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The Principles of the Use of Medications in the Elderly课程教案、知识点、字幕

苯海拉明 阿托品

东莨胆碱 呋喃妥因等

这些药物都被列入

美国老年医学会2015版

《Beers标准》公布的老年人潜在

不适当用药名单中

老年人由于各器官的贮备功能

以及身体内环境稳定性随年龄而衰退

对药物的耐受程度

以及安全幅度均明显下降

那在老年人群中

如何合理用药

才能既达到防病治病的目的

又不会给老年人带来身体损害呢

所谓合理用药

是指根据疾病种类

患者状况

和药理学理论选择最佳的药物及其制剂

制订或调整给药方案

以期有效 安全 经济地防治

和治愈疾病的措施

临床中有5个原则用来指导医务工作者

为老人合理 安全用药

由于老年人药物不良反应发生率高

病死率高和危害大

因此给老人用药时必须权衡利弊

遵循受益原则

以确保用药对患者有益

首先要求老年人用药要有明确的指征

其次

要求用药的受益风险比值大于1

若有适应症而用药的受益风险比值小于1时

不应给予药物治疗

比如老年人体检发现心律失常

各项检查后既没有器质性心脏病变

也没有血流动力学变化时

应尽可能不用或少用抗心律失常药

因为长期服用抗心律失常药

可使死亡率增加

资料表明

用药数目越多

药物不良反应发生率越高

如图所示

同时使用5种及以下数量的药物

不良反应发生率为4%

当用药种类大于15种时

则会有一半的几率出现不良反应

这提示我们

要预防或减少药物不良反应的发生

避免过多的药物合用

药物种类要尽量简单

最好5种以下

比如一位老人同时患有糖尿病 高血压

心绞痛 钙化心瓣膜病

单纯性肥胖 胆石症

前列腺增生等疾病

因为血糖控制不佳入院治疗

用药时要考虑主要矛盾

必须用药控制的疾病有

糖尿病 高血压和心绞痛

其他疾病症状不显

也不严重则可通过饮食

活动等非药物治疗方式进行病情控制

而需要用药的疾病中

还可选择具有兼顾治疗作用的药物

像高血压合并心绞痛

选用β受体阻滞剂或钙拮抗剂

前列增增生严重且合并高血压

选用α受体阻滞剂

另外

还要告知老人减少和控制服用补药

一般健康老年人不需要服用补药

而体弱多病的

可以在医师指导下适当服用滋补药物

第三个原则是小剂量原则

中国药典规定老年人用药剂量

为成人剂量的四分之三

剂量要准确适宜

必要时对老年患者进行血药浓度监测

以调整合理剂量

直到出现满意疗效而没有不良反应为止

像健康状况差

年龄大于70岁

低体重的老年人

则必须要减少药物剂量

再来看下择时原则

择时就是根据时间生物学

和时间药理学的特点

选择最合适的用药时间进行治疗

从而达到提高疗效和减少毒副作用的目的

因为许多疾病的发作 加重与缓解

都具有昼夜节律的变化

比如关节炎常在清晨出现关节僵硬

人的死亡高峰时间为凌晨4点到7点

药代动力学有昼夜的节律变化

比如白天肠道功能相对亢进

白天用药比夜间吸收快

血药浓度高

药效学也有时间性

胰岛素的降糖作用

和硝酸甘油的扩张冠状动脉作用

均是上午大于下午

因此

进行择时治疗时

主要根据疾病的发作

药代动力学和药效学的昼夜节律变化

来确定最佳的用药时间

暂停用药原则是指老年人在用药期间

应该要密切的观察

一旦出现新的症状

应考虑为药物的不良反应或是病情进展

前者应该要停药

后者则应该要加药

对于服药的老年人出现新的症状

停药受益可能要多于加药的受益

因此

暂停用药是现代老年病学中

最简单 有效的干预措施之一

值得高度重视

受益原则

五种药物原则

小剂量原则 择时原则

暂停用药原则

以上五大原则需要牢记

他们可以在一定程度上

帮助解决老年人药物不良反应发生率高

病死率高和危害大的临床难题

提高老年人用药的安全性

Gerontological Nursing课程列表:

CHAPTER 1: General Introduction to Geronological Nursing

-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

--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

--【Literature Recommendation】Obstacles and Policies of the Social Capital Participates in the Combination of Medical Care and Pension: A Literature Review

-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

-【Case Discussion】CHAPTER 1

CHAPTER 2: Elderly Health Assessment

-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

--【Literature Recommendation】Age-friendliness of living environments from the older person’s viewpoint: development of the Age-friendly Environment Assessment Tool

-Concept Map

--【Concept Map】Elderly Health Assessment(1)

--【Concept Map】Elderly Health Assessment(2)

-【Test】CHAPTER 2

-【Case Discussion】CHAPTER 2

CHAPTER3: Elderly Mental Health and Mental Health care

-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

--【Website Recommendation】

--【Documentary Recommendation】Depression:Out of the Shadows

--【Literature Recommendation】Management of depression in older adults:A review depression in older people

-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

-【Case Discussion】CHAPTER 3

CHAPTER4: Elderly Daily Care

-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

-【Case Discussion】CHAPTER 4

CHAPTER5:Medication Safety and Care for the Elderly

-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

--【Literature Recommendation】The American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

-5.4 Prevention of Adverse Drug Reactions in the Elderly

--Prevention of Adverse Drug Reactions in the Elderly

--【Literature Recommendation】Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies

-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

-【Case Discussion】CHAPTER 5

CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases

-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

--Dysphagia in the Elderly

-6.3 Urinary Incontinence in the Elderly

--Urinary Incontinence in the Elderly

-6.4 Constipation in the Elderly

--Constipation in the Elderly

--【Literature Recommendation】Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

-6.5 Dry Mouth in the Elderly

--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

--Senile Deafness

-6.9 Elderly Delirium

--Elderly Delirium

-6.10 Elderly Frailty

--Elderly Frailty

--【Literature Recommendation】Frailty in elderly people/Frailty in older people

-6.11 Pneumonia in the Elderly

--Pneumonia in the Elderly

-6.12 Hypertension in the Elderly

--Hypertension in the Elderly

--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension

-6.13 Stroke in the Elderly

--Stroke in the Elderly

-6.14 Stable Angina in the Elderly

--Stable Angina in the Elderly

--【Literature Recommendation】2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

-Concept Map

--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases

-【Test】CHAPTER 6

-【Case Discussion】CHAPTER 6

CHAPTER7 Hospice Care for the Elderly

-7.1 Concept of Hospice Care

--Concept of Hospice Care

--【Website Recommendation】 Definition of Palliative Care,WHO

-7.2 Death Education

--7.2.1 Death Education (1)

--7.2.2 Death Education (2)

--【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

--【Journal Recommendation】

-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

-【Case Discussion】CHAPTER 7

FINAL EXAM

-Final Exam

The Principles of the Use of Medications in the Elderly笔记与讨论

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