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Pharmacology Chapter 11

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The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)?
A) Serum creatinine levels
B) Creatinine clearance
C) Serum albumin levels
D) Liver function tests
Correct: B
Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older adult patients.
The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for this practice?
A) The percentage of drug absorbed often is decreased in older adults.
B) Most older adults have decreased body fat and increased lean mass.
C) Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels.
D) Renal function declines with age, leading to decreased drug excretion
Correct: D
Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age.
When preparing a teaching session for residents at an assisted living facility, the nurse will include what?
A) The importance of avoiding intentional underdosing
B) The importance of using multiple pharmacies for cost-effective savings on prescription drugs
C) The importance of taking double amounts of missed doses to maintain therapeutic levels of medications
D) The importance of reducing protein intake while taking prescription medications
Correct: A
Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug was simply not needed or because of unpleasant side effects. Polypharmacy should be avoided, as should doubling missed doses. Doubling a dose could result in intentional overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity
When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Correct: D
Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the older adult
Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.)
A) Taking a thorough drug history, including over-the-counter (OTC) medications.
B) Monitoring clinical response and laboratory results to help determine proper dosage.
C) Using as many drugs as possible to reduce symptoms and improve outcome.
D) Regularly monitoring patients for drug-drug and drug-nutrient interactions.
E) Helping patients to avoid prescriptions for drugs on the Beers list
Correct: A, B, D, E
A thorough drug history and careful monitoring can help reduce ADRs. Nurses should help patients use the simplest regimen possible to reduce the risk of ADRs. Monitoring patients for interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse effects in the elderly.