Chapter 20: Pharmacologic Management in Gerontologic Nursing

Geriatric medication management requires a deep understanding of how the aging process alters drug efficacy and safety. This comprehensive review examines the four critical phases of pharmacokinetics—absorption, distribution, metabolism, and excretion—identifying how decreased hepatic blood flow, reduced renal clearance, and changes in body composition, such as increased fat and decreased water, can lead to dangerous drug accumulation and toxicity. It also addresses pharmacodynamics, explaining how aging impacts receptor sensitivity and homeostatic mechanisms, necessitating a "start low and go slow" approach to dosing. A significant portion of the chapter is dedicated to patient safety, utilizing tools like the Beers Criteria to flag potentially inappropriate medications and strategies to combat polypharmacy, which is prevalent among older adults managing multiple chronic illnesses. The text highlights the roles of specific drug classes, including the risks associated with psychotropics like benzodiazepines and tricyclic antidepressants, the management of cardiovascular health using antihypertensives, and the careful application of antimicrobials. Furthermore, it discusses the critical intersection of medication use and quality of life, emphasizing the nurse’s role in assessing side effects that may impair cognition or mobility. Strategies for improving medication adherence are explored, addressing barriers such as high costs, complex regimens, and functional impairments. Finally, the chapter tackles the rising prevalence of substance abuse in the elderly—including alcohol, prescription opioids, and nicotine—providing essential screening tools like the CAGE and MAST-G to guide nursing assessment and intervention. By focusing on holistic, patient-centered care and the "six rights" of administration, healthcare professionals can significantly reduce the risk of adverse drug events and improve therapeutic outcomes for the aging population.