Please provide a peer response to each of the following discussions.
You must respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts and supporting your opinion with a reference. Your response (reply) posts are worth 2 points (1 point per response).
Quotes “…” cannot be used at a higher learning level for your assignments, so sentences need to be paraphrased and referenced.
Acceptable references include scholarly journal articles or primary legal sources (statutes, court opinions), journal articles, and books published in the last five years—no websites or videos are to be referenced without prior approval. Discussions using websites as references will receive an automatic 0.
Discussion # 1
Aging alters the processes drugs undergo to produce therapeutic effects. It involves pharmacokinetics, or what the body does to the drug. When a drug is taken, it goes through four phases: absorption, distribution, metabolism, and excretion. This is known as pharmacokinetics. Absorption is the movement of a drug from the site of administration to the systemic circulation. Drugs administered orally first need to enter the stomach and intestines. However, with aging, the risk for decreased secretion of gastric acid, slowed gastric emptying, and decreased gastrointestinal motility exists (Meiner & Yeager, 2019). It is important to know that although these effects may slow the absorption of oral drugs, they do not substantially affect the amount of drug absorption that occurs. Metabolism is the biotransformation of drugs into metabolites that are easily excreted. The drugs absorbed from the stomach or intestines first enter the circulation in the liver. In aging adults, there is a decrease in hepatic blood flow which may result in a decrease in the amount of a drug inactivated before entering the systemic circulation. This results in a greater amount of active drug and increases the risk that standard doses of drugs may result in drug toxicity. During the last phase, excretion, the drug is eliminated from the body and occurs through the kidneys. In an aging adult, a decrease in renal function typically occurs, therefore, drugs may accumulate to toxic levels.
Hyperkalemia is a common electrolyte problem in patients with chronic kidney disease. It is typically caused by medications in patients with poor kidney function. Patients with comorbidities such as, heart failure and diabetes are predisposed to electrolyte problems. Hyperkalemia from the use of salt substitutes is common in patients who are been on ACE inhibitors (Batra & Villgran, 2022). Interestingly, the serum potassium returns to baseline after stopping the salt substitutes. It is suggested to stop the salt substitute and not inapproriately withdraw the ACE inhibitors in the long term, given the cardio-renal protection of ACE inhibitors. Salt substitutes contain about 70 mEq/teaspoon of potassium chloride. The daily intake of potassium in a patient with normally functioning kidneys is recommended around 2000 to 3500 mg per day (50 to 90 mEq). Normal kidneys can maintain potassium balance if the intake is increased to 500 mEq/d slowly over a prolonged period. Impaired kidneys cannot handle excess potassium acutely and hence consumption of salt substitutes can lead to hyperkalemia.
Medication non-adherence is common in all age groups; however, it is more common in older adults, who tend to have more chronic and multiple illnesses that require more drug therapies. The most common reasons for non-adherence in older adults are the cost of the drugs, the fear of the side effects, scheduling, and the thought that the drugs are either ineffective or unnecessary. As a nurse, I think that I would first understand the reason for non-adherence and then take specific risk-targeted action to decrease this common problem. For example, if the patient has a difficulty reading or comprehending instructions; I would work further with the patient to correct any misunderstandings, establish the necessary support services or networks, and to advocate for patient-centered adjustments in drug regimens.
Discussion # 2
Therapeutic drug monitoring (TDM) ensures optimal drug efficacy and safety, an essential aspect of healthcare. Medicine reactions can range depending on the person and may have problems based on how age influences medicine absorption, metabolism, and excretion. Additionally, since the possible threat of hyperkalemia when used alongside drugs, the usage of salt replacements in older people needs to be cautiously considered. A standard remedy result for older people additionally relies upon treating pharmaceutical nonadherence. These subjects are discussed extensively in this discussion, which presents the effect of aging on drug-associated tactics, the interactions between medications and salt replacements, and methods for preventing and assessing older peoples’ no adherence to medicine.
Age and Drug Pharmacokinetics
Medication pharmacokinetics may be affected by age-related physiological modifications, which can affect drug absorption, distribution, metabolism, and excretion. Due to their frailty, these physiological changes can affect pharmacodynamics and pharmacokinetics (Hilmer & Kirkpatrick, 2021). Drug absorption rates in elderly persons may also change because of gastric acidity, gastrointestinal motility, and blood flow adjustments. A loss in hepatic and renal features also causes age-associated alterations in medicine metabolism and excretion. Longer drug half-lives, greater drug exposure, and higher risk of reactions can all come from this. Healthcare professionals should consider these age-related adjustments when choosing medicinal dosages and management.
Salt Substitutes and Hyperkalemia Risk
Salt replacements, which frequently contain potassium chloride, are used as an alternative. However, using salt replacements can bring about hyperkalemia, or a potassium content rise in the blood, in older individuals, especially people with compromised renal systems (Yuan et al., 2023). When salt replacements are blended with some medicines, mainly angiotensin-changing enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and potassium-sparing diuretics, this chance is increased.
These drugs impact how potassium is regulated and eliminated from the body. They may additionally bring about dangerous potassium levels when mixed with salt replacements, which could seriously affect the heart. Healthcare specialists should inform senior citizens about the potential dangers of taking salt substitutes with these medicinal drugs and advise appropriate substitutions to ensure electrolyte stability.
Preventing and evaluating risk factors for medication nonadherence in older adults
Older individuals frequently worry about medication nonadherence that may adversely affect the effectiveness of remedies. A varied method is needed to prevent non-adherence. First, patients and healthcare professionals need to communicate clearly. The necessity of prescription medications, their possible reactions, and the anticipated advantages must all be discussed in detail by healthcare specialists. Enhancing adherence can be done by streamlining medicine schedules, giving written guidelines, and employing medicine organizers.
Healthcare specialists can evaluate drug adherence through follow-up visits and solve any issues or worries. This action is because this population’s safety is at stake, giving the professionals the duty and responsibility for this (ICRC, 2014). Older people can better monitor their drug use by streamlining their treatment plans by decreasing the number of prescriptions and doses. Technology, like computerized pill dispensers or applications that remind customers to take their medicines, can also help with adherence.
Examining several characteristics, like cognitive function, bodily limits, financial restraints, and a robust support system, is essential when comparing risk factors for medicine non-adherence. Age-related cognitive deficits might make it more challenging for older individuals to remember and comply with complicated drug schedules. This threat may be reduced by evaluating cognitive health and, if necessary, consulting caretakers or family members.
Conclusion
In conclusion, the best outcomes for patients require careful therapeutic drug monitoring. When prescribing medications to elderly patients, it is crucial to consider age-related differences in drug absorption, metabolism, and excretion. When paired with some medications, salt replacements could cause hyperkalemia, making caution and education necessary. An all-encompassing strategy that includes excellent communication, streamlined regimens, technology aids, and addressing personal risk elements is needed to prevent and evaluate medication nonadherence in older individuals. Healthcare professionals can improve the efficacy and safety of remedies for older patients by incorporating these elements into their exercise.
Rubric
Discussion Rubric
Criteria Ratings Points
Identification of Main Issues, Problems, and Concepts
Distinguished – 5 points
Identify and demonstrate a sophisticated understanding of the issues, problems, and concepts.
Excellent – 4 points
Identifies and demonstrate an accomplished understanding of most of issues, problems, and concepts.
Fair – 2 points
Identifies and demonstrate an acceptable understanding of most of issues, problems, and concepts.
Poor – 1 point
Identifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts.
5 points
Use of Citations, Writing Mechanics and APA Formatting Guidelines
Distinguished – 3 points
Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.
Excellent – 2 points
Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.
Fair – 1 point
Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.
Poor – 0 points
Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.
3 points
Response to Posts of Peers
Distinguished – 2 points
Student constructively responded to two other posts and either extended, expanded or provided a rebuttal to each.
Fair – 1 point
Student constructively responded to one other post and either extended, expanded or provided a rebuttal.
Poor – 0 points
Student provided no response to a peer’s post.
2 points
Total Points 10
