pharm 12 13

• –Motility decreases
• –pH increases (decreased acid prodcution), may delay availablitly of drugs requiring low ph for absorption
• –Decrease in blood flow
• –Reduced albumin synthesis

• Slows rate of absorption
• Increases time drug remains in digestive tract
• Increases chance of adverse drug reactions

• Increases gastric pH
• May delay availability of drugs requiring a low pH for absorption

• –Heart muscle weakens
• –Cardiac output decreases (slows distribution of nutrients and drugs)
• –Blood pressure increases

• –Blood flow decreases
• –Fewer functional nephrons
• –Renal function declines
• --•Glomerular filtration rate decreases
• --•Results in prolonged exposure to certain medications

• Reduced rate of drug excretion
• Prolonged duration of drug action
• Increased risk of drug interactions

• –Brain mass decreases
• –Quantity of neurons decrease
• --•Cognition and sensory functions decline
• –Blood brain barrier more easily penetrated

• –Insulin secretion decreases
• –Production of growth hormone declines
• -Fat increases, Muscle mass decreases

• •Slower, yet still complete
• •Exaggerated GI adverse effects possible

• •Fat-soluble drugs stored in fat tissue
• •Water-soluble drugs build up in higher concentrations due to decreased total-body water
• •Decreased drug binding to plasma proteins
• --–Results in increased free drug concentrations
• --–Greaterpharmacologic effect
• •Increased permeability of the blood brain barrier leads to an enhanced CNS effects of certain drugs
• •Reduced cardiac output

Liver function declines which leads to higher concentrations of active drug

Renal function declines which leads to an increased serum drug level

• –Beta-receptor agonists
• –Beta-receptor antagonists

• –Anticholinergics
• –CNS depressants
• –Warfarin

• Concentration – phamacokinetics
• Effects– pharmacodynamics

• –Sudden change in mental status
• –Rapid weight loss
• –Restlessness
• –Anorexia
• –Changes in fluid balance
• –Changes in bowel habits

–Drugs that have a high risk of causing adverse drug reactions

–Use of these drugs should be avoided or closely monitored

–Nurses should be familiar with the list and potential adverse effects

• Antihistamines
• Benzodiazepines
• Digoxin (Lanoxin)
• Muscle relaxants
• Nonsteroidal antiinflammatory drugs (NSAIDs)
• Phenytoin (Dilantin)
• Tricyclic antidepressants

Sedation, confusion, anticholinergic effects

Confusion, depression, anticholinergic effects

Reduced renal clearance can cause serious toxicity

Sedation, weakness, anticholinergic effects

Photosensitivity,nephrotoxicity, fluid retention

Confusion, ataxia, slurred speech

Hallucinations, confusion, anticholinergic effects

• –Visual impairment
• –Hearing impairment
• –Functional impairment
• –Cognitive dysfunction

• •Nurses can suggest
• –Daily or weekly pill boxes
• –Calendars to assist in adherence
• –Provide education in a way that is easy to understand
• –Recommend ways to simplify the medication regimen

• •Review patient’s drug profile for any therapeutic duplications
• •Simplify patient’s drug regimen as much as possible
• •Encourage reporting of all OTC and herbal remedies taken
• •Encourage use of one primary care provider and one pharmacy

• •Review all medications (including OTC and herbal supplements) for possible interactions
• •Educate patient on potential interactions with foods
• •Review patients’ comorbid conditions for potential drug – disease interactions

• •Treating the whole person rather than just the symptoms
• •Assessing the entire person when developing pharmacotherapy outcomes
• •To deliver high quality health care the synergy of the individuality and the totality of the patient must be recognized

• •Term used in health care to describe psychological development in context of social environment
• •Involves both social and psychological aspects of a person’s life
• •Includes the spiritual nature of a person
• •Psycho-social-spiritual term used in health care

• •Living arrangements
• •Family involvement/interactions
• •Financial resources
• •Emotional condition
• •Physical condition
• •Cognitive functioning
• •Support (spiritual and relational)

hepatic metabolism

• •Ability of practitioners to provide care to people with diverse values, beliefs, and behaviors
• •Ability to adapt delivery of care to meet needs of these patients
• •Requiresknowledge of diversity
• •Attitude of awareness, openness, and sensitivity

• two or more versions of the same protein created by a mutation
• These proteins are responsible for metabolism, which changes how a drug is metabolised with someone who has a polymorphism
• •Discovered in enzymes that metabolize drugs
• •Discovered in proteins that serve as receptors for drugs
• •Can have an affect on drug action
• –“Mutated” version of enzyme may increase or decrease speed of drug metabolism and excretion

• •Receptors are proteins that accept the endogenous molecule in a lock-and-key type interaction
• •Simple changes in structure can result in defective protein receptor that no longer “accepts” drug
• •Receptor polymorphisms associated with increased risk for schizophrenia, prostate cancer, breast cancer, and many other disorders

• Polymorphism discovered in the enzyme acetyl transferase
• Metabolizes isoniazid (INH), drug prescribed for tuberculosis
• “Mutated” form of enzyme performs metabolic action (acetylation) slower
• Reduced hepatic metabolic process and clearance by kidneys result in INH levels reaching toxic levels

• Slow acetylators are usually Caucasians
• Fast acetylators found in patients of Japanese descent

• Asian Americans have an inherent absence of enzyme debrisoquin
• Defect that interferes with analgesic properties of codeine
• Interferes with metabolism of codeine to
• morphine

• African Americans have decreased effects from beta-adrenergic antagonist drugs (eg. propranolol (Inderal)
• Results from genetically influenced variance in plasma renin levels

Oxidation enzyme polymorphisms alter response to drugs warfarin (Coumadin) and diazepam (Valium)

• –Antihypertensives (beta-blockers) may cause male impotence
• •Males suffer strokes related to abruptly stopping the medication (b/c they have profound rebound htn,
• can’t just stop beta-blocker, it needs to be tapered down)

• –Benzodiazepines
• for anxiety eliminated slower by women
• •More significant if the woman is on oral contraceptives

•Aspirin is more effective in preventing heart attacks in men than women

A pt of African-American background responds better to calcium channel blocker than other meds used to treat htn! (better than beta-blocker, diuretic, etc.)