Therapeutic Drug Monitoring
Therapeutic drug monitoring entails incorporating repealed plasma drug concentration measurements as an effective strategy that guides the dosing regimen of a patient. The strategy can be utilized to verify the patient’s compliance with prescribed drugs, detect adverse drug reactions, and confirm drug toxicity or poisoning (Meiner & Yeager, 2019). It is a significant tool for drug therapy management among the elderly populations following the increase in the incidence of drug interactions, polypharmacy, and chronic health conditions. This paper will discuss how age affects drug metabolization, absorption, and excretion. Evaluation of risk factors and prevention of medication nonadherence in older adults will also be proposed.
With the advancement in age, there is a gradual decline in the physiological functionality of body tissues and organs. Following the decline in tissue, organ, and organ system functionality, drug metabolization, absorption, excretion, and distribution are significantly affected negatively among elderly individuals (Meiner & Yeager, 2019). Besides, elderly individuals are prone to adverse drug reactions following their age-related alterations in drug sensitivity. Drug dissolution and absorption are negatively affected by age-related changes in the gastrointestinal mucosa, such as a decrease in gastric acid secretion. In addition, drugs are destined to stay for a longer duration along the alimentary canal following a decrease in peristaltic movements with advancing age, hence greater drug absorption.
Regarding drug distribution, elderly adults are thus more prone to drug toxicity and poisoning incidents due to the tendency of drugs to remain in a free state at high levels in their plasma proteins. The elderly adults have increased fat percentage, decreased plasma proteins, and a corresponding decrease in lean tissues (Meiner & Yeager, 2019).As far as drug metabolism is concerned, the metabolic activity of CYP450 and other liver drug-metabolizing enzymes decreases with advancing age. The overall effect is a prolonged half-life of drugs, hence more likelihood for adverse reactions. The decrease in kidney function with advancing age increases the incidence of toxic drug reactions since they are the primary drug excretion organs in the body.
Angiotensin-converting enzyme (ACE) inhibitors comprise the commonly prescribed antihypertensive drugs among chronic hypertensive patients. Their mechanism of action entails relaxation and opening of blood vessels, promoting a free and smooth blood flow, hence lowing the blood pressure (Messerli et al., 2018). However, their concomitant use with salt substitutes is attributed to cause undesirable side effects such as hyperkalemia among older adults.
Such potentially life-threatening interaction can lead to a remarkable increase in serum potassium, hence stimulating a cascade of organ failure or malfunction. Therapeutic drug monitoring is thus of essence among hypertensive patients prescribed ACE inhibitors. A major intervention is to encourage restriction of dietary salt intake, teaching patients signs of hyperkalemia, and withdrawal of ACE inhibitors among the affected patients (Messerli et al., 2018).
Evaluation of risk factors and prevention of medication nonadherence in older adults is a significant health intervention aimed at enhancing their health outcomes. Therapeutic drug monitoring is thus of essence as far as medication adherence is concerned. The nurse or other health care provider should keep close monitoring after administering medications with possibly adverse or toxic reactions. Assessment of risk factors such as advanced age, which is attributable to dementia, could lead to missed dosages hence poor compliance to the treatment regimen. Necessary interventions such as assigning them to responsible individuals to monitor their compliance to treatment regimens are preferred.
References
Meiner, S. E. & Yeager, J.J. (2019). Gerontologic nursing-e-book. (6th Edition). Elsevier Health Sciences.
Messerli, F. H., Bangalore, S., Bavishi, C., & Rimoldi, S. F. (2018). Angiotensin-converting enzyme inhibitors in hypertension: to use or not to use? Journal of the American College of Cardiology, 71(13), 1474-1482.
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Question 
Therapeutic drug monitoring is a frequent practice in health care. How does age affect drug absorption, metabolization, and excretion?
Therapeutic Drug Monitoring
The use of salt substitutes can cause hyperkalemia in older adults when used in conjunction with what types of drugs?
Describe how you would prevent and evaluate risk factors for medication nonadherence in older adults.
at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources