After Studying Module 4 Lecture Materials And Resourc 725204

After Studyingmodule 4 Lecture Materials Resources Discuss The Fol

After studying Module 4 Lecture Materials & Resources, discuss the following: Therapeutic drug monitoring is a frequent practice in healthcare. How does age affect drug absorption, metabolization, and excretion? The use of salt substitutes can cause hyperkalemia in older adults when used in conjunction with what types of drugs? Describe how you would prevent and evaluate risk factors for medication nonadherence in older adults?

Paper For Above instruction

Therapeutic drug monitoring (TDM) plays a critical role in optimizing pharmacotherapy, especially among older adults who are more vulnerable to adverse effects and therapeutic inefficacies due to age-related physiological changes. As individuals age, their body's capacity to absorb, metabolize, and excrete medications undergoes significant alterations, necessitating careful management of drug therapy to ensure safety and efficacy.

Age significantly influences drug absorption primarily through physiological changes in the gastrointestinal (GI) tract. In older adults, gastric pH tends to increase due to decreased acid production, leading to a less acidic environment that can impair the solubility and absorption of certain medications such as calcium, iron, and some kinases (Mangoni & Jorgensen, 2019). Additionally, gastric emptying tends to be slower, which can delay the onset of drug action. The decreased splanchnic blood flow observed with aging can further diminish the rate and extent of drug absorption (Gandhi et al., 2020).

Metabolization primarily occurs in the liver, where phase I reactions—including oxidation, reduction, and hydrolysis—are crucial. Age-related hepatic changes include a reduction in liver size and hepatic blood flow by up to 40-50%, which can substantially decrease hepatic drug clearance (Rowland & Tozer, 2019). Consequently, drugs like benzodiazepines and propranolol, which depend heavily on hepatic metabolism, tend to have prolonged half-lives and increased plasma concentrations in older individuals. Phase II reactions, involving conjugation processes such as glucuronidation, are less affected by age (Mangoni & Jorgensen, 2019).

Excretion involves renal clearance, which diminishes significantly with age. Glomerular filtration rate (GFR) declines by approximately 1% annually after the age of 40, leading to decreased clearance of renally-excreted drugs like aminoglycosides, digoxin, and certain antibiotics (Rowland & Tozer, 2019). This decline necessitates careful dose adjustments to prevent drug accumulation and toxicity, especially as serum creatinine alone can be a misleading measure of renal function in older adults (Levine et al., 2020).

The potential for hyperkalemia is a significant concern when older adults use salt substitutes containing potassium. When combined with medications that impair potassium excretion or promote potassium retention, the risk increases. Notably, drugs such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), aldosterone antagonists (spironolactone), and potassium-sparing diuretics like amiloride can potentiate hyperkalemia when used with potassium-based salt substitutes (Kumar & Clark, 2018). These interactions can impair renal potassium excretion or increase potassium uptake, elevating serum potassium levels dangerously.

Preventing and evaluating risk factors for medication nonadherence in older adults entails a multifaceted approach. First, healthcare providers should conduct comprehensive medication reviews to identify potentially inappropriate medications and simplify regimens by minimizing pill burden (Katz et al., 2017). Utilizing pill organizers, medication schedules, or adherence aids can enhance compliance. Providers must also consider cognitive, psychological, and social factors—such as memory deficits, depression, or social isolation—that can impair adherence (López et al., 2020).

Educational interventions tailored to the individual's health literacy levels and cultural context are essential to improve understanding of medication purpose, administration, and potential side effects. Regular follow-up and monitoring, including periodic medication reconciliation and assessment of serum drug levels when appropriate, can help detect nonadherence early. Engaging caregivers and family members in the management plan can foster accountability and support, especially in patients with cognitive impairment. Ultimately, a patient-centered approach that respects autonomy while ensuring safety is paramount in managing chronic medication regimens among older adults (Tannenbaum et al., 2021).

References

  • Gandhi, A., et al. (2020). Impact of aging on pharmacokinetics and pharmacodynamics. Clinical Pharmacology & Therapeutics, 107(4), outreach pp 703-712.
  • Katz, P. R., et al. (2017). Strategies to improve medication adherence in older adults. Journal of Aging & Social Policy, 29(2), 125-138.
  • Kumar, P., & Clark, M. (2018). Clinical medicine (9th ed.). Elsevier.
  • Levine, M. D., et al. (2020). Renal function and drug dosing in the elderly. Geriatric Medicine, 18(3), 87-95.
  • López, M. M., et al. (2020). Social factors influencing medication adherence in elderly populations. Age and Aging, 49(5), 785-791.
  • Magnoni, F., & Jorgensen, C. C. (2019). Age-related changes in drug absorption, metabolism, and excretion. Pharmacotherapy, 39(7), 644-657.
  • Rowland, M., & Tozer, T. N. (2019). Clinical pharmacokinetics and pharmacodynamics (5th ed.). Wolters Kluwer.
  • Tannenbaum, C., et al. (2021). Patient-centered care approaches to improve medication adherence in the elderly. The Gerontologist, 61(4), 567-575.

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