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Unformatted text preview: ay be normal even though kidney function
is greatly reduced.
is 41 Pharmacodynamic
Changes in the Elderly Alterations in receptor properties may underlie altered
sensitivity to some drugs.
• Drugs with more intense effects in the elderly 42 Predisposing ADR Factors Drug accumulation secondary to reduced renal
function Polypharmacy Greater severity of illness Multiple pathologies Greater use of drugs that have a low therapeutic
index (for example, digoxin)
index Increased individual variation secondary to
altered Inadequate supervision of long-term therapy Poor patient adherence 43 Polypharmacy
• Longevity generally leads to increased
• Greatly increases the risk of drug interactions
and adverse effects.
• Result from simultaneously increased use of
prescriptive and over-the-counter drugs.
• Results from multiple disease processes and
prescribing behaviors of health care providers.
44 Promoting Adherence with Unintentional
Nonadherence Simplified drug regimens
Clear, concise verbal and written instructions
Appropriate dosage form
Clearly labeled and easy-to-open containers
Frequent monitoring 45 Intentional Nonadherence Most cases (75%) of nonadherence are intentional.
Reasons include: • Expense, side effects, patient’’s conviction that the drug is
unnecessary or the dosage too high
unnecessary 46 Assessment of at-Risk Older Adult
• Complete drug history
List of all medications taken by client
List of all prescribers for client
Review of prescription bottles for possible
use of multiple pharmacies for
• Review of all medication expiration dates
• Assessment of self-medication practices
• Assessment of limitations to selfmedication 47 Patient Education
• Review all medications with patient.
Have patient repeat information.
Time needed for learning often increases.
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This document was uploaded on 03/25/2014.
- Spring '14