NUR 39700: Week 2 Discussion: Medication in the Elderly
You are assigned a new admission. The client’s diagnoses include:
1) Dementia
2) Parkinson’s disease
3) CVA with residual L-sided weakness
4) Osteoporosis
5) Urinary incontinence
6) Recurrent UTIs
7) Hypertension
8) CAD; stent 2 years ago
9) CHF (EF 30%)
10) Atrial fibrillation
11) Hyperlipidemia
12) Osteoarthritis, especially hips and knees
13) Macular degeneration
14) Type 2 DM
15) Peripheral neuropathy
16) Chronic renal insufficiency
17) Anemia
18) Hypothyroidism
19) COPD on oxygen
20) Diverticulosis
The client’s medication list includes:
1) donepezil (Aricept) 5 mg PO daily
2) Sinemet 10/100 PO TID
3) aspirin 325 mg PO daily
4) warfarin (Coumadin) 5 mg PO qHS
5) tolterodine (Detrol) 2 mg PO BID
6) atorvastatin (Lipitor) 40 mg PO qHS
7) insulin (long-acting and sliding scale)
8) gabapentin (Neurontin) 300 mg PO TID
9) iron sulfate 325 mg PO TID
10) trazodone 50 mg PO qHS
11) levothyroxine 50 mcg PO daily
12) furosemide (Lasix) 60 mg PO BID
13) potassium chloride 20 mEq PO daily
14) metoprolol 100 mg PO BID
15) lisinopril 20 mg PO daily
16) amlodipine 10 mg PO daily
17) acetaminophen 1,000 mg PO TID
18) docusate sodium 100 mg PO BID
19) polyethylene glycol powder (Miralax) 17 g PO daily
20) tiotropium (Spiriva) 18 mcg inhaled daily
21) montelukast (Singulair) 10 mg PO daily
22) fluticasone/salmeterol (Advair) 100/50 inhaled BID
23) Albuterol/Atrovent nebulizers PRN for wheezing
24) multivitamin one PO daily
25) vitamin E 400 IU PO daily
26) calcium carbonate 500 mg PO TID
27) vitamin D 800 units PO daily
28) kava root 100 mg PO QID
29) nitrofurantoin (Macrobid) 100 mg PO qHS
Based on your review of the three references found in the library guide under readings and the information in the case study:
1) List three medications you would have concerns in administering to an elderly client and explain why.
2) Discuss what alternatives you might recommend to either the client or provider.
3) Describe the teaching and/or information you would need to provide to ensure the client understands the medication regimen prior to discharge.
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Writing Guide:
Three medications that may raise concerns in administering to an elderly client include:
a) Warfarin (Coumadin): Warfarin is an anticoagulant that may increase the risk of bleeding in elderly patients. Elderly patients may also have difficulty managing the medication regimen, leading to potential complications. Additionally, warfarin has many drug interactions, including interactions with many of the other medications listed in the client’s medication list, which could increase the risk of bleeding or other adverse effects.
b) Gabapentin (Neurontin): Gabapentin is an anticonvulsant medication that is often used to treat neuropathic pain. However, it can cause sedation, confusion, and dizziness, which could lead to falls and other complications in elderly patients. Additionally, gabapentin can interact with other medications, such as opioids, which could increase the risk of adverse effects.
c) Kava root: Kava root is a natural supplement that is sometimes used to treat anxiety and insomnia. However, it can interact with many medications, including those used to treat Parkinson’s disease and depression, potentially leading to adverse effects. Additionally, the safety of kava root is unclear, and it may be associated with liver toxicity.
Alternatives to consider:
a) Warfarin (Coumadin): Alternatives to warfarin may include newer anticoagulant medications, such as apixaban or dabigatran, which may be easier to manage and have fewer drug interactions.
b) Gabapentin (Neurontin): Alternatives to gabapentin may include non-pharmacologic treatments, such as physical therapy, massage therapy, or acupuncture, as well as other medications, such as pregabalin or duloxetine, which may have fewer adverse effects.
c) Kava root: Given the potential risks associated with kava root, it may be best to avoid this supplement and consider other non-pharmacologic treatments or alternative medications, as appropriate.
Teaching and information to provide:
a) Ensure the client understands the name, dose, frequency, and route of administration for each medication.
b) Review potential adverse effects and drug interactions for each medication.
c) Discuss strategies for managing medication regimens, such as using pillboxes or setting reminders.
d) Emphasize the importance of taking medications as prescribed and not altering doses without consulting a healthcare provider.
e) Provide information on how to refill prescriptions and obtain new medications, as needed.
f) Encourage the client to ask questions and seek clarification as needed to ensure full understanding of the medication regimen.
g) Provide information on how to monitor for potential adverse effects or drug interactions, and when to seek medical attention if concerns arise.
h) Discuss the importance of regular follow-up appointments with healthcare providers to monitor the effectiveness and safety of the medication regimen.
i) Provide information on lifestyle modifications, such as diet and exercise, that can support medication management and overall health.
j) Review any special instructions for administration, such as taking medications with food or avoiding certain activities after taking specific medications.
k) Provide clear and concise written instructions for the medication regimen, along with contact information for healthcare providers and pharmacies.
l) Encourage the client to involve a family member or caregiver in medication management and to communicate any concerns or difficulties with medication administration to healthcare providers
