A nurse is reviewing medication records of older adults living in extended care. Which concepts about the pharmacotherapy of older adults should be considered? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply

Question

1. Plasma-binding of drugs is greater in those over age 65.
2. Drug distribution is slowed in the older adult.
3. The half-life of many drugs is lessened in older adults.
4. First-pass metabolism is reduced in the older adult.
5. Changes in the kidney may result in decreased drug excretion.

Answer 1

2,4,5
Rationale 1: The aging liver produces less albumin, resulting in decreased plasma protein-binding ability and increased levels of free drug in the bloodstream.
Rationale 2: The aging cardiovascular system has decreased cardiac output and less efficient blood circulation, which slow drug distribution.
Rationale 3: Enzyme production in the liver is decreased and the visceral blood flow is diminished, resulting in reduced hepatic drug metabolism and increased drug half-life.
Rationale 4: The decline in hepatic function reduces first-pass metabolism.
Rationale 5: Changes in the kidney result in decreased drug excretion.
Global Rationale: The aging cardiovascular system has decreased cardiac output and less efficient blood circulation, which slow drug distribution. The decline in hepatic function reduces first-pass metabolism. Changes in the kidney result in decreased drug excretion. The aging cardiovascular system has decreased cardiac output and less efficient blood circulation, which slow drug distribution. Enzyme production in the liver is decreased and the visceral blood flow is diminished, resulting in reduced hepatic drug metabolism and increased drug half-life.