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physiological changes such as:
- increased body fat
- decreased body water
- decreased muscle mass
- changes in renal and liver function
these changes can affect the way the body absorbs, distributes, metabolises and eliminates drugs.

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- body fat (increases the volume of distribution for highly lipophilic drugs (eg, diazepam, chlordiazepoxide) and may meaningfully increase their elimination half-lives.)
- metabolism rate
- total body water and muscle mass are decreased
- greater risk of dehydration
- may refuse nutrition
- refusing medication
- more likely to experience adverse drug reactions
- education
- reduced gastric acidicy
- general reduction in blood flow
- thinner skin, faster topical absorption
- loss of muscle ton, affects distribution
- liver decreased binding capability
- more likely to experience medication toxicity

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physiological changes can affect the way our body metabolises drugs, causing adverse reactions.

Older people are more likely to be taking multiple medications (‘polypharmacy’), which increases the risk of medications being implicated in hospital admissions.

Up to 30 per cent of hospital admissions of people aged 65 years and over are medication-related, and approximately half of these could be prevented¹.

Medication-related admissions in older people can be caused by adverse drug reactions, failure to take a prescribed medication and errors with taking medications.

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Note: this maybe what you need to consider???

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What factors may result in impaired medication effects in these patients?

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Mrs Marple now has constipation. What medication/s will you give her to relieve this?
Deakin Hospital Protocol needs to be considered for this decision

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Note: Always consider:
Is there anything in the patient's condition/ past history that may increase the risks?

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Esomeprazole

Class: Proton pump inhibitor
MOA:  Binds to the proton pump and inhibits acid (HCL) secretion
Signs and symptoms:  headache, N&V, diarrhoea, abdominal pain and constipation
Drug to drug interactions: catalopram, tacrolimus and enzalutamide
How to prevent, assess or manage risks/nursing considerations:
- GIT disturbances: Avoid alcohol and foods that may cause an increase in GI irritation
- Electrolyte disturbances: maintain adequate fluid balance, monitor electrolyte levels, signs of hyponatremia/hypomagnesemia
- Risk of accumulation: monitor for adverse effects when higher doses are used in hepatic impairment

Tamoxifen:
MOA:  competes with oestrogen/oestradiol to bind to receptors in the breast tissue, thereby inhibiting tumour growth
Risks: advise pt to warn you or the doc if they experience any abnormal vaginal bleeding, discharge, or pain and pressure in the pelvic region while taking tamoxifen or when stop taking it.

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Morphine

Class:
MOA:
Signs and symptoms:

Drug to drug interactions:
How to prevent, assess or manage risks/nursing considerations:

Tamoxifen:
MOA:
Risks:

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Panadol Osteo

Class: Non-Narcotic Analgesia
MOA: Inhibition of prostoglandin synthesis indicated for mild-moderate pain. Also has an antipyretic effect.
Signs and symptoms:  liver damage
Drug to drug interactions:
How to prevent, assess or manage risks/nursing considerations: Educate patient on dosage amounts to reduce risk of overdose

Tamoxifen:
MOA:
Risks:

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Ondansetron

Class: 5HT3 antagonists
MOA: Central and peripheral 5HT3 receptor blockade.
Signs and symptoms:
- Nausea
- Vomiting
Drug to drug interactions:
- tramdole
- apomorphine
- rifampicin
How to prevent, assess or manage risks/nursing considerations:
- monitor GI
- falls risk assessment
- check motor function
- monitor liver function?
- 4-8 max of 24 dose

Tamoxifen: Selective estrogen receptor modulators
MOA: Compete with estrogen for receptor sites in breast tissue (anti-estrogenic effect) inhibiting tumour growth. Also have estrogen agonist activity on endometrium, bone and lipids. Suppression of other growth factors and cytokines may occur.
Risks: (common side effects)
- leg cramps
- alopecia
- hot flushes
- sweating
- vaginal discharge
- nausea
- oedema
- increase in hepatic enzymes and bilirubin
- fatty liver
- uterine polyps

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Naproxen

Class:NSAID's
MOA:Naproxen blocks arachidonate binding to competitively inhibit both cyclooxygenase (COX) isoenzymes, COX-1 and COX-2, resulting in analgesic and anti-inflammatory effects.
Signs and symptoms: Paget's disease , acute gout, spondylitis, RA, pain and primary dysmenorrhea.
Drug to drug interactions:ACE inhibitors (such as captopril, lisinopril), angiotensin II receptor blockers (such as losartan, valsartan), cidofovir, corticosteroids (such as prednisone), lithium, "water pills" (diuretics such as furosemide)
How to prevent, assess or manage risks/nursing considerations: The lowest possible dose should be used for the shortest possible duration.Patients taking naproxen should receive monitoring for pain relief, significant changes in blood pressure, worsening kidney function, and GI symptoms such as gastroesophageal reflux disease (GERD), abdominal pain, or melena. For patients on chronic NSAID therapy, periodic monitoring with complete blood counts to assess for anemia and chemistry panels to evaluate kidney and liver function merit consideration. Also, educate the patient regarding interaction of medicines with other drug  such as vitamins or herbs.

Tamoxifen:
MOA:It selectively binds to estrogen receptors, producing both estrogenic and anti-estrogen effects
Risks:It can increases the risk of cancer of the uterus including endometrium cancer and uterine sarcoma.

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What would they be for this medication chart?

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Significant risks / drug-drug interactions???                           

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Significant risks / drug-drug interactions???                           

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How / why does it occur?
What are they and what signs and symptoms would we see?
What do we as nurses do;
- prevent and/ or manage these?

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Compare and contrast the significant risks for Tamoxifen

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Compare and contrast the significant risks for Tamoxifen

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What were your significant risks Tamoxifen? Are you able to group these risks? Why are they significant?
Do you understand the MoA of how the patient might develop the risks?
Did you need to go and look them up again?