After studying Module 4: Lecture Materials & Resources, discuss the following:
Therapeutic drug monitoring is a frequent practice in health care. How does age affect drug absorption, metabolization and excretion?
The use of salt substitutes can cause hyperkalemia in older adults when use in conjunction with what types of drugs?
Describe how you would prevent and evaluate risk factors for medication nonadherence in older adults?
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Therapeutic drug monitoring is a frequent practice in health care. How does age affect drug absorption, metabolization, and excretion?
Age can affect the drug's absorption, hence playing an essential role in drug monitoring. The aged typically have decreased gastric acid and decreased flow of intestinal blood. The stomach time is also decreased hence affecting the speed, but no effect on the quality and drug absorption (McCuistion et al., 2021). There is a delayed starting time for action and delayed maximum effects of drugs.in some drugs, the solubility is affected hence affecting the rate of absorption. People of advanced age show a rise in drug concentration in their blood which affects the metabolism and significantly reduces the effectiveness and hence exposes them to a risk of adverse reaction to most drugs. There is evidence of reduced activity of enzymes in the liver hence prolonging the drug's effect. Metabolism is affected by reduced blood flow in the liver courtesy of the reduced parental cells (McCuistion et al., 2021). These are the factors contributing to the complexities of eliminating drugs among the elderly hence contributing to the improved effects of drugs and causing more adverse reactions. The aged usually have compromised mechanisms in how the body's drugs are excreted (McCuistion et al., 2021). There is a reduced or decreased renal function and the rate at which blood flows to the kidneys. This causes the dosage to be reduced, and the pharmacokinetics attributes it to the reduction of renal function.
The use of salt substitutes can cause hyperkalemia in older adults when used in conjunction with what types of drugs?
Drugs containing potassium put one at risk of hyperkalemia .those drugs are advocated for people who need to reduce their blood pressure. It decreases the chances of stroke and glomerular, renal vascular, and tubular damage. Increased concentration of potassium is known to reduce ventricular arrhythmias risks, especially in cardiac patients ("Review for "The use of salt substitutes to replace sodium chloride in food products: A review," 2022). Another benefit is reducing the intake of sodium. The application and the use of salt substitutes can easily cause hyperkalemia in the aged, mainly when used in conjunction with drugs prescribed for patients with angiotensin-converting enzyme inhibitors, potassium-sparing diuretics, angiotensin receptor blockers .basically the salt substitutes that contain potassium are known to cause hyperkalemia and may threaten an individual’s life.
Describe how you would prevent and evaluate risk factors for medication nonadherence in older adults.
Older people are, in most cases, the people who do not adhere to the medication .there are some factors and reasons contributing to nonadherence, and it is essential if one can try to evaluate the risk factors and be in a position to prevent the medication nonadherence (McCuistion et al., 2021). From the evaluation, attempting to reduce the number of medications is essential. The aged usually get tired of medication making it necessary to reduce the frequency. It is also essential that the patients can be encouraged to visit with medication appointments at their hands. This has proven to be the best way to encourage the aged to and appointments and hence reduce medical nonadherence to patients ("Review for "The use of salt substitutes to replace sodium chloride in food products: A review," 2022). The number of pharmacies must also be reduced, and the healthcare attendants must attempt to discuss the cost frequently since cos has proven to be a significant barrier towards adherence. The concerned people must try to leverage the technology for most patients between appointments. Furthermore, we must be watchful of the appearance of the warning signs.
McCuistion, L. E., Yeager, J. J., Winton, M. B., & DiMaggio, K. V. (2021). Pharmacology E-book: A patient-centered nursing process approach. Elsevier Health Sciences.
Review for "The use of salt substitutes to replace sodium chloride in food products: A review." (2022). https://doi.org/10.1111/ijfs.16075/v1/review2Links to an external site.
Therapeutic Drug Monitoring
Empirical findings show that aging exerts severe changes in human organs, altering the body's functions. As age increases, the human body tissue and organ functions gradually decline. An analysis of the pharmacokinetics and pharmacodynamics between the young and the old shows altered functions among the old. The decline in bodily functions explains the decline in the management of the drugs taken by patients in this age bracket. The altered body functions, high drug sensitivity, and reduced cognitive functionality impact the intake, administration, absorption, metabolism, and excretion after drug intake among the aged.
Age has an adverse effect on drug absorption. The elderly have a relatively reduced or weak gastrointestinal movement and a slow or relatively reduced gastric emptying rate. This has a significant effect on drug absorption as it relies on gastrointestinal mucosa to absorb and digest the drugs taken. The weakened movement and reduced speed enhance a slow gastric emptying rate. Resultantly, drugs stay in the tract for longer hours than expected, slowing down the absorption rate of oral drugs (Drenth‐van Maanen, Wilting & Jansen, 2020).). On the other hand, empirical evidence shows limited clinical importance of age-related impacts on drug absorption. Thus, the aging process can negatively or positively affect drug absorption.
First-pass metabolism of drugs is generally reduced as drug users advance in their age. Clinicians attribute this decreased metabolization to the reduction in liver mass, slower blood flow, and slow enzyme activity. Aging decreases first-pass metabolism resulting in a slower concentration of drug substances in the blood (Lecture Notes, Slide 6). However, age has a negligible effect on drugs with a broad therapeutic margin. For instance, age does not affect transdermal absorption. Age, on the other hand, affects excretion. The decreased kidney size for adults primarily affects excretion. This reduction affects the glomerular filtration, reducing the clearing rate for soluble antibiotics and nonsteroidal drugs, among others. Morbidity, a commonly prevalent factor among the aged, exacerbates the reduced kidney functions, reducing renal excretion.
Clinical observations and practice have also recommended using salt substitutes because of the numerous benefits accrued. For instance, potassium-enriched salt substitutes have found a suitable application in medicine, especially with their impact on lowering blood pressure and hypertension (Lecture Notes, Slide 23). However, clinical observations warn of the over-dependence on these substitutes as they may cause adverse effects such as hyperkalemia in older adults. A combination of salt substitutes with other drugs creates a conducive environment for developing hyperkalemia (Greer et al., 2020). Some of the drug categories that combine with salt substitutes to increase the risk of hyperkalemia include; renin-angiotensin inhibitors, nonsteroidal anti-inflammatory drugs, and angiotensin II receptor blockers.
Medication nonadherence is a serious challenge affecting older adults. Older adults may have a relatively higher prescription of drugs due to the numerous challenges characterized by their age. Importantly, there is low adherence to medication among the demographic (Lecture Notes, Slide 35). Clinicians can identify and evaluate risk factors for medication nonadherence and prevent such occurrences. In assessing the risk factors and preventing nonadherence to adult medication, clinicians should first identify the risk factors. Some of the most common risk factors for medication nonadherence among adult patients are the number of prescribed medications, reduced appointments, dependence on pharmacies, costs, and limited interactions with patients. Clinicians can prevent these risk factors by leveraging technology to increase interactions with patients in between appointments, watching for nonadherence signs, discussing costs and the importance of medication compliance (Lecture Notes, Slide 36), discouraging the use of pharmacies, and reducing the number of medications administered to one patient at a time. These approaches can help evaluate the risk factors and enhance medication compliance among adult patients.
Drenth‐van Maanen, A. C., Wilting, I., & Jansen, P. A. (2020). Prescribing medicines to older people—How to consider the impact of aging on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921-1930.
Greer, R. C., Marklund, M., Anderson, C. A., Cobb, L. K., Dalcin, A. T., Henry, M., & Appel, L. J. (2020). Potassium-enriched salt substitutes as a means to lower blood pressure: benefits and risks. Hypertension, 75(2), 266-274.
Lecture Notes. (n.d) Chapter 15: Laboratory and Diagnostic Tests
Lecture Notes. (n.d) Chapter 16: Drugs and Aging
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