当前课程知识点:老年护理学(Gerontological Nursing) > CHAPTER5:Medication Safety and Care for the Elderly > 5.2 Common Adverse Drug Reactions and Their Causes in the Elderly > Common Adverse Drug Reactions and Their Causes in the Elderly
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药物不良反应是指在常规剂量情况下
由于药物或药物相互作用
而发生的与防治目的无关
不利或有害的反应
包括药物副作用 毒性作用
变态反应 继发反应
和特异性遗传素质有关的反应等
WHO报道
全世界三分之一死亡病例的原因
不是疾病本身
而是不合理用药
而发生药物不良反应的人群中
老年人约占三分之一
老年人由于身体机能退化
慢性病患病率高
用药几率增加
同时肝肾功能减退
药物代谢和排泄降低
以及对药物的敏感性改变等
因此
不可避免的成为药物不良反应主要受害者
老年人常见的药物不良反应包括
精神症状 直立性低血压
耳毒性 尿潴留和药物中毒
具体我们看下这些症状的产生原因
以及临床表现
药物最容易影响中枢神经系统
而老年人由于神经系统功能减退
脑血流量 脑细胞数
以及代谢活力下降
受体的敏感度改变等
对药物直接
或间接的中枢抑制作用更为敏感
这会导致加剧导致神经系统的毒性反应
如出现头晕 头痛
嗜睡甚至精神异常
抽搐 癫痫样发作等症状
导致老年人精神症状的药物有
抗胆碱能药 抗抑郁药
抗精神病药 洋地黄类
降压药 抗心律失常药
皮质激素 镇静安眠药等
比如老年痴呆患者
使用中枢抗胆碱药 左旋多巴
可加重痴呆症状
高血压患者常年服用降压药
可引起老年抑郁症
临床上有应用上述药物时
护理人员应注意观察
有无神经精神不良反应的发生
伴随年龄增长
老年人因为心血管系统的调节功能减弱
对血压的变化较为不敏感
常不能根据血压变化做出适当调节
即使没有药物的影响
也会出现体位改变而感到头晕
加上如有使用三环类抗抑郁药
利尿剂 血管扩张药等药物时
会引起交感神经兴奋性减弱
血容量不足或血管扩张
尤其容易发生体位性低血压
第三个常见症状为耳毒性
由于内耳毛细胞的数目下降
老人常有听力减弱的表现
并且毛细胞损害后难以再生
如果应用具有耳毒性副作用的药物
如氨基糖苷类抗生素和多黏菌素
容易造成永久性耳聋
也有其他前庭 耳蜗的损害症状
前庭损害的主要症状有
眩晕 头痛 恶心和共济失调
耳蜗损害的症状有
耳鸣 耳聋等
第四个常见症状为尿潴留
一些药物有副交感神经阻滞作用
加上老年人常有前列腺肥大
使用呋塞米 依他尼酸等
强效的利尿剂特别容易引起尿潴留
老年人用药还很容易产生肝毒性
肾毒性和心脏毒性反应
肝肾功能的正常与否
决定了机体对药物处置的能力
然而
人体各个重要器官的生理功能
会随着年龄增长减退
大家看一下这张曲线图
60岁以上老年人的肾脏排泄毒物的功能
比25岁时要下降20%
肝脏血流量比年轻时下降40%
肝肾功能异常会使药物代谢和排泄减少
半衰期延长
血药浓度增加
药物不良反应发生率增加
因此
在给老人用药时
尤其要注重评估肝肾功能指标
如果异常就要考虑药物的代谢和排泄途径
肝功能异常时
选择经肾脏排泄的药物
肾功能异常时
选择经肝胆排泄的药物
尽量避免或减少肝肾毒性的发生
老年人服药后
出现高发生率的药物不良反应
除了增龄性原因导致药动学
和药效学发生改变外
还与并发多种疾病
而同时接受多种药物治疗
以及部分老人缺乏医药常识
擅自服用 滥用滋补药
保健药 抗衰老药和维生素等非处方药
用药的次数和剂量不当等有关系
因此
我们在密切观察药物不良反应表现以外
还需要认真评估老年人既往的疾病
询问老人及其家属平时服药情况
医护患共同合作
控制老年人的用药安全
-1.1 Human Life Expectancy and Age Classification of the Elderly
--Human Life Expectancy and Age Classification of the Elderly
--【Vedio Recommendation】 How do we measure life expectancy ?
-1.2 Population Aging
--【Literature Recommendation】World Report on Ageing and Health: 2015
-1.3 Influence and Countermeasures of Population Aging
--Influence and Countermeasures of Population Aging
--【Literature Recommendation】World Population Ageing Highlights:2019
-1.4 Goals and Principles of Elderly Care
--Goals and Principles of Elderly Care
--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice
-1.5 Theories Related to Elderly Care
--1.5.1 Personality Development Theory and Life Review
--1.5.2 Disengagement Theory and Activity Theory
--1.5.3 Self-efficacy and Chronic Disease Management
--【Vedio Recommendation】8 Stages of Development by Erik Erikson
--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging
--【Book Recommendation】Self-Efficacy in Changing Societies
-1.6 Elderly Support and Elderly Care
--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care
--1.6.2 Home-based Elderly Care Model
--1.6.3 Institutional Elderly Care Model
--1.6.4 Integrated Medical and Nursing Care Model
--【Vedio Recommendation】Day in the Life of Home Care
--【Website Recommendation】Official Website of the National Institutes of Health
-Concept Map
--【Concept Map】General Introduction to Geronological Nursing
-【Test】CHAPTER 1
-2.1 Aging Changes in the Elderly
--2.1.1 Aging of the Respiratory System
--2.1.2 Aging of the Cardiovascular System
--2.1.3 Aging of the Digestive System
--2.1.4 Aging of the Urinary System
--2.1.5 Aging of the Endocrine System
--2.1.6 Aging of the Motor System
--2.1.7 Aging of the Nervous System
--2.1.8 Aging of the Sensory System
--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging
--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology
-2.2 Comprehensive Health Assessment of the Elderly
--Comprehensive Health Assessment of the Elderly
--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review
-2.3 Principles of Elderly Health Assessment
--Principles of Elderly Health Assessment
-2.4 Assessment of the Functional Status of the Elderly
--Assessment of the Functional Status of the Elderly
--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale
-2.5 Assessment of Cognitive Function in the Elderly
--Assessment of Cognitive Function in the Elderly
-2.6 Assessment and Adjustment of the Living Environment for the Elderly
--Assessment and Adjustment of the Living Environment for the Elderly
-Concept Map
--【Concept Map】Elderly Health Assessment(1)
--【Concept Map】Elderly Health Assessment(2)
-【Test】CHAPTER 2
-3.1 Overview of the Psychological Characteristics of the Elderly
--Overview of the Psychological Characteristics of the Elderly
-3.2 Influencing Factors of Psychological Changes in the Elderly
--Influencing Factors of Psychological Changes in the Elderly
-3.3 Common Psychological Issues and Their Management in the Elderly
--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)
--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)
--【Book Recommendation】Development Through the Lifespan
-3.4 Depression in the Elderly
--3.4.1 Overview of Depression in the Elderly
--3.4.2 Clinical Symptoms of Depression in the Elderly
--3.4.3 Caring for Elderly Patients with Depression
--【Documentary Recommendation】Depression:Out of the Shadows
-3.5 Elderly Patients with Dementia
--3.5.1 Identification of Dementia Symptoms in the Elderly
--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia
--3.5.3 Safety Care of Elderly Patients with Dementia
--【Website Recommendation】The Global Voice on Demaentia
-Concept Map
--【Concept Map】Elderly Mental Health and Mental Health Care
-【Test】CHAPTER 3
-4.1 Precautions for Daily Care of the Elderly
--Precautions for Daily Care of the Elderly
-4.2 General Care of Elderly Skin
--4.2.1 Characteristics and General Care of Elderly Skin
--4.2.2 Skin Itching and Its Management in the Elderly
--【Website Recommendation】American Academy of Dermatology
-4.3 Clothing Hygiene for the Elderly
--Clothing Hygiene for the Elderly
--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly
-4.4 Dietary Care for the Elderly
--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs
--4.4.2 Dietary Care for the Elderly
--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics
--【Website Recommendation】Nutrition for older persons
-4.5 Sleep Guidance for the Elderly
--4.5.1 Sleep Characteristics of the Elderly
--4.5.2 Sleep Guidance for the Elderly
--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems
--【Website Recommendation】American Academy of Sleep Medicine
-4.6 Exercises Guidance for the Elderly
--4.6.1 Evaluation of Exercise Intensity in the Elderly
--4.6.2 Precautions Elderly Undertaking Exercises
--【Website Recommendation】American College of Sport Medicine
--【Book Recommendation】Handbook of Activities for the Elderly
-Concept Map
--【Concept Map】Elderly Daily Care
-【Test】CHAPTER 4
-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--【Website Recommendation】How Drugs Work In the Elderly
-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly
--Common Adverse Drug Reactions and Their Causes in the Elderly
-5.3 The Principles of the Use of Medications in the Elderly
--The Principles of the Use of Medications in the Elderly
-5.4 Prevention of Adverse Drug Reactions in the Elderly
--Prevention of Adverse Drug Reactions in the Elderly
-5.5 Medication Compliance in the Elderly
--Medication Compliance in the Elderly
-Concept Map
--【Concept Map】Medication Safety and Care for the Elderly
-【Test】CHAPTER 5
-6.1 Falls in the Elderly
--6.1.1 Epidemiological Characteristics of Elderly Falls
--6.1.2 Risk Factors for Falls in the Elderly
--6.1.3 Prevention of Falls in the Elderly
--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)
-6.2 Dysphagia in the Elderly
-6.3 Urinary Incontinence in the Elderly
--Urinary Incontinence in the Elderly
-6.4 Constipation in the Elderly
-6.5 Dry Mouth in the Elderly
--【Website Recommendation】Academy of Nutrition and Dietetics
-6.6 Elderly Nutritional Deficiencies
--Elderly Nutritional Deficiencies - emaciation
-6.7 Visual Impairment in the Elderly
--Visual Impairment in the Elderly
--【Website Recommendation】Senior Eye Exams
-6.8 Senile Deafness
-6.9 Elderly Delirium
-6.10 Elderly Frailty
--【Literature Recommendation】Frailty in elderly people/Frailty in older people
-6.11 Pneumonia in the Elderly
-6.12 Hypertension in the Elderly
--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension
-6.13 Stroke in the Elderly
-6.14 Stable Angina in the Elderly
--Stable Angina in the Elderly
-Concept Map
--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases
-【Test】CHAPTER 6
-7.1 Concept of Hospice Care
--【Website Recommendation】 Definition of Palliative Care,WHO
-7.2 Death Education
--【Book Recommendation】The Meaning of Death by Herman Feife
-7.3 Nursing for Pain in the Dying Elderly
--Nursing for Pain in the Dying Elderly
-7.4 Nursing for Major Bleeding in the Dying Elderly
--Nursing for Major Bleeding in the Dying Elderly
-7.5 Nursing for Delirium in the Dying Elderly
--Nursing for Delirium in the Dying Elderly
-7.6 Nursing for Dyspnea in the Dying Elderly
--Nursing for Dyspnea in the Dying Elderly
--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA
-7.7 Psychological Problems and Nursing in the Dying Elderly
--Psychological Problems and Nursing in the Dying Elderly
--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross
-7.8 Grief Counseling for the Widowed Elderly
--Grief Counseling for the Widowed Elderly
--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela
-Concept Map
--【Concept Map】Hospice Care for the Elderly
-【Test】CHAPTER 7