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Nursing Pharmacology · NCLEX-RN

Nursing Pharmacology: Geriatric Medication Considerations

Polypharmacy risk, Beers Criteria medications, and age-related pharmacokinetic changes tested on NCLEX-RN.

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What is polypharmacy?
The use of multiple medications, typically five or more, by one patient at the same time.
What is the primary risk associated with polypharmacy in older adults?
Increased risk of adverse drug events and drug-drug interactions.
What organization publishes the Beers Criteria?
The American Geriatrics Society.
What is the purpose of the Beers Criteria?
To identify medications that are potentially inappropriate for use in older adults.
Why are benzodiazepines listed on the Beers Criteria for older adults?
They increase the risk of falls, fractures, and cognitive impairment.
Which benzodiazepine duration is more strongly discouraged in older adults, short-acting or long-acting?
Long-acting (for example, diazepam).
Why should first-generation antihistamines like diphenhydramine be avoided in older adults?
They have strong anticholinergic effects that cause confusion, dry mouth, and urinary retention.
Name a common anticholinergic effect that can be mistaken for dementia in an older adult.
Acute confusion or cognitive impairment.
Why are NSAIDs high-risk medications for older adults?
They increase the risk of GI bleeding and kidney injury.
What is the "triple whammy" combination that raises acute kidney injury risk in older adults?
An NSAID, an ACE inhibitor (or ARB), and a diuretic taken together.
Why is meperidine avoided in older adults?
Its metabolite accumulates and can cause neurotoxicity, including seizures.
Why are skeletal muscle relaxants like cyclobenzaprine avoided in older adults?
They cause sedation, anticholinergic effects, and increased fall risk.
What nursing principle guides medication dosing in older adults?
Start low and go slow.
Why does gastric acid production tend to decrease with age?
Age-related decline in parietal cell function reduces stomach acid, which can alter drug absorption.
How does aging typically affect body fat and lean muscle composition?
Body fat increases while lean muscle mass decreases.

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