how the body interacts with the administered medication.
Introduction
According to Grogan and Preuss (2022), pharmacokinetics is the study of how a medication moves through the body and how the body interacts with the administered medication. Burchum & Rosenthal (2021) enumerated the four pharmacokinetics processes: absorption, distribution, metabolism, and excretion. Meanwhile, pharmacokinetics was defined as the study of physiological effects or actions of medication in the body (Marino, et al., 2022). Grogan and Preuss (2022) stated that in the absorption process, the duration and concentration of drugs could be affected depending on how a person’s body processes the medication. The processes could be affected by aging, drug-to-drug interactions, route of administration, different illnesses, or organ problems.
I currently work at a skilled nurse facility, and we have a patient that is an 88-year-old female who is a s/p fall, left hip fracture with a history of HTN, DM, DVT, multiple falls at home, osteoporosis, and HLD. The patient is alert and oriented x 1, combative, always attempts to get up from her bed, and asks to bring her home. Pad alarm was consented and applied. Even after multiple times of reminding the patient to stay on her bed and to use the call light for help, she will still try to get up and will shout for help. Per family, at home, the patient is given Melatonin 10mg, which sometimes helps and sometimes does not. MD was informed about the situation, and while waiting for orders that night, the patient fell from her bed. No injuries, no active bleeding, and normal vital signs were noted. MD ordered Ativan 0.5mg PO. Medication was administered, and still patient has not calmed down. The next night, the patient was shouting in the room, asking for help and wanting to go home. A sitter was requested, and MD added 0.5mg of Ativan to administer. In the morning, the sitter was about to feed the patient, and the sitter panicked. The patient was difficult to arouse. Staff went into the room. Vital signs were checked, and it was within normal limits. The patient was still sleeping at that time of the day, which was unusual. The patient was put under close monitoring, and later that day, the patient woke up. Vital signs were stable, and the patient returned to attempting to get up and shouting. Ativan was responsible for the difficulty of arousing the patient. MD lowered the Ativan back to 0.5mg, and the next nights, the patient was responding well.
Conclusion
Healthcare professionals should be careful of using benzodiazepines, especially with the older age populations. According to Ghiasi, et al. (2022) Ativan toxicity can cause CNS and respiratory depression, such as extreme drowsiness, muscle weakness, confusion, hypotension, and coma. Ghiasi, et al. (2022) suggested tapering Ativan, but in the case scenario above, Ativan was increased the next night as medication did not help immediately on the first day. In Beers Criteria, the American Geriatrics Society (2019) stated that healthcare professionals should be aware of the increased sensitivity of older adults to benzodiazepines, especially of the decreased metabolism on long-acting agents. American Geriatrics Society (2019) suggested that benzodiazepines should be avoided by older adults as much as possible.
References:
American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (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. doi:10.1111/jgs.15767
Ghiasi, N., Bhansali, R., & Marwaha, R. (2022). Lorazepam.
https://www.ncbi.nlm.nih.gov/books/NBK532890/
Grogan, S. & Preuss, C. (2022). Pharmacokinetics.
https://www.ncbi.nlm.nih.gov/books/NBK557744
Marino, M., Jamal, Z. & Zito, P. (2022). Pharmacodynamics.
https://www.ncbi.nlm.nih.gov/books/NBK507791/
Rosenthal, L. & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses
and physician assistants (2nd ed.) St. Louis, MO: Elsevier.