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Geriatrics
Aging is a normal part of life and every person plays the course a little differently. As an advanced practice registered nurse (APRN) it is important to understand the aging process and how each body system changes throughout that time. Older individuals process drug therapy differently and it is important to note the changes that may need to be made to their medication regimen as a patient gets older (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 73).
Older adults have numerous barriers that they need to overcome, such as multiple medications due to several medical problems. A lag in memory may lead to improper medication administration. Furthermore, a long list of medications could lead to adverse mediation reactions (Arcangelo et al., 2017, p. 73).
Cardiovascular Patients
When looking at the cardiovascular system you are considering the make-up of the vascular system and the heart muscle. The blood flow to each of the body's organs is vital for its survival. Furthermore, medications you give for heart conditions can change the way the heart pumps, how fast it pumps, and how much pressure is within the heart. Each of these factors is extremely important as medications are dosed and determined.
Response to Drug Therapy
Older adults typically have a delayed response to gastric emptying, therefore, this will delay medication absorption. There is also a decreased amount of gastric secretions which will affect mediation absorption (Arcangelo et al., 2017, p. 74).
Older adults naturally have a lower amount of albumin, which is a protein that aids in mediation metabolism. For example, some medications, like propranolol, bind to protein sites. Propranolol is often given for high blood pressure, chest pain, or atrial fibrillation. When the patient takes up less binding sites, the medications takes up more sites and toxicity can occur in the patient. For a patient taking Propranolol, his or her blood pressure may drop more than needed is the dose isn't adjusted with age (Arcangelo et al., 2017, p. 74).
A drop in lean body mass and an increase in total fat also often occur. This is important to note because some medications are absorbed better by lean body mass and the medication will stay in the elderly patient's body longer because they don't have much for lean body mass (Arcangelo et al., 2017, p. 74-75).
The liver metabolizes most of the drugs in the body. In the elderly patients, you see less blood flow and a smaller liver. Again, smaller medication dosages may be needed to prevent hepatic toxicity (Arcangelo et al., 2017, p. 75)
Drug excretion typically happens in the kidneys. Blood flow in the kidneys decreases after the age of 40, so it when giving medications you may have to leave more time between doses to ensure proper clearance (Arcangelo et al., 2017, p. 75).
Drug Therapy
When treating a medical condition like hypertension, the patient will often be prescribed two medications from different classes to fix the problem. This can be beneficial for the patient because less of each medication is being asked to be metabolized through the body. There is a smaller risk the patient will have toxicity of the drug (Huether & McCance, 2017, p. 604).
Furthermore, there are disadvantages for patients taking multiple medications. For example, they are more likely to have a medication reaction. Polypharmacy is a probing problem for older adults, and it cause confusion for these individuals. By keeping there mediations regimen small, compliance is more likely to occur (Agbonjinmi, 2017).
Agbonjinmi, L. A. (2017). Polypharmacy: Inappropriate median use in elderly and its associated
effects. West African Journal Of Nursing, 28(1), 56-65.
Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.).
(2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.).
Ambler, PA: Lippincott Williams & Wilkins.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis,
MO: Mosby.