpha antagonists
      • Diuretics (including caffeine)
      • Calcium channel blockers
      • Sedative hypnotics and any CNS depressants, including ETOH
    • 50. Behavioral Intervention
      • Toileting assistance
        • Timed voiding/ scheduled toileting
        • Habit training
        • Prompt/Timely voiding
      • Pelvic floor muscle exercise or Kegel’s exercise.
    • 51. Other Measures & Support
      • Intermittent urinary catheterization
      • Indwelling urinary catheterization
      • External collection system
      • Absorbent products
      • Dietary and fluid management
    • 52. AIDS in Older Adults
      • Acquired Immunodeficiency Syndrome or AIDS  is a disease of the human immune system caused by the human immunodeficiency virus (HIV)
      • This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors.
    • 53. Mode of Transmission
      • HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, pre-seminal fluid, and breast milk.
    • 54.
      • This transmission can involve 
        • anal vaginal or oral sex
        • blood transfusion
        • contaminated hypodermic needles
        • exchange between mother and baby during pregnancy and childbirth, breastfeeding 
        • other exposure to one of the above bodily fluids.
    • 55.
      • According to a report of the Centers for Disease Control and Prevention, between 1981 to 1989, more than 10% of all AIDS patients in US were 50 years of age or older at the time of diagnosis, and about 3% were age 60 years or older.
    • 56. Common AIDS-indicator diseases in older people are
      • Pneumocystis carinii pneumonia.
      • Malignancies such Kaposis Sarcoma
      • Wasting syndrome
      • HIV encephalopathy
    • 57.  
    • 58. Pneumocystis carinii pneumonia
    • 59. Wasting Syndrome
    • 60.  
    • 61. END Thank you!!
    • 62.  
    • 63.  
    • 64.