NURS 6540 Week 4: Pharmacology and Aging Essay Assignment Paper

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NURS 6540 Week 4: Pharmacology and Aging Essay Assignment Paper

NURS 6540: Advanced Practice Care of Frail Elders | Week 4

While advancements in pharmacology and medicine have enabled patients to live longer, healthier lives, there are risks associated with pharmacology and geriatric patients. Studies have shown that approximately half of hospitalizations for adverse drug events involve geriatric patients (Budnitz, Lovegrove, Shehab, & Richards, 2011). This can be contributed to body changes due to aging, as well as issues with polypharmacy. Consider Maynard Merel, a 91-year-old patient who takes 10 different pills every day. He has been diagnosed with multiple disorders, including hyperlipidemia, hypertension, an underactive thyroid, and chronic asthma. In addition to the risks of taking multiple drugs at one time, he faces problems with remembering which drug serves which purpose and how much to take of each (Ahuja & Salahi, 2011). Like Merel, many geriatric patients have multiple health issues often resulting in polypharmacy and further increasing risks of adverse drug events. As an advanced practice nurse, you must be aware of potential risks associated with geriatric patients and prescription drugs, over-the-counter drugs, and herbal treatments.

This week, as you examine pharmacology and aging, you focus on implications of over-the-counter drug use in geriatric patients. You also explore strategies for educating these patients on the use of over-the-counter drugs. Then, you consider implications of medication adherence for the geriatric population, as well as strategies to improve adherence.

Learning Objectives

By the end of this week, students will:

• Analyze potential implications of the use of over-the-counter drugs for frail elders
• Analyze strategies for educating geriatric patients on the use of over-the-counter drugs
• Evaluate implications of geriatric medication adherence issues on patient health
• Design strategies to improve medication adherence for geriatric patients
• Analyze aging theories in nursing practice*
• Analyze implications of age-related changes in geriatric patients*
• Analyze the use of functional assessments to distinguish between normal and abnormal implications of aging*
• Evaluate diagnoses for patients*
• Evaluate treatment and management plans*

*These Learning Objectives support assignments that are due this week, but were assigned in Weeks 1–3.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

• • Chapter 12, “Pharmacotherapy” (pp. 84-92)

This chapter explores principles of pharmacotherapy for geriatrics, including age-associated changes in pharmacokinetics and pharmacodynamics. It also examines common drug-related issues specific to the geriatric population, such as overprescribed and under-prescribed medications, adverse drug reactions, drug-disease interactions, and nonadherence to medications.

American Geriatrics Society 2015 Beers Criteria Update Expert Panel, Fick, D. M., Semla, T. P., Beizer, J., Brandt, N., Dombrowski, R., … & Giovannetti, E. (2015). American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63(11), 2227–2246.

American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society 2015 Beers Criteria Update Expert Panel, Fick, D. M., Semla, T. P., Beizer, J., Brandt, N., Dombrowski, R., … & Giovannetti, E., in Journal of the American Geriatrics Society, Vol. 63/Issue 11. Copyright 2015 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

This article examines three categories of medications that impact older adults: those that are potentially inappropriate and must be avoided, those that are potentially inappropriate and must be avoided in older adults with certain diseases, and those that must be used with caution.

Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.

 

• • Chapter 3, “Simplifying the Pillbox: Drugs and Aging” (pp. 25–42)

This chapter examines appropriate prescribing methods, as well as inappropriate prescribing methods, in older adults. It then identifies drugs that are potentially inappropriate in older adults aged 65 years and over and older adults with specific health conditions. It also proposes strategies for maintaining drug adherence in older adult patients.

Budnitz, D., Lovegrove, M., Shehab, N., & Richards, C. (2011). Emergency hospitalizations for adverse drug events in older Americans. The New England Journal of Medicine, 365(21), 2002–2012.

This article examines the impact of adverse drug events on hospitalizations in older adults. It also identifies strategies for reducing hospitalizations as a result of adverse drug events.

Hines, L., & Murphy, J. (2011). Potentially harmful drug-drug interactions in the elderly: A review. American Journal of Geriatric Pharmacotherapy, 9(6), 364–377.

Potentially harmful drug-drug interactions in the elderly: A review by Hines, L., & Murphy, J., in the American Journal of Geriatric Pharmacotherapy, 9(6). Copyright 2011 by Elsevier Rapid Publications. Reprinted by permission of Elsevier Rapid Publications via the Copyright Clearance Center.

This article explores factors and age-related changes that make the elderly more susceptible to drug interactions. It also identifies drugs that increase risk of hospitalization in older adults, as well as strategies for minimizing risks.

Hoskins, B. L. (2011). Safe prescribing for the elderly. Nurse Practitioner, 36(12), 47–52.

This article describes strategies for safe and effective prescribing in older adults and explores age-related changes that impact pharmacokinetic and pharmacodynamic processes.

Required Media

Laureate Education (Producer). (2014). Drug interactions [Multimedia file]. Baltimore, MD: Author.

This interactive media piece explores pharmacology and polypharmacy issues with frail elder patients.

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Discussion: Over-the-Counter Drugs

Pharmacokinetic and pharmacodynamic processes differ among patients across their life spans. For geriatric patients, alterations due to aging make them especially prone to adverse drug reactions. The various health issues that affect many geriatric patients further complicate this, as the need to treat these multiple health issues often results in polypharmacy. Although treatments are frequently drugs prescribed by the health care provider, many geriatric patients also take over-the-counter (OTC) drugs. While the provider sometimes recommends these OTC drugs, patients often select the drugs on their own. This makes patient education on pharmacology key when caring for geriatric patients. Many patients assume that if drugs are available over the counter, then they are safe to take. However, due to issues related to polypharmacy and how their aging bodies process drugs, OTC drugs may have serious implications for patients.

To prepare:

• Review the American Geriatrics Society article and interactive media piece in this week’s Learning Resources.
• Select one of the following over-the-counter drugs commonly used by geriatric patients:
  • Antacids or acid suppressants
  • Antidiarrheal
  • Antihistamines
  • Antimicrobial ointments
  • Antispasmodics for the bladder
  • Cough suppressants
  • Laxatives
  • Neutraceuticals (choose one; e.g., ginseng, St. John’s wart, etc.)
  • Pain medications (choose one; e.g., acetaminophen, ibuprofen, rub-on pain ointments/patches, etc.)
  • Supplements (choose one; e.g., calcium, iron, etc.)
  • Vaginal creams
• Research the over-the-counter drug you selected. Visit a local pharmacy and explore the types/varieties of the drug that are available. Reflect on the ingredients in each type/variety, including additional active ingredients.
• Consult with the pharmacist about the ingredients in each type/variety, including how to make safe and effective clinical decisions in relation to this drug. Discuss potential interactions in frail elders and precautions related to the drug based on Beers Criteria. If one is available, you may consult with a pharmacist at your practicum site as an alternative to visiting a pharmacy.
• Consider ways to educate elders about the OTC drug you selected.

By Day 5

Post a PowerPoint presentation that addresses the following:

• Describe the over-the-counter drug that you selected.
• Identify the types/varieties of the drug that are available. Describe the ingredients in each type/variety including additional active ingredients.
• Explain the key information that you need to know about this OTC drug to make safe and effective clinical decisions. Include potential interactions in frail elders and describe any precautions related to the drug based on Beers Criteria.
• Explain how you would educate elders about the OTC drug you selected.

Read a selection of your colleagues’ responses.

By Day 7

Respond to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected a different drug than you did.

• Suggest additional interactions in frail elders that may be caused by the ingredients in your colleagues’ drugs.
• Provide insights to drug-drug interactions between the drug you selected and the drugs your colleagues selected.
• Validate an idea with your own clinical experiences and additional literature search.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

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