cause several alterations in the absorption, distribution, metabolism, and excretion of drugs (Sera& Uritsky, 2016). While pharmacokinetics can affect the rate of clearance of a drug, pharmacodynamics can affect a drug’s magnitude (Sera & Uritsky, 2016). Selected CaseMajority of my nursing experience is working in long-term care with older adults. In one scenario I can recall at the facility, a 69-year-old African American female with multiple co-morbidities was prescribed a PRN order for Ativan (Lorazepam) to be administered by mouth. The resident has been diagnosed with dementia with behavioral disturbances and had been having difficulty sleeping and becoming agitated. Under normal circumstances, after administering the PRN Ativan the behavior should lessen or completely stop, but in this case, with continued administration of the PRN dose as ordered, there was no change. The resident’s behavior of increasing agitation and restlessness became worse and led to psychological symptoms of visual hallucinations. Benzodiazepines such as Ativan belong to the hypnotic-sedative class of drugs, which have anxiolytic, sedative and hypnotic properties owing to their action on the gamma amino butyric acid (GABA) receptors in the central nervous system (Sarkar & Singh, 2016). Benzodiazepines are known to impair cognitive function, physical coordination, and balance (Sarkar & Singh, 2016). Pharmacokinetics of benzodiazepines in the elderly depends on certain age-related and drug-related factors (Sarkar & Singh, 2016). Due to aging, certain structural and
functional changes occur in the brain, and with these changes, there might be a greater sensitivityof the aging brain to the effects of benzodiazepines (Sarkar & Singh, 2016). Therefore, the elderly population is more susceptible to adverse events while taking benzodiazepines in comparison to other age groups. Personalized Plan of CareA proper plan of care can include appropriately selecting drugs that have clear evidence for their indicated use, as well as whether it is appropriate for the patient's circumstances, and whose benefits outweigh the risks (Aguirre et al., 2017). For pharmacologic treatment of
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- Summer '15
- Pharmacology, Benzodiazepine