Beers criteria
Topic 2 DQ 1
The Beers criteria contain a list of drugs that are potentially unsafe for use in older persons. Utilize the provided resource, “American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults” for assistance in completing this question. Select a drug on the “avoid” list that you have administered to an older patient or a drug that you know is prescribed for an older adult.
Relate the outcome of using this drug to the pharmacokinetics (absorption, metabolism, distribution, and excretion) of drugs in an older client. In addition to the link, cite one other reference to support your post. Make sure that you select a different drug than your peers. Include the name of the drug in the subject line so that the drugs can be followed. Include your references in APA style.
Sample student answer 1
Hydroxyzine
Hydroxyzine is a medication used for different purposes. It can act as an antihistamine and is used to prevent the actions of histamine during an allergic reaction. It is also used to suppress symptoms of anxiety and tension.
However, the drug has some anticholinergic effects which make it part of the “avoid list” for geriatric patients. Anticholinergic drugs bind to the muscarinic receptors and block acetylcholine neurotransmission. Acetylcholine neurotransmission is involved in several major body functions related to basal functioning of the body such as urination, intestinal transit, or heart rhythm regulation (López-Álvarez et al., 2019).
According to the American Geriatrics Society (2019), Hydroxyzine is highly anticholinergic, with reduced clearance as one advances in age. What this means is that the drug’s side effects are likely to worsen as one ages. Some of these side effects include drowsiness, urine retention, constipation, dry mouth, confusion, to list a few. Based on the increased level of toxicity in older adults, the drug is to be avoided.
Reference
American Geriatrics Society. (2019). American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674-694. https://doi.org/10.1111/jgs.15767
López-Álvarez, J., Sevilla-Llewellyn-Jones, J., & Agüera-Ortiz, L. (2019). Anticholinergic Drugs in Geriatric Psychopharmacology. Frontiers in Neuroscience, 13, 1309. https://doi.org/10.3389/fnins.2019.01309
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Sample student answer 2
Replies to Robertta Shelton
Zolpidem (Ambien)
The American Geriatrics Society’s Beer’s criteria for medication use in older adults is very useful when caring for the geriatric population. I have a few years of experience in med/surg, where my primary population was geriatric. Many of the medications on this list stood out to me, as I have administered them in various dosages to my patients.
One of the medication in particular, Zolpidem, is one of the medications that I personally found had a negative impact on a few of my past patients. Zolpidem is in the drug class, nonbenzodiazepine benzodiazepine receptor agonist hypnotics, though it is similar to benzodiazepines. It has the potential to be addictive.
American Geriatrics Society (2019) states that Zolpidem has “adverse events similar to those of benzodiazepines in older adults (eg, delirium, falls, fractures); increased emergency room visits/hospitalizations; motor vehicle crashes; minimal improvement in sleep latency and duration” (p. 7). With this being said, this drug is potentially very dangerous and/or deadly to the geriatric population and should be avoided if possible. A research study found that the most common adverse effect in the older population from this drug is impaired balance and/or falls (Kajiwara et al., 2016).
I have personally seen a case where a patient has been admitted for a hip fracture from a fall, while being prescribed Zolpidem. It was presumed that the adverse reactions from this drug created the fall. At any age, especially the elderly, falls are very dangerous. It is also dangerous to operate to fix fractures in the elderly, leading to immobility or death at times. There are plenty of other safe alternatives for insomnia that should be used before Zolpidem.
References
American Geriatrics Society. (2019). American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674-694. https://doi.org/10.1111/jgs.15767
Kajiwara, A., Yamamura, M., Murase, M., Koda, H., Hirota, S., Ishizuka, T., Morita, K., Oniki, K., Saruwatari, J., & Nakagawa, K. (2016). Safety analysis of zolpidem in elderly subjects 80 years of age or older: adverse event monitoring in Japanese subjects. Aging & mental health, 20(6), 611–615. https://doi.org/10.1080/13607863.2015.1031640
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Topic 2 DQ 2
Many people are using herbal medications and dietary supplements for the prevention and treatment of medical problems. Review two current research articles about two of these products. Based on the findings, what would be the implications for you as a nurse? What additional research needs to be done in this area? Cite the two references to support your answer. Make sure that you select different herbal medications and dietary supplements than your peers. Include the name of the herbal medication and dietary supplement in the subject line so that the medications can be followed. Include your references in APA style.
Sample student answer 1
Schisandra Chinensis and Dandelion
Also known as the five flavor berry, or Chinese magnolia vine is one of the common traditional medicine, native to eastern Asia. The fruits of the plant have a long history of medicinal uses, including treatment of coughs, stomach ailments, anti-cancer properties liver issues, to list a few. Research by Nowak et al. (2019) indicates that the plant extracts have a variety of beneficial health effects, with no side effects.
What this implies is that it can be used as an alternative medication for different ailments and a preventive dietary supplement in place of synthesized medications. However, further research needs to be conducted on a recommended dosage to achieve effectiveness for different ailments and the molecular mechanisms of action of the plant’s extracts (Nowak et al., 2019).
Dandelion is another common plant that is said to have some medicinal value. According to research by Wirngo et al. (2016), dandelion was found to have anti-diabetic properties due to the presence of chicoric acid, taraxasterol (TS), chlorogenic acid, and sesquiterpene lactones as part of its chemical attributes.
However, there is still very limited evidence to second the pharmacological, physiological, and biochemical mechanisms underlying the effects of dandelion-derived compounds on type-2 diabetes that warrants further research (Wirngo et al., 2016). Therefore, as a nurse, I would take caution when recommending the same to patients as an alternative medication.
Reference
Nowak, A., Zakłos-Szyda, M., Błasiak, J., Nowak, A., Zhang, Z., & Zhang, B. (2019). Potential of Schisandra chinensis (Turcz.) Baill. in Human Health and Nutrition: A Review of Current Knowledge and Therapeutic Perspectives. Nutrients, 11(2), 333. https://doi.org/10.3390/nu11020333
Wirngo, F. E., Lambert, M. N., & Jeppesen, P. B. (2016). The Physiological Effects of Dandelion (Taraxacum Officinale) in Type 2 Diabetes. The review of diabetic studies : RDS, 13(2-3), 113–131. https://doi.org/10.1900/RDS.2016.13.113
Sample student answer 2
Replies to Robertta Shelton
Quercetin and Goldenseal Root
Quercetin is an antioxidant from the flavonoid group. Known for its anti-inflammatory and immunomodulary characteristics, quercetin is primarily found in fruits and vegetables but is also present in red wine and black tea. As a nurse I would advise patients that long-term use of quercetin longer than 12-16 weeks has not yet been studied and should proceed with caution (Salehi et al., 2021). Salehi et al. found that quercetin has antiparasitic, antimicrobial, and anticancer effects, among others (2021). The authors of this journal article recommend further research regarding pharmacokinetics and bioavailability of quercetin.
Goldenseal root (Hydrastis Candensis) is an herb from the buttercup family. Goldenseal is often used for immune support and treatment of gastric ulcers. Patel et al. (2016) caution the possibility of “drug-induced cholestatic hepatitis” associated with this dietary supplement. As a nurse I would advise patients with existing acute or chronic liver damage to avoid goldenseal root. Additionally, the effects of taking goldenseal doses greater than 30mg per day are not currently known (Patel et al., 2016).
References:
Patel, D., Mohammed, A., Basu, A., Asija, A., Jain, S., Pawar, A.S., Danilewitz, M. (2016). Goldenseal root powder (Hydrastis Canadensis) associated hepatotoxicity. American Journal of Gastroenterology, 110, S368-S369.
Salehi, B., Machin, L., Monzote, L., Sharifi-Rad, J., Ezzat, S.M., Salem, M.A., Merghany, R.M., El Mahdy, N.M., Kılıç, C.S., Sytar, O., Sharifi-Rad, M., Sharopov, F., Martins, N., Martorell, M., & Cho, W.C. (2020). Therapeutic potential of quercetin: New insights and perspectives for human health. ACS omega, 5(20), 11849–11872. https://doi.org/10.1021/acsomega.0c01818
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