After studying Module 4: Lecture Materials & Resources, discuss the following:

  • Therapeutic drug monitoring is a frequent practice in health care. How does age affect drug absorption, metabolization and excretion?
  • The use of salt substitutes can cause hyperkalemia in older adults when use in conjunction with what types of drugs?
  • Describe how you would prevent and evaluate risk factors for medication nonadherence in older adults?

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

 

Read and watch the lecture resources & materials below early in the week to help you respond to the discussion questions and to complete your assignment(s).

Read

Watch

Chapter 15

Laboratory and Diagnostic Tests

Copyright © 2019, by Elsevier Inc. All rights reserved.

Aging does not affect the life span of an erythrocyte, but replenishment after bleeding may be delayed due to a decrease in hematopoietic tissue in the marrow of the long bones.

Anemia may be unnoticed if it is mild.

Anemia symptoms include fatigue, shortness of breath, and paresthesia.

Chronic pulmonary disease or heart failure may led to overproduction of RBCs—polycythemia.

Red Blood Cells

Copyright © 2019, by Elsevier Inc. All rights reserved.

2

Hematocrit and hemoglobin values decline slightly after the age of 90.

Hemoglobin and Hematocrit

Copyright © 2019, by Elsevier Inc. All rights reserved.

3

Decrease in leukocytes may be related to drugs or severe infection.

Increase in leukocytes is generally seen with infections.

White cell count may be only moderately elevated in older adults with infection like pneumonia.

Other typical symptoms of infection such as fever, pain, and lymphadenopathy may be minimal or absent in older adults with infections, therefore look for sudden onset of confusion or lethargy.

Drugs can also cause an increase in leukocytes.

White Blood Cells

Copyright © 2019, by Elsevier Inc. All rights reserved.

4

4

Reduced effect on the bone marrow to release and store neutrophils

Impaired function of lymphocytes in vitro is suspected to cause a reduction in antibody response in later life.

Possibility of decline in monocyte function leading to increased susceptibility to infections and increased incidence of malignancies

Educating older adults about importance of participating in cancer screenings and maintaining immunizations throughout life are essential.

Effect of Aging on
White Blood Cells

Copyright © 2019, by Elsevier Inc. All rights reserved.

5

Decrease in folic acid can indicate macrocytic anemia, megaloblastic anemia, and liver and renal disease.

Alcohol and various other drugs are known to interfere with absorption of folate.

Anticonvulsants, antimalarials, and methotrexate decrease folic acid levels.

Important to assess patients regarding their nutritional intake, including alcohol consumption habits

Elevated levels of folic acid may be seen in people with pernicious anemia.

Folic Acid

Copyright © 2019, by Elsevier Inc. All rights reserved.

6

6

Deficiency is caused by malabsorption secondary to gastric bypass, pancreatic disease, ileal resection or inflammation, prolonged use of certain medications, and strict vegan diets.

Ma

Chapter 16

Drugs and Aging

Copyright © 2019, by Elsevier Inc. All rights reserved.

Drugs are important in the management of conditions and the maintenance of well-being in older adults.

All drugs carry some level of risk.

Important to understand how aging and conditions associated with aging can affect drug processes and actions.

Demographics of Drug Use

Copyright © 2019, by Elsevier Inc. All rights reserved.

2

Aging alters dynamic processes that drugs undergo to produce therapeutic effects.

Pharmacokinetic changes: what the body does to the drugs.

Pharmacodynamic changes: what the drug does to the body.

Changes in Drug Response
With Aging

Copyright © 2019, by Elsevier Inc. All rights reserved.

3

Movement of a drug from site of administration to systemic circulation

Aging is accompanied by decreased secretion of gastric acid, slowed gastric emptying, and decreased gastrointestinal motility which may slow absorption of oral drugs.

The first dose of a new drug may take longer to take effect.

Reduction in subcutaneous fat alters topical drug absorption.

Pharmacokinetic Changes: Absorption

Copyright © 2019, by Elsevier Inc. All rights reserved.

4

Movement of drug from systemic circulation to site of action

Total body water decreases with aging; results in higher concentrations of water-soluble drugs.

Decreased lean body mass and increased percentage of fat storage offer increased storage capability for fat-soluble drugs.

Decreased protein available for binding may cause toxicity and difficulty maintaining stable drug levels of drugs that are highly protein bound.

Pharmacokinetic Changes: Distribution

Copyright © 2019, by Elsevier Inc. All rights reserved.

5

Biotransformation of drugs into metabolites that are more easily excreted

A decrease in hepatic blood flow occur that may result in a decrease in the amount of a drug inactivated before entering the systemic circulation causing a greater amount of active drug, increasing the risk that standard drug doses may have toxic effects.

Pharmacokinetic Changes: Metabolism

Copyright © 2019, by Elsevier Inc. All rights reserved.

6

Elimination of drugs from body primarily via kidneys

With decreased renal function, half-life increases and drugs may accumulate to toxic levels.

Renal function typically decreases with aging and the best indicator of renal function is glomerular filtration rate (GFR).

Pharmacokinetic Changes: Excretion

Copyright © 2019, by Elsevier Inc. All rights reserved.

7

Careful patient monitoring to assess adequacy o