Health in The Geriatric Essay

Im working on a nursing writing question and need guidance and explanation

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Article review (300 words)

Look at this article on the intersection of Religion, Spirituality, and Health in the Geriatric Outpatient population and let me know what you think!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466615/

Response 1 (300 words)

Amiodarone

My area of nursing requires caring for patients post cardiac and other chest surgeries. The nature of this sometimes causes unwanted excitement from the patient’s heart. Atrial fibrillation with a rapid ventricular response happens often in this patient population, and our first line treatment always includes intravenous Amiodarone. I never knew that this was drug listed as to avoid on the “American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” This list was intended to make pharmaceutical recommendations for adults over the age of 65 in all healthcare settings except for hospice or palliative. Amiodarone made this list due to its greater toxicities than other antiarrhythmics. (American Geriatrics Society Panel, 2019).

Amiodarone is an antiarrhythmic drug that contains iodine. It is used for severe supraventricular and ventricular tachyarrhythmias. It has properties of class I, II, III, and IV antiarrhythmics, alpha blocking properties, and blocks K+ channels. This drug has a long half-life and distributes into tissues. (Whalen, 2018). Amiodarone toxicities are seen in solid organs due to its pharmacokinetic properties. Pulmonary toxicity from Amiodarone is the most serious of the toxicities and is seen in four to seventeen percent of patients. (Ramachandran et al., 2020).

Health in The Geriatric Essay

So why would we use this drug in elderly (or any) patients over another antidysrhythmic? My colleges in the non-surgical cardiology world consider Diltiazem to be the gold standard drug to treat Atrial Fibrillation with rapid ventricular response. The drug comes IV as well, and works just as quickly. The reason we continue to use this drug, even with recommendations to avoid and higher risk of toxicity, is patient population tolerance. Amiodarone IV causes less hypotension than diltiazem. Surgery patients of this nature are typically hypovolemic and barely maintaining perfusing blood pressures. Diltiazem IV is not tolerated by most of this population and the drop in blood pressure would require us to also infuse pressors and or give unwanted fluid boluses.

References

American Geriatrics Society Panel. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. https://agingresources.org/wp-content/uploads/2019/08/2019-BEERS-critieria-update.pdf

Ramachandran, D., Varghese, J., Haridas, M., Venkitakrishnan, R., Augustine, J., & Cleetus, M. (2020). Acute Presentation of Amiodarone Toxicity with Pleural Involvement. Journal of Clinical & Diagnostic Research, 14(12), 4–7. https://doi-org.lopes.idm.oclc.org/10.7860/JCDR/2020/45355.14325

Whalen, K. (2018). Lippincott© illustrated reviews: Pharmacology (7th ed.). Wolters Kluwer Health.

Response 2 (300)

Robaxin (methocarbamol)

The American Geriatric Society Beer’s list criteria is a resource developed by an interdisciplinary team of thirteen professionals that describes potentially inappropriate medication for patients aged 65 and older. The goal of the Beers Criteria is to improve medication selection, educate, and reduce adverse drug events (American Geriatrics Society, 2019). The Beer’s list has reference points for clinicians for each medication listed which includes the quality of the evidence used to make the decisions and the strength of the team’s recommendation. The team of expert pharmacist, clinicians, and nurses not only listed medications to avoid but also those to approach with caution based on certain medical conditions. Use of this tool is great when trying to reduce drug interactions, polypharmacy and sentinel events in various clinical settings.

Health in The Geriatric Essay

The drug I selected from the “avoid” list that is often prescribed to older patients in the primary care setting is Robaxin (methocarbamol). Robaxin is a CNS depressant that functions as a skeletal muscle relaxant used to treat muscle spasticity and associated pain (National Center for Biotechnology Information, 2021). Though administration routes include intramuscular and oral, my patients are typically prescribed 500mg-750mg, 1-2 tablets, 3-4 times a day. Side effects of Robaxin include drowsiness and dizziness which could possibly present more severely in the older population due to the changes of the aging body. Increased falls are also possible and can lead to fractures and other injuries. After oral administration, methocarbamol is rapidly absorbed into the GI tract. For an elderly patient absorption into the blood stream, which is 30 minutes, could be delayed due to reduced gastrointestinal blood flow or motility and changes in gastric PH (Gujjarlamudi, 2016). A younger, healthy averages 1-2 hours for distribution of this medication from the blood stream to the extracellular fluids and tissues. Reduced total body water and increased body fat that are common in the older adult can alter distribution (Gujjarlamudi, 2016). Medication can accumulate if there is less water to dilute them and more fat tissue to store them. Metabolism of methocarbamol takes place in the liver via the controlled rate of enzymes. As people age, enzymatic activity decreases, meaning older people have difficulty metabolizing certain drugs and often need smaller doses per pound of body weight (Merk Manual, 2020). Methocarbamol is excreted through the kidneys. Clinicians must consider the decreased blood flow, filtration rate and tubular secretion when prescribing methocarbamol to an elderly patient (Gujjarlamudi, 2016). Natural changes in the body of the older adult cause prolonged effects and increased risk of toxicity.

References

American Geriatrics Society. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Retrieved from: https://agingresources.org/wp-content/uploads/2019/08/2019-BEERS-critieria-update.pdf

Gujjarlamudi H. B. (2016). Polytherapy and drug interactions in elderly. Journal of mid-life health, 7(3), 105–107. https://doi.org/10.4103/0976-7800.191021

Merck Manual. (2020). Drug metabolism. Retrieved from: https://www.merckmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-metabolism

National Center for Biotechnology Information. (2021). PubChem Compound Summary for CID 4107, Methocarbamol. Retrieved October 26, 2021 from https://pubchem.ncbi.nlm.nih.gov/compound/Methocarbamol

Health in The Geriatric Essay