Benzodiazepine & Antipsychotic Medication Use in Older Adults Response

Benzodiazepine & Antipsychotic Medication Use in Older Adults Response ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Benzodiazepine & Antipsychotic Medication Use in Older Adults Response Please respond Week 1 Discussion Initial Post Pharmacokinetics and Pharmacodynamics A patient from my clinical experience is described as a Mr. X a 75 year male with a right hip fracture from a fall. He had a known history new onset dementia and COPD. The patient arrived to the unit post-operative R ORIF. He became increasingly confused over the course of his stay. He made several attempts to get out of the bed, fought staff with care, pulled his oxygen off and lines and tubes out. He was not getting any sleep. He had to eventually be restrained to prevent self-injury. However he aggressively attempted to get out of his soft bilateral wrist restraints. This caused stress on his heart and increased his oxygen demand. He was given a one-time dose of Ativan 2mg IV. The Ativan calmed him down for hours and then the cycle would start over again. The confusion / delirium became worse. However, the IV Ativan was then scheduled and after a few doses the patient became difficult to arouse. The patient became hypotensive and oxygen demand required the need for intubation. Chest x-ray indicated pneumonia. The relationship between the body and drugs is referred to as and Pharmacodynamics. Pharmacokinetics is the study of the movement of drugs through the body. The Pharmacokinetic processes are absorption, distribution, metabolism and excretion (Rosenthal and Burchum, 2018). Pharmacodynamics is how drugs affects the body(Rosenthal and Burchum, 2018). Mr. X experienced a long course of recovery. The use of Ativan, his age and co- morbidities influenced the Pharmacokinetic and Pharmacodynamic processes the patient experienced. The elderly have a decreased metabolism and excretion of benzodiazepines ( Neft, Oetther, Halloway& Hanneman, 2019). Distribution plays a significant role in age related changes including decreased fluid volume, decreased muscle mass, organ perfusion and serum albumin concentration. The effects are altered serum concentration, drugs are in the system longer, stronger drug effects at lower doses. Resulting in increased side effects and toxicity (Kratz and Diefenbacher, 2019). The American Geriatrics Society (AGS) placed Benzodiazepines on a list of medication to avoid in patients over the age of 65. ( Neft, Oetther, Halloway& Hanneman, 2019). Benzodiazepines are known to cause respiratory depression and cognitive deficits in the elderly for the reasons aforementioned (Markota et al. 2016). I would develop a plan for Mr. X, first off I would request a sitter and ask family to come in and be with the patient. There are many different medications he could have been given. I would try a precedex gtt and go from there. Bradycardia is a side effect but I have seen patients do well on this medication. Mr. X is not an uncommon patient in the ICU. However, if there is an understanding of Pharmacokinetics with drug therapy this may increase beneficial effects and minimize unnecessary patient harm. References Kratz, T., & Diefenbacher, A. (2019). Psychopharmacological treatment in older people: Avoiding drug interactions and polypharmacy. Deutsches Aerzteblatt International , 116 (29/30), 508–518. https://doi-org.ezp.waldenulibrary.org/10.3238/arztebl.2019.0508 Markota, M., Rummans, T. A., Bostwick, J. M., & Lapid, M. I. (2016). Benzodiazepine use in older adults: Dangers, management, and alternative therapies. Mayo Clinic Proceedings , 91 (11), 1632–1639 Neft, M. W., Oerther, S., Halloway, S., Hanneman, S. K., & Mitchell, A. M. (2019). Benzodiazepine and antipsychotic medication use in older adults. Nursing open , 7 (1), 4–6. Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier 4 hours ago JACQUELINE NABUKEERA RE: advanced Pharm Hi Beth Thank you for the informative post.As effective as Ativan is, it is very risky in the elderly population like it can cause sedation, confusion, sleepiness, and so on. The American Geriatrics Society added Ativan a benzodiazepine on a medication list that should be avoided to adults 65 years and older(Markota, et al., 2016). Several significant psychiatric associations also advise against using benzodiazepines for the elderly as they are always risky (Tannenbaum, 2015). In your scenario, I would be interested in knowing whether the patient’s size was considered in relation to the needed body surface for the 2mg Ativan given, also thinking of other medications or treatments that could work safely for this older patient. However, your individualized plan of care ensures that all precautions have been addressed for the patient’s safety. Thank you for your post. References Markota, M., Rummans, T., Bostwick, M., & Lapid, M. (2016). Benzodiazepine is in older adults: dangers, management, and alternative therapies. Psychiatric and Psychology. (11), 1632- 1639. Tannenbaum, C. (2015). Inappropriate benzodiazepine use in elderly patients and their reduction. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10