Deck 21: Drugs for the Geriatric Patient

Question 1

Define the term listed below.
Geriatrics _________________________________________________________________

Answer 1

"Geriatrics" is the branch of medicine that helps in pertaining to the diseases and disorders of people whose age is 65 years or older. It is the study of diseases of the aged people like in an aging condition where the body loses its ability to cope with stress and make it harder for the older adult to bounce back after diseases. So, the geriatrics branch helps in understanding the type of diseases and thereby administering medications accordingly.
Geriatrics medicine is also different from normal medication care as it is dependent upon the physiological alteration in advancing age, multiple diseases, environmental factors and genetic variations which may not be there when treating young individuals.
Aging brings changes in patterns of daily living in an individual. Without fully and proper knowledge of the disease, it is not possible to adjust the appropriate dosage and routes. Therefore, geriatrics help in the effective treatment of old aged individuals.

Question 2

Define the term listed below.
Gerontology ______________________________________________________________

Answer 2

"Gerontology" is the study of aging and problems of the aged people. As the first sign of aging is the loss of visual sharpness - requiring reading glasses or it may be the slowdown of the digestive system in other individuals and results in constipation. Not only these two are signs of aging; there are lots of more signs covered under gerontology.
Some important changes in the system of body due to aging that generally studied in gerontology are in -
• Integumentary system - skin becomes thinner and drier
• Cardiovascular system - heart becomes less efficient
• Respiratory system - less expansion of lungs
• Nervous system - Brain cells dies and brain weight decreases
• Sensory system - ability to perceives messages by senses decreases
• Gastrointestinal system - secretions of digestive tract slow down
• Urinary system - less blood flows to the kidney
• Endocrine system - less hormone secretion
• Reproductive system - sex hormone production decreases
• Musculoskeletal system - muscle loses strength and flexibility

Question 3

Define the term listed below.
Polypharmacy _____________________________________________________________

Answer 3

The practice of administering number of medications together i.e. polypharmacy is more common among older adults due to number of factors. The reasons can be multiple health care providers, use of herbal therapy and administering over-the-counter (OTC) medications.
The common practice among older adults is to receive 5 or more prescription drugs as well as over-the-counter drugs. This practice is increasing although it is associated with the increased risk for morbidity and mortality in older adults.
Therefore, to avoid this problem the physician must consider all the medications that the patient is taking and then prescribe accordingly. The patient must be properly educated about the harmful effects and interactions as a result of administering number of drugs by them.
The increasing age also increases the number of medications to be consumed by an individual person. At one or the other time an individual especially older adults get tired of taking these medicines. The reason behind this is that the older adults are known to consume 30% of all prescription medications.

Question 4

Define the term listed below.
OTC medications __________________________________________________________

Question 5

Briefly describe the major changes that occur in the following body systems as one ages.
Integumentary system _______________________________________________________
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Question 6

Briefly describe the major changes that occur in the following body systems as one ages.
Cardiovascular system _______________________________________________________
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Question 7

Briefly describe the major changes that occur in the following body systems as one ages.
Respiratory system __________________________________________________________
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Question 8

Briefly describe the major changes that occur in the following body systems as one ages.
Nervous system ____________________________________________________________
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Question 9

Briefly describe the major changes that occur in the following body systems as one ages.
Sensory system _____________________________________________________________
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Question 10

Briefly describe the major changes that occur in the following body systems as one ages.
Gastrointestinal system ______________________________________________________
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Question 11

Briefly describe the major changes that occur in the following body systems as one ages.
Urinary system _____________________________________________________________
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Question 12

Briefly describe the major changes that occur in the following body systems as one ages.
Endocrine system ___________________________________________________________
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Question 13

Briefly describe the major changes that occur in the following body systems as one ages.
Reproductive system ________________________________________________________
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Question 14

Briefly describe the major changes that occur in the following body systems as one ages.
Musculoskeletal system ______________________________________________________
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Question 15

True or False
Place a T in the blank if the statement is true. Place an F in the blank if the statement is false.
_________ Older adults make up the largest group of users of pharmaceuticals.

Question 16

True or False
Place a T in the blank if the statement is true. Place an F in the blank if the statement is false.
_________ Older adults are less likely to experience adverse reactions than are younger patients.

Question 17

True or False
Place a T in the blank if the statement is true. Place an F in the blank if the statement is false.
_________ It is recommended that older adult patients bring a list of all prescription drugs, over-the-counter drugs, and herbal remedies they are taking to their healthcare provider.

Question 18

True or False
Place a T in the blank if the statement is true. Place an F in the blank if the statement is false.
_________ Normally, an older adult patient has the same physician to treat all of his or her illnesses and conditions.

Question 19

True or False
Place a T in the blank if the statement is true. Place an F in the blank if the statement is false.
_________ An older adult patient who takes cathartics will have increased absorption of any drug.

Question 20

True or False
Place a T in the blank if the statement is true. Place an F in the blank if the statement is false.
_________ Older adult patients who drink alcohol and take sedatives will experience increased sedation.

Question 21

Answer the following question in the space provided.
How and why does a physician usually adjust the normal adult dose when ordering medications for an older adult patient? _______________________________________________________
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Question 22

Drug Calculations
The physician orders hydromorphone ( Dilaudid ) 3 mg intramuscularly prn. Available is 4 mg/mL. Prepare to administer _________ mL to your patient.

Question 23

Drug Calculations
The physician orders naproxen ( Naprosyn ) 250 mg orally bid. Available are 500-mg tablets. You will give your patient _________ tablets.

Question 24

Drug Calculations
The physician orders heparin 3000 units subcutaneously daily. Available is 5000 units/ 0.5 mL. Prepare to administer _________ mL to your patient.

Question 25

Drug Calculations
The physician orders verapamil ( Calan ) 80 mg orally tid. Available are 40-mg tablets. You will give your patient _________ tablets

Question 26

Drug Calculations
The physician orders donepezil ( Aricept ) 10 mg orally daily. Available are 5-mg tablets. You will give your patient _________ tablets.

Question 27

Circle the correct letter
Which of the following should you consider before administering medications to an older adult?

A) Loss of visual sharpness is the last sign of aging.
B) Most older adults are more active than they were when they were younger.
C) The digestive tract speeds up with aging.
D) The presence of disease makes it harder to regain health.

Question 28

Circle the correct letter
You should monitor an older adult for which of the following drug interactions?

A) The absorption of tetracycline is reduced with antacids.
B) Tagamet decreases the effect of warfarin ( Coumadin ).
C) Lithium decreases salt loss when given with diuretics.
D) A potassium-sparing diuretic and an ACE inhibitor given together may result in hypokalemia.

Question 29

Circle the correct letter
Which of the following questions would be most beneficial to ask an older adult who takes a sedative and complains of increased sedation?

A) "How much sleep do you get?"
B) "Do you drink alcohol?"
C) "Do you eat before bedtime?"
D) "How many times do you get up during the night?"

Question 30

Circle the correct letter
Which of the following should you consider in the treatment plan when administering medications to an older adult?

A) Ask the patient his or her name for identification
B) Administer all the medications at one time.
C) Never administer a liquid medication when the patient has trouble swallowing.
D) Administer medications at regularly scheduled times.

Question 31

Circle the correct letter
Why is it important to inform an older adult not to take bisacodyl ( Dulcolax ) tablets and an antacid together?

A) The two drugs taken together cancel each other's effect.
B) The action of the antacid is decreased.
C) The enteric coating of the Dulcolax dissolves, resulting in gastric irritation.
D) There is decreased action of Dulcolax.

Question 32

Case Studies
A patient who has multiple chronic health conditions and is taking a variety of medications complains of dry mouth, blurred vision, urine retention, and constipation. How should you determine what is causing these symptoms? What is the explanation for the cause of these symptoms? What should you do with this information? _________________________________________
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Question 33

Case Studies
An older adult patient tells you he is starting to experience more constipation. He doesn't understand why this is suddenly a problem. What is the plausible cause? What advice can you give the patient that will help prevent constipation? ___________________________________________
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Question 34

Critical Thinking
The following are situations or scenes that might take place in a long-term care facility or in a hospital unit that has many older adult patients. Answer the questions briefly, using the information in this chapter.
Mr. Jones and Mr. Smith are both 80 years old. Mr. Jones is strong and physically active and enjoys taking walks. He wears glasses to correct his failing vision. He is forgetful sometimes and tends to tell the same jokes over and over again. Mr. Smith, on the other hand, is frail and walks with a cane, but his watchful eyes take in everything that goes on. His mind is sharp, and he entertains the nursing home staff with his views of current political and social events. Why are these men so different in their physical ability and mental alertness, even though they are the same age? What does this mean in terms of their medication therapy?
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Question 35

Critical Thinking
The following are situations or scenes that might take place in a long-term care facility or in a hospital unit that has many older adult patients. Answer the questions briefly, using the information in this chapter.
Ms. Peach is taking life easier than she used to, because she finds that her energy runs out more quickly now that she is 72. Her breathing has become slightly faster and shallower than before, which the physician says is normal for a person her age. What changes has her respiratory system probably undergone as a result of aging?
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Question 36

Critical Thinking
The following are situations or scenes that might take place in a long-term care facility or in a hospital unit that has many older adult patients. Answer the questions briefly, using the information in this chapter.
"Doc Webster" is a delightful older adult man who is full of stories about the days when he practiced surgery in a big city hospital. He is taking a number of medications for heart disease and a nervous condition. Today, when you go to his room, he does not answer to his name and has forgotten where he is. It's hard for you to give him his medication instructions, because he can't seem to concentrate on what you are saying. What possible reasons might explain why he appears confused?
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Question 37

Critical Thinking
The following are situations or scenes that might take place in a long-term care facility or in a hospital unit that has many older adult patients. Answer the questions briefly, using the information in this chapter.
In giving Mrs. Nimitz, an older adult, her medications, you want to be sure to treat her as an independent, intelligent adult. How can you help her be responsible for taking her medications?
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Question 38

Critical Thinking
The following are situations or scenes that might take place in a long-term care facility or in a hospital unit that has many older adult patients. Answer the questions briefly, using the information in this chapter.
Mr. Redbone is taking medication for an infection and several other minor disorders. Because of his advanced age, you know that his liver and kidneys are not working as well as they once did. What effect does a weakened kidney or liver have on how the body handles drugs? What adverse reactions should you be on the lookout for?
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Question 39

Critical Thinking
The following are situations or scenes that might take place in a long-term care facility or in a hospital unit that has many older adult patients. Answer the questions briefly, using the information in this chapter.
Mrs. Mendoza is suffering from phlebitis and must take an anticoagulant to keep blood clots from forming. She keeps a bottle of aspirin in her purse for occasional arthritic pain. She also has an old bottle of tranquilizers her sister gave her. She hasn't mentioned the aspirin and tranranquilizers to her doctor, but she asks you if it would be all right to take them when necessary. What should you say?
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Question 40

Critical Thinking
The following are situations or scenes that might take place in a long-term care facility or in a hospital unit that has many older adult patients. Answer the questions briefly, using the information in this chapter.
Your facility has recently admitted a number of new patients, so the staff's workload is heavier than usual. You are busy giving medications and carrying out your other duties. You would like to put off your charting until the end of the day, but you're not sure you should. How will your decision affect the welfare of your patients?
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Question 41

Critical Thinking
The following are situations or scenes that might take place in a long-term care facility or in a hospital unit that has many older adult patients. Answer the questions briefly, using the information in this chapter.
A new older adult patient, Mr. Minassian, is getting his first dose of medicine. You are instructing him on the usual side effects of the drug. He is smiling and nodding, but he does not seem to understand what you are saying. What can you do to make sure he gets the information he needs?
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Question 42

Critical Thinking
The following are situations or scenes that might take place in a long-term care facility or in a hospital unit that has many older adult patients. Answer the questions briefly, using the information in this chapter.
Ms. Brill sweetly declines any medications you offer her, saying that she doesn't need them. You are worried because you know that her blood pressure could become dangerously high if she fails to take the antihypertensive and she needs Diabinese to control a tendency toward high blood sugar. What should you do?
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