Older Adults
Ageing can influence many aspects of absorption, distribution, metabolism, and excretion (ADME) with excretion the most affected. This is because by the age of 65, the human kidney is almost a third less efficient than younger adults. This can lead to drugs not being cleared as efficiently from the kidneys, building up, and causing toxicity. Another cause for concern is the effects and side‐effects of some drugs which may contribute to falls in frail adults due to postural hypotension and other factors.
A form of low blood pressure that happens when you stand up from sitting or lying down. Symptoms include dizziness, fainting (syncope), confusion, or blurred vision.
Patients being admitted to hospital from the community, on any of these ‘high risk drugs’ should be reviewed by a Doctor or Pharmacist and all staff should be made aware of this risk factor. Table 1.2 shows some of these drugs to be made aware of.
Table 1.2 Drugs which may contribute to falls.
| Drug class | Indications | Examples of drugs |
|---|---|---|
| Antipsychotics | Psychosis delirium | Haloperidol, Promazine, Trifluoperazine, Quetiapine, Olanzapine, Prochlorperazine. Risperidone |
| Antidepressants | Mood | Amitriptyline, Trazodone, Fluoxetine, Citalopram. Paroxetine, Sertraline |
| Hypnotics (sedatives) | Insomnia | Zopiclone, Zolpidem |
| Benzodiazepines Hypnotics (sedatives) | Insomnia, agitation | Diazepam, Lorazepam, Temazepam, Nitrazepam |
| Anti‐hypertensives | High blood pressure | Ramipril, Lisinopril, Perindopril, Valsartan, Hydralazine, Bisoprolol, Atenolol, Propranolol |
| Antidiabetics | Diabetes | Glibenclamide, Glipizide, Metformin, Sitagliptin |
| Opiates | Pain | Codeine, Tramadol, Morphine, Fentanyl, Buprenorphine, Oxycodone |
| Diuretics | Heart failure, fluid overload, hypertension | Bendroflumethiazide, Furosemide, Bumetanide, Amiloride |
| Nitrates | Cardiovascular disease | Isosorbide mononitrate, Glyceryltrinitrate (GTN) Nicorandil |
| Parkinson's Medication | Parkinson's disease | Co‐Beneldopa, Co‐Careldopa, Selegline Hydrochloride, Pramipexole |
| Non‐steroidal anti‐inflammatory drug (NSAIDS) | Pain, inflammation | Ibuprofen, Naproxen, Diclofenac |
| Antimuscarinics (anticholinergics) | These are mentioned in other classes, e.g. for urinary incontinence | Procyclidine, Oxybutynin, Tolterodine, Amitriptyline |
| Aminoglycosides | Infection | Vancomycin, Gentamicin |
| Antihistamines | Allergies, itch | Chlorphenamine, Hydralazine, Cetirizine |
ADMINISTERING DRUGS SAFELY
Drug Administration Competence
Many hospitals have drug administration competencies for staff to ‘prove’ that they are competent in the clinical skill of drug administration. Only when these competencies have been signed off can a nurse administer medications alone. Also, the student in healthcare, i.e. Registered nurse, Nursing Associate, etc. will need to be signed off in their medicines management competencies as part of their pre‐reg training. Appendix 1 shows an adaption of a typical section of post‐reg medicines management competencies.
Calculations Competence
Also, in order to be able to administer intravenous medications, qualified staff are required to pass a drug calculations test to prove mathematical ability, as poor mathematical skills have been indicated in medication errors with the misplacement of the decimal point leading to a tenfold error overdosing or underdosing. Many healthcare environments also set calculation tests during the interview stage.
Activity 1.4 shows a sample question of the sort that you may be expected to answer in one of these tests. Don't worry if your reaction to answering these questions is
Drug calculations sample question.
A drug is presented as 5 g in 500 ml A patient weighing 70 kg is prescribed 10 mg/kg/h of the drug.
1 How many milligrammes per hour of the drug does the patient need?
2 How many millilitres per hour do you set the infusion pump?
But remember to keep the decimal units the same throughout the formula.
Reports and Safety Alerts
In order to alert health carers of the problems around drug administration, the Department of Health and National Safety Patient Agency (NPSA) issue reports and safety alerts, perhaps when mistakes have been made for shared awareness:
Problems with missed doses,
Promoting safer use/monitoring of patients on anticoagulant therapy (e.g. warfarin for deep‐vein thrombosis [DVT]),
Promoting safer measurement and administration