Iatrogenic prescribing in acute care: learning from our mistakes

1. The pharmacokinetics of medications (i.e., absorption, distribution, metabolism, elimination) are altered in older adults because of age-related changes in body composition, diminished vascularity, and atrophy of end-organs. 2. The result of altered pharmacokinetics is often a stronger drug effect than seen in younger adults, a longer duration of drug action, and higher risk of adverse drug effects and drug-drug interactions. 3. Nurses working with older adults should be aware of measures to prevent potential adverse drug effects, including being aware of adverse effects of drugs and that the effects of drugs in older adults are atypical; being aware that changing more than one medication or dosage at a time may make interpretation of the response more difficult; being aware that many drugs with narrow therapeutic windows can and should be monitored via serum levels, and that renal insufficiency will increase the chance of adverse drug effects for renally excreted drugs.