A nurse is preparing to give medications to four geriatric patients who are all taking multiple medications. Which patient is most likely to have an adverse drug reaction related to increased drug effects?
a. Obese patient
b. Patient with decreased serum creatinine
c. Patient with chronic diarrhea
d. Thin patient with a chronically low appetite
ANS: D
The patient who is thin and has a poor appetite has an increased risk of malnutrition, with significant lowering of serum albumin. This can result in increased free drug levels of protein-bound drugs and can lead to drug toxicity. Obesity, which involves increased adipose tissue, would cause lipid-soluble drugs to deposit in adipose tissue, with a resulting reduction of drug effects. Decreased serum creatinine in an older adult patient may just be a function of a decrease in lean body mass and not of renal function. Chronic diarrhea would accelerate the passage of medications through the GI tract and reduce absorption.
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