2. Learning Objectives
1. Explain the interaction between
normal aging and responses to drug
therapy in older people.
2. Identify principles of safe medication
management with older persons in a
variety of patient care settings.
3. Discuss measures to prevent and
reduce polypharmacy in older patients.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
3. Learning Objectives
4. Describe assessments to monitor older
patients for adverse drug effects and
polypharmacy.
5. Apply principles of teaching and
learning to promote compliance and
adherence to the medication regimen.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
4. Learning Objectives
6. List nonpharmacological therapies that
may be useful as alternatives to
medications.
7. Discuss issues related to ensuring the
safe use drug therapy by the older
person.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
5. Introduction
• Drug therapy in the older person
presents many challenges in ensuring
the appropriate use of medications.
• The nurse is in a pivotal position to use
nursing assessments and nursing
interventions to promote the
appropriate use of medications.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
6. Cultural Diversity and Medication
Gerontological Nursing, Third Edition
Patricia A. Tabloski
Use
• Cultural diversity and ethnic
background can affect the older
person’s beliefs about health, illness,
medications, and physiological
response to medications.
7. Pharmacodynamic Alterations
• In addition to the alterations due to
normal aging processes, older persons
are more likely to have chronic
pathological conditions that may affect
responses to drugs.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
8. Box 6-1 Definitions of Adverse Drug Reactions and Adverse Drug Events
Gerontological Nursing, Third Edition
Patricia A. Tabloski
9. Adverse Drug Events of Concern in
Older Persons
• Side effects including amnesia,
depression, nausea, vomiting, lethargy,
confusion, and visual disturbances
occur more often in older persons than
in younger patients.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
10. Box 6-2 Heuristic for Remembering Anticholinergic Effects
Gerontological Nursing, Third Edition
Patricia A. Tabloski
11. Box 6-4 Warning Signs of NSAID-Induced Gastric Irritation
Gerontological Nursing, Third Edition
Patricia A. Tabloski
12. Adverse Effects of Interactions
• When multiple medications are used,
there is a greater chance of drug-drug
interactions, ADEs, and ADRs.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
13. Promoting Medication
Effectiveness and Safety
• The nurse has a pivotal role in ensuring
that a person’s drug therapy is both
effective for the person’s condition and
to prevent, detect, or to intervene as
early as possible if the person develops
adverse drug effects.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
14. Promoting Medication
Effectiveness and Safety
• The “five rights” of medication
administration:
–Right patient
–Right drug
–Right dose
–Right route
–Right time
Gerontological Nursing, Third Edition
Patricia A. Tabloski
15. Potentially Inappropriate Drugs
• Some drugs are considered to be
inappropriate to use for older persons
because of their adverse effects.
• “Beers list”
• The nurse can use the list as a basis of
questioning the prescribing clinician
about the appropriateness of a drug
being used in a particular patient.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
16. Appropriate Use of Psychotropics
• The use of psychotropic drugs in older
persons, especially those in institutional
settings, is of concern due to potential
use of these drugs for less than optimal
therapeutic reasons.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
17. Medication Management
• The nurse has a major role in
promoting the safe and effective
management of medications.
• This includes the correct storage,
preparation, and administration.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
18. Medication Management
• The nurse can be instrumental in
promoting compliance and appropriate
management of drug therapy by older
patients or their caregivers in the
home.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
19. Assessing Older Patients’
Appropriate Use of Medications
• Assessment of drug effects is a nursing
responsibility.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
20. Financial Considerations in
Medication Use
• Financial pressures may result in
people taking dangerous actions related
to prescription drugs.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
21. Medicare Part D
• Medicare part D went into effect and
has assisted many with their drug
costs.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
22. Patient and Family Teaching
• Educating patients and families is
critical so that nurses can interpret
scientific data and individualize the
nursing care plan.
Gerontological Nursing, Third Edition
Patricia A. Tabloski
