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Safe drug use in elderly


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Safe drug use in elderly

  1. 1. By Mrs. Rani R. Shetty Asst. Professor L.T.C.N
  2. 2. INTRODUCTION <ul><li>The older population uses a large number and variety of medications. The number of drugs used by elders increases with age ( Kaufman et al 2002). </li></ul><ul><li>Most commonly used drugs </li></ul><ul><ul><li>Cardiovascular agents </li></ul></ul><ul><ul><li>Antihypertensive </li></ul></ul><ul><ul><li>Analgesics </li></ul></ul><ul><ul><li>Acute arthritic agents </li></ul></ul><ul><ul><li>Sedatives </li></ul></ul><ul><ul><li>Laxatives </li></ul></ul><ul><ul><li>Antacids. </li></ul></ul><ul><ul><li>All the above drugs can cause variety of adverse effects. </li></ul></ul>
  3. 3. REASONS FOR ADVERSE REACTIONS <ul><li>Age related differences in </li></ul><ul><ul><li>Absorption </li></ul></ul><ul><ul><li>Distribution </li></ul></ul><ul><ul><li>Metabolism </li></ul></ul><ul><ul><li>Excretion of drugs. </li></ul></ul><ul><li>Age related differences in </li></ul><ul><ul><li>Biological and </li></ul></ul><ul><ul><li>Therapeutic effect of drugs at the site of action or on the target organ. </li></ul></ul>
  4. 4. MEASURES TO IMPROVE ABSORPTION <ul><ul><ul><li>Encourage exercises as it stimulates circulation. </li></ul></ul></ul><ul><ul><ul><li>Use of heat and massages will increase blood flow at the absorption site. </li></ul></ul></ul><ul><ul><ul><li>Prevent fluid volume deficit, hypothermia, and hypotension. </li></ul></ul></ul><ul><ul><ul><li>Do not administer preparations that neutralize gastric secretions if a low pH is required for drug absorption. </li></ul></ul></ul><ul><ul><ul><li>Monitor for drug-drug and drug-food and drug-herb interactions. </li></ul></ul></ul>
  5. 6. Measures to Improve Distribution of Drug <ul><li>Maintain the Following </li></ul><ul><ul><li>Normal circulation. </li></ul></ul><ul><ul><li>Normal membrane permeability. </li></ul></ul><ul><ul><li>Normal Body Temperature. </li></ul></ul><ul><ul><li>Normal S. Albumin and protein levels. </li></ul></ul><ul><ul><li>Monitor for: </li></ul></ul><ul><ul><ul><li>Dehydration. </li></ul></ul></ul><ul><ul><ul><li>Hypoalbumineamia. </li></ul></ul></ul><ul><ul><ul><li>Serum levels of the drug. </li></ul></ul></ul><ul><ul><ul><li>Serum creatinine levels. </li></ul></ul></ul>
  6. 7. Measure to Improve Metabolism, Detoxification and Excretion of Drugs <ul><li>Maintain the following </li></ul><ul><ul><li>Normal liver functions. </li></ul></ul><ul><ul><li>Normal Kidney functions. </li></ul></ul><ul><ul><li>Normal Circulation </li></ul></ul><ul><li>Monitor for: </li></ul><ul><ul><li>Biological half-life of the drug. </li></ul></ul><ul><ul><li>Hydration Status. </li></ul></ul><ul><ul><li>Normal body temperature. </li></ul></ul><ul><ul><li>Renal functions. </li></ul></ul><ul><ul><li>Encourage exercise and adequate Fluid intake. </li></ul></ul>
  7. 9. Monitor for Adverse Reactions <ul><li>Elderly has a high risk for adverse reactions. </li></ul><ul><li>One needs to remember the following facts regarding adverse reactions </li></ul><ul><ul><ul><li>The sign and symptom of an adverse reaction to a given drug may differ in older persons. </li></ul></ul></ul><ul><ul><ul><li>A prolonged time may be required for an adverse reaction to become apparent in the older adults. </li></ul></ul></ul><ul><ul><ul><li>An adverse reaction to a drug may be demonstrated even after the drug has to been discontinued. </li></ul></ul></ul><ul><ul><ul><li>Adverse reactions to a drug that has been used over a long period without problem can develop suddenly. </li></ul></ul></ul><ul><ul><ul><li>An elderly may exhibit varying degrees of mental dysfunctions to commonly used drugs. </li></ul></ul></ul><ul><ul><ul><li>Even most subtle changes in mental states could be linked to a medication and should be reviewed. </li></ul></ul></ul><ul><ul><ul><li>Mental and cognitive problems arising from adverse reactions of drugs should not be treated with drugs. </li></ul></ul></ul>
  8. 10. Safe Practices Check List <ul><li>Before administering drug to an elderly ask for drug history. </li></ul><ul><li>Check the prescriptions for appropriateness of dosages, consider whether the dose is the lowest. </li></ul><ul><li>Consider whether the drug is really needed. </li></ul><ul><li>Instead of a sedative, warm milk and a back rub is given to induce sleep. </li></ul><ul><li>If a person had a bowel movement, withhold laxatives. </li></ul>
  9. 11. <ul><li>Check how long a patient is on a particular medicine and can it be discontinued. </li></ul><ul><li>Check whether a person is allergic to a drug, before administering it. </li></ul><ul><li>Check for new signs of drug reaction. </li></ul><ul><li>Check whether the drug can have interaction with other drugs, herbs or food items. </li></ul><ul><li>Check for any instructions accompanying the drug administration. </li></ul>
  10. 12. <ul><li>Use the preferable routes like IV, inhalation or local application. </li></ul><ul><li>If the elderly cannot swallow the tablet/capsule, then use the liquid form of the drug. </li></ul><ul><li>Instead of suppositories, local application is preferred. </li></ul><ul><li>Check for Hypovolemia, Hypothermia and Hypotension. </li></ul><ul><li>Encourage exercise to enhance absorption. </li></ul>
  11. 13. <ul><li>Maintain low pH by providing neutralizing agents in oral medication. </li></ul><ul><li>Monitor S. Albumin, Creatinine and Urine Creatinine clearance levels. </li></ul><ul><li>Monitor for adverse reactions, even after the drug is discontinued. </li></ul><ul><li>Educate the client and care givers about medication, self administration, ways to improve compliance. </li></ul><ul><li>Schedule administration of drug around certain activities of daily living to avoid forgetfulness. </li></ul>
  12. 14. Conclusion <ul><li>Use Drugs cautiously in Older People. </li></ul><ul><li>The benefits of a drug should outweigh the risks and adverse reactions. </li></ul><ul><li>It should do more good than harm. </li></ul><ul><li>Encourage Life Style changes such as </li></ul><ul><ul><li>Diet modification. </li></ul></ul><ul><ul><li>Regular exercise. </li></ul></ul><ul><ul><li>Effective stress management techniques. </li></ul></ul><ul><ul><li>Regular schedules for sleep, rest and elimination. </li></ul></ul><ul><li>Avoid over the counter medication and drug dependence. </li></ul>