pharmacology, nutrition, and the older adult: interactions and implications - chapter 17
DESCRIPTION
Medication can affect Basic functions Obtaining and utilizing nutrition Potential for medication interaction Polypharmacy When a person uses multiple medicationsTRANSCRIPT
Pharmacology, Nutrition, and the Older Adult: Interactions and
ImplicationsChapter 17
Introduction
• Medication can affect– Basic functions – Obtaining and utilizing nutrition
• Potential for medication interaction• Polypharmacy– When a person uses multiple medications
Common Classes of Medicationsin the Older Adult
• Cardiovascular/antihypertensives– Decrease appetite– Can cause dysgeusia– Can cause dehydration
• Hypoglycemics– Can cause increase fat formation and stability
Common Classes of Medicationsin the Older Adult
• Analgesics– Can cause gastric and espohageal injury and
bleeding – Can affect renal function– Can cause constipation and depress consciousness
• Psychiatric medications– Can affect consciousness and appetite
Medicare Part D
• Medicare Part D pharmacy plan – A three-tiered approach to cost and cost-sharing– Deductible,– “Doughnut hole”– Out-of-pocket threshold
• The Center for Medicare and Medicaid Services (CMS)– Offers assistance for those who cannot afford the
medication costs under Part D
Use of Complementaryand Alternative Medicines
• Use of herbal remedies has increased dramatically
• High risk for potential problems– Polypharmacy– Decreased metabolism– Elimination of medication• Increased sensitivity to the effects of
medications
Food and Medication Interactions
• Food and nutrients can alter a medication’s effectiveness in many ways– Increases or decrease absorption of medication– Interferes with a medication’s metabolism or
action– Prohibits the removal of a medication from the
body– Affects the medication’s absorption– Medication-nutrient interaction
Pharmacokinetic and Pharmacodynamic Changes in Aging• Absorption– Age-related changes in GI tract
• Distribution– Volume of distribution– Decrease in cardiac output and plasma protein
concentrations • Metabolism– Liver’s ability to metabolize medications becomes
less efficient
Pharmacokinetic and Pharmacodynamic Changes in Aging• Elimination– Medications excreted by the kidney
• Effect of Medications on Target Cells Homeostasis– Related to homeostatic functions and receptor
responses• Receptors– Functionality of various tissue receptors changes
with age
Normal Physiology of Nutrition
• Requires consciousness and appetite• Nutrition from appetite to elimination– Various medications can affect this process in
both positive and negative ways
Consciousness
• Medications that Affect Consciousness– Sedation can lead to a disinterest in eating– Some medications can cause increase in food
intake or stimulate appetite
Appetite
• Regulated by peripheral messengers, central messengers, and monoamines
• Intact sensation of taste and smell are important in stimulating appetite
• Concerns with GI problems• Several medications can influence appetite in
a positive or negative manner• Attention to potential anticholinergic effects
of medications
Physical Manipulation
• Chewing, Bolus Formation, and Swallowing– Effected by disordered consciousness and
disordered coordination• Coordination and Motor Function– Predisposed to movement disorders– Extrapyramidal symptoms– Medication-induced parkinsonism
• Peristalsis– Controlled by a complex system of
neurotransmitters
Medications that HaveGastrointestinal Effects
• Affect digestion of food by– Causing dysphagia• Side effects of the medication• Complication of the medication’s therapeutic
action• Medication-induced esophageal injury• Xerostomia
– Affecting peristalsis– Altering the acidity in the stomach
Medications that Cause Gastrointestinal Injury
• Older adults more susceptible due to:– Decreased saliva production– Esophageal motility– Greater incidence of cardiomegaly
• Medications have different mechanisms for inducing esophageal injury
Medications that AffectGastrointestinal Motility
• Common use of medications that cause either diarrhea or constipation
• Medications that affect the CNS, nerve conduction, and smooth muscle functions
Medications that AffectGastric Acidity
• Increased risk for peptic ulcer disease and gastroesophageal reflux disease
• Some medications require an acidic environment for absorption
Absorption and Utilizationof Nutrients
• Generally not subject to pharmacological interaction
Conclusion
• Awareness of medication-nutrient and medication-diet interactions is fundamental to delivery of sound medical treatment
• Medication kinetics can vary widely within an individual with alterations in diet
• Clear communication must exist between older adults and/or their caregivers and medical professionals to avoid potential adverse consequences