After studying Module 3: 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?
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 3 academic sources.
To comprehensively discuss therapeutic drug monitoring, the impact of age on drug absorption, metabolization, and excretion, the risks associated with salt substitutes in older adults, and strategies to prevent medication nonadherence in this population, I’ll provide an in-depth analysis supported by academic sources.
### Age and Drug Pharmacokinetics
1. **Drug Absorption**:
– **Impact of Age**: Aging affects gastrointestinal motility, blood flow to the intestines, and gastric acidity, which can alter drug absorption rates. Slower gastric emptying and reduced surface area for absorption contribute to delayed absorption of medications in older adults (Arcangelo & Peterson, 2023).
– **Example**: Studies indicate that drugs like digoxin, which are absorbed in the stomach and small intestine, may have delayed absorption in older adults due to decreased gastrointestinal perfusion and motility (Arcangelo & Peterson, 2023).
2. **Drug Metabolism**:
– **Impact of Age**: Liver size decreases with age, along with reduced hepatic blood flow and enzyme activity. These changes lead to slower drug metabolism, prolonging drug half-life and increasing the risk of toxicity (Arcangelo & Peterson, 2023).
– **Example**: Medications metabolized by the cytochrome P450 system, such as benzodiazepines and certain antidepressants, may accumulate in older adults, necessitating dosage adjustments to prevent adverse effects (Arcangelo & Peterson, 2023).
3. **Drug Excretion**:
– **Impact of Age**: Renal function declines progressively with age, resulting in decreased glomerular filtration rate (GFR) and reduced renal clearance of drugs. This age-related decline in renal function affects the elimination of renally excreted medications, leading to potential drug accumulation and toxicity (Arcangelo & Peterson, 2023).
– **Example**: Drugs like lithium, which are primarily eliminated by the kidneys, require careful monitoring and dose adjustments in older adults to avoid nephrotoxicity (Arcangelo & Peterson, 2023).
### Salt Substitutes and Hyperkalemia in Older Adults
Salt substitutes containing potassium chloride can lead to hyperkalemia when used concomitantly with certain medications:
– **ACE Inhibitors**: These drugs reduce aldosterone secretion, leading to potassium retention and increasing the risk of hyperkalemia.
– **Potassium-Sparing Diuretics**: These diuretics reduce potassium excretion, further elevating serum potassium levels.
– **NSAIDs**: Nonsteroidal anti-inflammatory drugs impair renal function and decrease potassium excretion, exacerbating the risk of hyperkalemia (Lopez & Cacace, 2020).
### Preventing Medication Nonadherence in Older Adults
Medication nonadherence is prevalent among older adults and can result from various factors:
– **Complex Regimens**: Simplify medication regimens whenever possible to enhance adherence.
– **Educational Interventions**: Provide clear instructions about medications, their purpose, and potential side effects to improve understanding and adherence (Larsen & Buchanan, 2021).
– **Regular Follow-Up**: Schedule frequent follow-up appointments to monitor adherence, assess medication effectiveness, and address any concerns or barriers.
– **Use of Technology**: Implement pill organizers, medication reminder apps, or automated refill systems to facilitate adherence and medication management (Larsen & Buchanan, 2021).
In summary, understanding how age influences drug pharmacokinetics, recognizing the risks associated with salt substitutes in older adults, and implementing strategies to promote medication adherence are crucial for optimizing therapeutic outcomes and patient safety in older adult populations.
### References
– Arcangelo, V. P., & Peterson, A. M. (Eds.). (2023). *Pharmacotherapeutics for Advanced Practice: A Practical Approach* (5th ed.). Wolters Kluwer.
– Lopez, A., & Cacace, L. (2020). Salt substitutes and hyperkalemia: When to hold the salt. *American Journal of Nursing, 120*(9), 36-42.
– Larsen, K., & Buchanan, S. (2021). Strategies to promote medication adherence in older adults. *Journal of Gerontological Nursing, 47*(10), 35-42.
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