UMD 6501 Benzodiazepine Antipsychotic Medication Use in Older Adults Response

Please respond

Pharmacokinetics and Pharmacodynamics

In my professional practice, I had a patient named Mr. X, a 75-year-old man with a right hip fracture following a fall. He was known to have COPD and new-onset dementia. After surgery, the patient arrived at the facility by RORIF. Over the duration of his stay, he lost more and more of his senses. He tried numerous times to get out of bed, carefully resisted the personnel, and ripped his oxygen off as well as lines and tubes. He wasn’t sleeping at all. He eventually needed to be restrained to stop him from hurting himself. UMD 6501 Benzodiazepine Antipsychotic Medication Use in Older Adults Response

He made a determined effort, nonetheless, to break free of his gentle bilateral wrist restraints. His heart was under stress, and he needed more oxygen as a result. Ativan 2 mg IV was administered to him as a single dosage. He was soothed by the Ativan for many hours, after which the cycle would repeat. The delirium/confusion grew worse. But after the IV Ativan was planned, it proved challenging to awaken the patient after a few doses. As a result of the patient’s hypotension, intubation was necessary to meet the patient’s oxygen needs.

Pneumonia was seen on the chest x-ray. Pharmacodynamics is the study of how the body and medications interact. Pharmacokinetics is the study of how medications are metabolized within the body. Absorption, distribution, metabolism, and excretion are pharmacokinetic processes (Rosenthal and Burchum, 2018). The body’s reaction to medications is called pharmacodynamics (Rosenthal and Burchum, 2018). UMD 6501 Benzodiazepine Antipsychotic Medication Use in Older Adults Response

Mr. X experienced a long course of recovery. The use of Ativan, his age and co- morbidities influenced the Pharmacokinetic and Pharmacodynamic processes the patient experienced. The elderly have a decreased metabolism and excretion of benzodiazepines ( Neft, Oetther, Halloway& Hanneman, 2019). Distribution plays a significant role in age related changes including decreased fluid volume, decreased muscle mass, organ perfusion and serum albumin concentration. The effects are altered serum concentration, drugs are in the system longer, stronger drug effects at lower doses. Resulting in increased side effects and toxicity (Kratz and Diefenbacher, 2019). UMD 6501 Benzodiazepine Antipsychotic Medication Use in Older Adults Response

The American Geriatrics Society (AGS) placed Benzodiazepines on a list of medication to avoid in patients over the age of 65. ( Neft, Oetther, Halloway& Hanneman, 2019). Benzodiazepines are known to cause respiratory depression and cognitive deficits in the elderly for the reasons aforementioned (Markota et al. 2016). I would develop a plan for Mr. X, first off I would request a sitter and ask family to come in and be with the patient. UMD 6501 Benzodiazepine Antipsychotic Medication Use in Older Adults Response

There are many different medications he could have been given. I would try a precedex gtt and go from there. Bradycardia is a side effect but I have seen patients do well on this medication. Mr. X is not an uncommon patient in the ICU. However, if there is an understanding of Pharmacokinetics with drug therapy this may increase beneficial effects and minimize unnecessary patient harm.

UMD 6501 Benzodiazepine Antipsychotic Medication Use in Older Adults Response References

Kratz, T., & Diefenbacher, A. (2019). Psychopharmacological treatment in older people: Avoiding drug interactions and polypharmacy. Deutsches Aerzteblatt International, 116(29/30), 508–518. https://doi-org.ezp.waldenulibrary.org/10.3238/arztebl.2019.0508
Markota, M., Rummans, T. A., Bostwick, J. M., & Lapid, M. I. (2016). Benzodiazepine use in older adults: Dangers, management, and alternative therapies. Mayo Clinic Proceedings, 91(11), 1632–1639
Neft, M. W., Oerther, S., Halloway, S., Hanneman, S. K., & Mitchell, A. M. (2019). Benzodiazepine and antipsychotic medication use in older adults. Nursing open, 7(1), 4–6.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier

4 hours ago

JACQUELINE NABUKEERA

RE: advanced Pharm

Hi Beth

Thank you for the informative post.As effective as Ativan is, it is very risky in the elderly population like it can cause sedation, confusion, sleepiness, and so on. The American Geriatrics Society added Ativan a benzodiazepine on a medication list that should be avoided to adults 65 years and older(Markota, et al., 2016). Several significant psychiatric associations also advise against using benzodiazepines for the elderly as they are always risky (Tannenbaum, 2015). UMD 6501 Benzodiazepine Antipsychotic Medication Use in Older Adults Response

In your scenario, I would be interested in knowing whether the patient’s size was considered in relation to the needed body surface for the 2mg Ativan given, also thinking of other medications or treatments that could work safely for this older patient. However, your individualized plan of care ensures that all precautions have been addressed for the patient’s safety. Thank you for your post. UMD 6501 Benzodiazepine Antipsychotic Medication Use in Older Adults Response

References

Markota, M., Rummans, T., Bostwick, M., & Lapid, M. (2016). Benzodiazepine is in older adults: dangers, management, and alternative therapies. Psychiatric and Psychology. (11), 1632-1639.
Tannenbaum, C. (2015). Inappropriate benzodiazepine use in elderly patients and their reduction.