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Decrease the body's ability to break down or remove medication from the system due to:
-increased body fat
- decreased body water
-decreased muscle mass
-changes in renal and liver function

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Decreased renal and liver function in elderly, so absorption, distribution, metabolism and excretion is inhibited. Therefore, drugs accumulate in their systems longer and at higher levels than younger people. Also altered body composition (more fat, less water), decreased body size. Increases adverse effects of drugs. Polypharmacy causing dehydration and other med errors

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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 inhibitors
MOA: Bind to the hydrogen/potassium ATPase enzyme system, inhibiting both stimulated and basal acid secretion.
Signs and symptoms: headache, n + v, diarrhoea, abdo pain, constipation, flatulence
Drug to drug interactions: apalutamide, enzalutamide,
How to prevent, assess or manage risks/nursing considerations: notify doctors if pt develops black stools or vomit that looks like coffee grounds, advice pt to avoid alcohol and foods that cause an increase in GI irritation

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Morphine

Class: opioid analgesic
MOA: Opioid analgesics act on receptors in the CNS and GIT producing analgesia, respiratory depression, sedation and constipation
Signs and symptoms:
- respiratory depression
- blurred visoon
- sedation
- GIT upset
- restlessness
Drug to drug interactions:
- rifampicin (antibiotic) increases metabolism which decreases effect

How to prevent, assess or manage risks/nursing considerations:
- dependence
- monitor BLs
- pain assessment
- monitor mental status
- monitor for respiratory depression
- use with caution for patients with head injuries
- take blood pressure before administration
- assistance with mobilisation (falls risk)

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Panadol Osteo

Class: Analgesic
MOA: inhibits prostaglandin synthesis, provides mild to moderate pain and fever
Signs and symptoms: skin rash, wheezing, tightness in chest, difficulty breathing, swelling, nausea
Drug to drug interactions:
Warfarin, Metoclopramide, Chloraphenicol, Alcohol, Probenecid, Cholestyramine
How to prevent, assess or manage risks/nursing considerations: take with water, can be taken with or without food, caplets must not be crushed, max daily dose (4g), should not be used with other paracetamol-containing drugs

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Tamoxifen
Class:
sex hormone/ cancer treatment
MOA:
Acts  on estrogen receptor sites in breast tissue to stop the growth of tumours growing in breast tissue.
Signs and symptoms:
hot flushes, sweating, vaginal discharge, nausea, oedema,  fatty liver, uterine polyps
Drug to drug interactions:
warfarin - Tamoxifen increases Wararin anticoagulant effect and increases bleeding.
How to prevent, assess or manage risks/nursing considerations:
careful risk assessment should be done by specialist to ensure drug is correct for patient, especially menopause patients as it can cause an increase in endometrial cancer developing.

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Naproxen

Class: NSAID
MOA: Inhibit production of prostaglandins by blocking COX enzymes, reducing inflammation and producing analgesic effects
Signs and symptoms:
- GIT bleeding
- NSAID induced renal impairment
- Increase risk of cardiovascular events
- Changes in blood pressure
Drug to drug interactions:
- None on drug chart
How to prevent, assess or manage risks/nursing considerations:
- Monitor complete blood count to assess kidney and liver function
- Taken with food
- Use lowest effective dose for the shortest period of time to reduce complications

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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?