Purpose

This assignment aims to increase the nurse practitioner's awareness and sensitivity to pharmacokinetic changes and prescribing implications occurring in the frail elderly related to these changes and potential adverse effects of polypharmacy in the frail elderly patient.

Instructions

1. Describe a patient who is age 65 or older and takes at least 12 prescription medications, over-the-counter (OTC) medications, and herbal supplements.
2. Describe your patient, including age, gender, ethnicity, medical diagnoses, medication allergies, and list of prescriptions/OTC medications/herbal supplements, including dosage, route, and frequency.
3. Describe three age-related changes that can affect the pharmacokinetics and pharmacodynamics.
4. Using Beer's criteria, review the patient's medication list to identify medications that are potentially inappropriate. What medications should be continued? What medications should you consider stopping? What alternative medications could be used in place of the medications you would consider stopping?
5. What are two challenges you as an NP face with regard to regulation of complementary and alternative medications (CAM) in care of the frail elderly?
6. As an NP, what is one specific strategy you will use to assess medication reconciliation, including CAM and over-the-counter medications, in the frail elderly population?

Before finalizing your work, you should:

• be sure to read the assignment description above carefully;
• consult the grading rubric (under the Course Resources) to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors.

Your writing assignment should:

• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics;
• use APA current edition format; and
• Be supported with at least five scholarly, peer-reviewed sources from the past 5 years, external to those assigned for this unit.

Please see the Writing Center located in the student portal for assistance with writing, APA style, and online communication.

Describe a patient who is age 65 or older and takes at least 12 prescription medications, over-the-counter (OTC) medications, and herbal supplements.

According to recent data, the number of older adults taking multiple medications has increased significantly over the past few decades. This is mainly due to the fact that chronic health conditions and diseases become more common as we age, leading to an increase in prescription medication use.

However, this also means a higher risk of polypharmacy and potential drug interactions among older adults. Consider Mrs. R, a 70-year-old woman with multiple chronic illnesses, hypertension, osteoporosis, and diabetes mellitus type 2.

She takes a total of 16 different medications every day at varying dosages and frequencies: 7 prescription drugs, four over-the-counter (OTC) medications, including aspirin for arthritis pain relief, and five herbal supplements recommended by her daughter. Mrs. R's prescription medication regimen includes furosemide for edema management, lisinopril for hypertension control, metformin for glycemic control in diabetes mellitus type 2 patients, and alendronate for osteoporosis prevention and treatment.

Additionally, she takes OTC ibuprofen on occasion for arthritis-related pain. Mrs. R's herbal supplements include bilberry extract, which is thought by some to aid with eye health function, while ginkgo biloba is suggested to enhance cognitive function. In contrast, turmeric extract has anti-inflammatory properties that may assist in reducing inflammation associated with arthritis pain relief.

It's important to note that both OTC medications and herbal supplements can interact with prescription drugs resulting in adverse side effects or amplifying pharmacokinetic activity leading to toxicity or other significant adverse outcomes such as an increased risk of falling, which can be especially dangerous considering Mrs. R's history of falls. Mrs.R illustrates how complex medication regimens can become among older adults who suffer from multiple chronic illnesses necessitating various pharmaceuticals and non-prescription supplements/OTC agents used in tandem, often without medical counsel, which puts them at an increased risk of polypharmacy.

Age-related changes that affect pharmacokinetics and pharmacodynamics in this patient population must be taken into account as well. This complexity underscores the importance of education regarding these pharmacological interactions, which is vital for nurses and other healthcare providers who work with elderly patients.

Describe your patient's age, gender, ethnicity, medical diagnoses, medication allergies, and list of prescriptions/OTC medications/herbal supplements, including dosage, route, and frequency.

To illustrate the importance of nurse awareness and sensitivity to pharmacokinetic changes and prescribing implications, let us consider a patient who is age 65 or older and takes at least 12 prescription medications, over-the-counter (OTC) medications, and herbal supplements. The patient we will focus on is a 70-year-old female of Caucasian ethnicity with a history of hypertension, type II diabetes mellitus, dyslipidemia, osteoarthritis, depression, and insomnia. She has no known medication allergies.

The patient's current medication list includes the following prescriptions: lisinopril 10 mg once daily in the morning for hypertension; metformin 1 gram twice daily before meals for diabetes; atorvastatin 40 mg once daily at bedtime for dyslipidemia; naproxen sodium 220 mg twice daily with food as needed for osteoarthritis pain; sertraline 100 mg once daily in the morning for depression; doxepin hydrochloride 10 milligrams at bedtime as needed for insomnia. Additionally, she also takes several over-the-counter medications and herbal supplements: acetaminophen (Tylenol) extra strength tablet every six hours as needed for pain and fever; calcium carbonate/vitamin D3 supplement, one tablet twice a day with food to promote bone health; omega-3 fatty acid supplement one capsule twice a day with meals to improve cardiovascular health.

Her primary care physician carefully prescribes the dosages of each medication. The route of administration varies depending on the medication's formulation.

For instance, lisinopril is an oral tablet that needs to be taken by mouth, while naproxen sodium is an oral tablet that should be taken with plenty of water. It's worth noting that this patient takes medications that can cause adverse effects such as dizziness or drowsiness.

This could put her at risk of falling or injuring herself. Therefore, nurses must have a detailed understanding of each patient's medication regimen to identify potential adverse drug reactions and provide appropriate interventions to mitigate any possible harm.

Describe three age-related changes that can affect the pharmacokinetics and pharmacodynamics.

As individuals age, their body undergoes numerous changes that can significantly impact how they respond to medications. These changes can affect pharmacokinetics and pharmacodynamics and contribute to an increased risk of medication-related adverse effects. Three age-related changes that can affect pharmacokinetics and pharmacodynamics include alterations in renal function, hepatic metabolism, and gastrointestinal absorption.

Renal function tends to decline with age, with a reduced glomerular filtration rate (GFR) leading to a decreased ability to clear medications from the body. This decline in renal function can impact drug elimination, increasing the risk of accumulating certain medications.

Additionally, alterations in protein binding can occur with aging, leading to an increased concentration of unbound active drugs within the body. Aging also impacts Hepatic metabolism as reductions in hepatic blood flow and decreased enzyme activity may lead to delayed metabolism of certain medications.

This delayed metabolism may result in higher serum concentrations of certain drugs, potentially causing toxicity or other adverse effects. Moreover, aging is often associated with hepatic fat accumulation and fibrosis, which might reduce the liver's capacity for biotransformation.

Gastrointestinal absorption may also be impacted by normal aging processes such as impaired gastric emptying time or reduced intestinal motility leading to decreased bioavailability of some drugs such as oral hypoglycemics or antibiotics. In addition, intrinsic factors such as reduced production of hydrochloric acid or intestinal enzymes (e.g., lactase) due to atrophic gastritis or other age-associated conditions might diminish overall drug absorption efficiency.

It is essential for healthcare providers who prescribe medications or care for patients who take them regularly to be aware of how normal aging processes influence pharmacokinetic parameters, including absorption (bioavailability), distribution (protein binding), biotransformation (metabolism), excretion (renal clearance). Understanding these modifications associated with advancing age can help clinicians select the appropriate dose, frequency, and route of administration for patients and monitor drug therapy by using biomarkers (e.g., creatinine clearance) or therapeutic drug monitoring (TDM) when indicated.

Using Beer's criteria, review the patient's medication list to identify medications that are potentially inappropriate. What medications should be continued? What medications should you consider stopping? What alternative medications could be used in place of the medications you would consider stopping?

When treating elderly patients, nurses need to be aware of the potential risks associated with certain medications. One tool that can be used to evaluate the appropriateness of medication use in older adults is Beer's criteria.

This set of guidelines was created to help healthcare professionals identify medications that should be avoided or used with caution in older adults. When reviewing a patient's medication list using Beer's criteria, it is essential first to consider any potentially inappropriate medications for use due to their potential adverse effects.

For example, benzodiazepines and barbiturates are often listed as potentially inappropriate due to their increased risk for falls and cognitive impairment in older adults. In this case, evaluating whether these drugs are necessary for the patient's treatment and if alternative therapies could be used instead would be essential.

Another consideration when using Beer's criteria is whether a medication dosing regimen should be changed due to changes in renal function or hepatic metabolism. For example, drugs such as digoxin and warfarin may need to adjust their doses based on changes in renal function or hepatic metabolism associated with aging.

When evaluating a patient's medication list using Beer's criteria, it is also important to consider any potential drug interactions between multiple medications they are taking. Older adults are more susceptible to drug interactions due to changes in hepatic metabolism and renal excretion associated with aging.

For example, combining anticoagulant therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding events. When reviewing a patient's medication list using Beer's criteria, nurses and other healthcare professionals involved in care team management need to plan interventions related to optimized prescription and the de-prescribing process.

Decisions regarding deprescribing should always involve discussions with patients/ family members/caregivers regarding the benefits versus risks of continuing therapy. In some cases, discontinuing medication altogether might be indicated, while in others, an alternative treatment can be prescribed that does not pose the same risks as the medication being stopped.

Beer's criteria is a valuable tool for healthcare professionals to use when evaluating the appropriateness of medication use in older adults. By reviewing a patient's medication list and considering factors such as potential adverse effects, dosing adjustments needed due to changes in renal function or hepatic metabolism, drug interactions, and the deprescribing process, healthcare professionals can optimize care plans for older adults while minimizing potential risks associated with their medications.

What are two challenges you as an NP face with regard to the regulation of complementary and alternative medications (CAM) in the care of the frail elderly?

One of the biggest challenges nurse practitioners (NPs) face regarding complementary and alternative medications (CAM) in caring for the frail elderly is the lack of regulation. Unlike prescription drugs, CAM therapies are not subject to the same rigorous testing and approval processes by regulatory agencies such as the Food and Drug Administration (FDA).

This makes it difficult for NPs to know exactly what they are prescribing, how it will interact with other medications, or what side effects may occur. Additionally, there is significant variability in quality control among CAM products, which can further complicate matters.

Another challenge NPs face in this area is patient reluctance or resistance to divulge their use of CAM therapies. Patients may hesitate to disclose their use of these therapies due to fear of disapproval from their provider or belief that they are not harmful.

This can lead to potential drug interactions that could be dangerous for older adults already taking multiple medications. NPS needs to establish trust with patients so that they feel comfortable sharing information about their use of CAM therapies.

Additionally, there needs to be more standardization regarding how CAM therapies are labeled or marketed. One product may claim a specific concentration or dosage, while another may have completely different specifications.

Consistent labeling and dosing guidelines make it easier for NPs to determine appropriate doses or ensure consistency across different products. Cultural barriers can exist when discussing CAM with older adults from diverse backgrounds.

Many cultures have traditions surrounding herbal remedies and other natural therapies passed down through generations. Patients from these cultures may hesitate to discontinue these remedies even if they have potentially adverse consequences when used alongside prescription medications.

Overall, navigating the world of complementary and alternative medications in care for frail elderly patients presents several complex challenges for nurse practitioners. While regulation continues to evolve in this area, NPs must remain vigilant in ensuring the safe use of CAM therapies in conjunction with prescription medications.

As an NP, what is one specific strategy you will use to assess medication reconciliation, including CAM and over-the-counter medications, in the frail elderly population?

6. As an NP, what is one specific strategy you will use to assess medication reconciliation, including CAM and over-the-counter medications, in the frail elderly population? Medication reconciliation is critical in ensuring safe and effective pharmacotherapy for the aging population.

A comprehensive medication history should be obtained at every visit and compared with previous lists to identify changes in drug regimens. Medication reconciliation includes evaluating all medications, including CAM and over-the-counter (OTC) products.

A specific strategy that I will use as an NP when assessing medication reconciliation includes conducting a thorough review of the patient's medication list, emphasizing identifying potential drug interactions or duplications. This can be achieved using online resources such as Epocrates or Medscape drug interaction checkers.

These tools help to identify potential adverse reactions between prescription medications, OTC products, and CAMs that patients may be taking. Another important aspect of my strategy is educating patients about their current medication regimen, ensuring they understand why they are taking each drug, how it works, expected benefits, and possible side effects.

Patients may need to learn which drugs are prescription-only or which ones are available OTC; therefore, healthcare providers need to explain this information so that there's clarity. When assessing medication reconciliation in frail elderly patients, I will also consider the patient's functional abilities when implementing new pharmacotherapy regimens.

Depending on the complexity of a patient's regimen, it can be helpful to provide written instructions with clear language for both patient and caregiver so that everyone knows the steps involved in taking various medications at the appropriate time throughout the day. Addressing pharmacokinetic changes and prescribing implications is essential when caring for older adults who require multiple prescription medications daily and CAMs, which could cause severe side effects if taken concurrently with other drugs. Carefully assessing medication reconciliation procedures can help eliminate adverse drug events while improving health outcomes for the elderly population.

Conclusion

The importance of nurses' awareness and sensitivity to pharmacokinetic changes and prescribing implications cannot be overstated. Nurses play a crucial role in ensuring that patients receive appropriate medication management, especially in the elderly population.

Understanding the physiological changes that occur with age, including changes in renal and hepatic function, absorption, distribution, and metabolism, is essential. With this knowledge, nurses can identify potential adverse drug events due to age-related pharmacokinetic changes.

Additionally, understanding Beer's criteria is crucial for identifying potentially inappropriate medications in the elderly population. Nurses must critically evaluate patients' medication lists to ensure they receive appropriate medications.

This evaluation includes considering alternative medications that may be better suited for this population. One challenge nurses face when caring for frail elderly patients is the regulation of complementary and alternative medications (CAM).

Due to their lack of FDA approval or oversight, CAMs may cause harm or interfere with prescribed medications. Therefore it is essential to assess all CAM use carefully.

As an NP specializing in the care of the frail elderly population, one specific strategy I will use to assess medication reconciliation is reviewing patients' medical records regularly for updated medication lists. Additionally, I will encourage open communication between patients and healthcare providers regarding CAM use and integrate regular follow-up visits into their care plan.

Improving awareness and sensitivity among nurses regarding pharmacokinetic changes and prescribing implications is essential for providing safe medication management practices for our aging population. Implementing strategies such as assessing Beer's criteria regularly and evaluating all CAM use carefully while encouraging open communication between healthcare providers and patients can improve outcomes for our most vulnerable populations.