PharmacologicalAspect of Aging
PharmacologicalAspect of Aging
Ageis one of the patient specific factors that has an influence on drugpharmacokinetic properties. Variability in physiology continuouslyincreases with advancing age leading to significant changes in thepharmacokinetic and pharmacodynamics properties of the drug in use.Some of the pharmacokinetic changes may include a decrease in hepaticand renal clearance whereas the pharmacodynamics changes result in anincreased sensitivity to different categories of drugs (Midlöv,2013).The level of tolerance with regards to medication is usually low inindividuals with advanced age as compared to younger individuals(Wooten,2012).
Thehypothetical patient in this scenario is a 67-year old womanundergoing treatment for Diabetes Mellitus, Congestive Heart Failure,and Peripheral Artery Disease. She is on five different medicationswhich include
Aspirin 81mg daily
Lovastatin 40mg daily before sleeping.
Metformin 500mg three times daily.
Cilostazol (Pletal) 100mg twice a day.
Ibopamine 100mg twice a day
Someof the physiological changes that might affect drug absorption andexcretion include
The decreased rate of absorbing substances within the small intestines.
Progressive reduction in the volume and flow of blood in the liver as a result of advanced age.
Change in the neuroendocrine responses due to physical stress especially as a consequence of a change in function of hypothalamic pituitary adrenal.
There is a decreased renal function in elderly individuals which in turn affect the excretion of many drugs.
Enzyme stability is also affected within the pancreas due to advanced age. Enzymes such as lipase and trypsin drastically reduce while others remain constant such as amylase.
Advanced age also relates to a decrease in the renal mass which ultimately leads to a decline in the rate of glomerular filtration and renal plasma flow.
Reduced level of serum albumin associates with advanced age.
The homeostasis changes involve reduction in the ability to respond to physiological challenges and the associated side effects of drugs (Phillips, 2011).
Theclinical manifestations with regards to the physiological changesabove and concerning the prescribed drugs include
Ibopamine some of the clinical manifestations include – a headache, weakness, difficulty breathing, loss of appetite, nausea, and vomiting.
Aspirin some of the clinical presentations include nausea, vomiting, stomach pain, headache and allergic reactions.
Metformin some of the clinical presentations include nausea, vomiting, diarrhea, chills, irregular heartbeat and difficulty breathing.
Cilostazol the clinical presentations may include diarrhea, headache, palpitations, dizziness, peripheral edema, abdominal pain, and rhinitis.
Lovastatin clinical presentations include fever, chest pain, weight gain, dark-colored 0urine, muscle pain and weight gain.
Inthe determination of whether the medications provided by the clientare appropriate, five questions have to be asked
Are the drugs being administered appropriately for the condition being treated?
Will the medication have an effect with regards to other conditions affecting the patient?
Are the drugs being administered at the right dose for the correct dose?
Is there an interaction between the medications administered?
Can the patient conditions have an impact on the drugs administered?
Nursesare in a better position to detect inconsistencies concerning drugadministration to patients. They usually serve as the finalcheckpoint concerning medication use hence, they reduce the riskemanating from drug interactions (Szczepuraand Nelson, 2011).The nursing actions aimed at preventing potential drug reactionsinclude
Nurses must know the system used for ordering medication within their respective health facilities.
They should review the drug regimens keeping in mind the desired outcomes, drug duplications, and how drugs interact.
They should compare the initial drug orders and compare with those dispensed before the patient takes the first dose.
Patient identity should be confirmed before the first dose and later monitoring of the patient to determine any effects associated with the administered drugs.
There should be a strict administration of dosages at respective times.
In the absence of standard drug administration systems, calculations should be checked by a second person.
In case there are missing doses, these should not be replaced by another patient’s regimen and the pharmacist contacted.
Wooten,J. M. (2012). Pharmacotherapy considerations in elderly adults. SouthMed J,105(8),437-445.
Szczepura,A., Wild, D., & Nelson, S. (2011). Medication administrationerrors for older people in long-term residential care. BMCgeriatrics,11(1),1.
Phillips,R. M. (2011). The challenge of medication management in older adults.NursingMade Incredibly Easy,9(1),24-31.
Midlöv,P. (2013). Pharmacokinetics and pharmacodynamics in the elderly. OAElderly Medicine,1(1),1.