Pharmacotherapies for smoking cessation in the elderly

by Kathleen Zanlocki RN

Every year in the U.S. over 392,000 people die from tobacco caused diseases, making it the leading cause of preventable death. Another 50,000 people die from exposure to secondhand smoke ("Stop smoking," 2011). The most common causes for smoking related mortality in patients over age 60 are lung cancer, cardiovascular disease, and chronic obstructive pulmonary disease (Mauk, 2010). Today’s elderly population grew into adulthood when smoking was socially acceptable by most adults and even some teenagers (Elhassan & Chow, 2007). Smoking was allowed in physician offices and even hospitals, and until 1969 elderly patients in nursing homes were still being given free cigarettes on the annual “respect for the aged” holiday (Elhassan & Chow, 2007). However, awareness of the addictive properties of tobacco spead, and smoking cessation became a recognized public health effort as more research data and evidence accumulated. (Elhassan & Chow, 2007).
The use of pharmacotherapy can be a key part of various methods used in assisting patients with their tobacco dependence (Mauk, 2010). According to the FDA, there are 2 first-line therapies used to treat withdrawal symptoms from smoking cessation; Wellbutrin XL and nicotine replacement therapy (Fiore, Jaen & Baker, 2009). Nicotine replacement therapy is the most widely used form of pharmacotherapy for managing nicotine dependence and withdrawal. These therapies include the transdermal patch, nasal spray, gum, lozenges, and nicotine inhalers. All have been shown to be effective in comparison with placebo (Fiore, Jaen & Baker, 2009). Wellbutrin XL is an antidepressant unrelated to selective serotonin reuptake inhibitors or tricyclic antidepressants. This drug’s mechanism of action related to smoking cessation is unknown. Side effects may include insomnia and loss of appetite (Fiore, Jaen & Baker, 2009). Second-line pharmacotherapies that are not approved for use for smoking cessation by the FDA are: clonidine and nortriptyline. The side effects of clonidine may include hypotension, rebound hypertension, dizziness, constipation, and agitation. The side effects of nortriptyline may include a risk of arrythmias (Fiore, Jaen & Baker, 2009).

All of these therapies may or may not be effective, but the first step in treating tobacco dependence is the patient's willingness to quit(Mauk, 2010).

References

Elhassan, A., & Chow, R. (2007). Smoking cessation in the elderly. Clinical Geriatrics, 15(2), 38-45. Retrieved from http://www.sbggpr.org.br/artigos/Como on 10/28/2011.
American Lung Association, (2011). Stop smoking. Retrieved from http://www.lungusa.org/stop-smoking
Fiore, M. C., Jaen, C. R., & Baker, T. B. US Department of Health and Human Services, Office of the Surgeon General. (2009). Treating tobacco use and dependence: 2008 update. Retrieved from http://www.surgeongeneral.gov/tobacco/tobaqrg2.htm
Mauk, K. L. (2010). Gerontological Nursing (2nd Ed.). Valpraraiso, Indiana: Jones and Bartlett Publishers.

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Saw Palmetto as Treatment for BPH

by Angelique Todd, RN

Benign prostatic hyperplasia, more commonly known as BPH is a non-cancerous enlargement of the prostate gland. This can be due to long- term stimulation of male sex hormone androgen. Microscopic appearance of BPH occurs typically by age 30 and is present in 50 percent of men by the age of 50 and 80 percent of men by age 80 (Burnett, 2006). It is said that, with longevity, every male will experience some level of this condition (Mauk, 2010). Symptoms may vary, but usually include urinary frequency, urgency, or inability to urinate.

Saw palmetto comes from a palm- like plant found in the southeast part of the U.S. It has been used to relieve symptoms related to BPH. Supporters claim that it has an anti-androgenic effect that with long-term use can reduce prostate cell proliferation, therefore minimizing symptoms. Some side effects include: nausea and vomiting, diarrhea, and bad breath. It is also believed to have anti-inflammatory and anti-platelet effects, and may be useful in chronic pelvic pain, bladder disorders, decreased sex drive, hair loss and hormone imbalance (Margaret A. Fitzgerald, December 2007). Finasteride is also a commonly used drug in the treatment of BPH. Effects are similar to those of saw palmetto and results of both are evident in PSA levels. In contrast the side effects are considerably different. Impotence, abnormal ejaculation and loss of sex drive are just a few. Older adult males may consider this to be more of a disadvantage when deciding whether to use a more traditional method of treatment.

As with most herbal supplements, safety, effectiveness or purity is not governed by the FDA making its use risky. When weighing the pros and cons of both a more holistic approach is needed it is the responsibility of the nurse to be knowledgeable about the modalities the client may be using and contraindications involved with other medications (Mauk, 2010). Basic knowledge in this area will give the nurse the tools necessary to help the patient make the most informed decision possible.

References

Burnett, A. W. (2006). "Benign Prostatic Hyperplasia in Primary Care: What you need to know.". Journal of Urology Issue75 , 19-24

Margaret A. Fitzgerald, D. A.-C. (December 2007). Herbal facts, herbal fallacies. Amercan Nurse Today , 27-32.

Mauk, K. L. (2010). Review of the Aging of Physiological Systems. In K. L. Mauk, Gerontological Nursing : Competencies for Care (pp. 150-151). Sudbury: Jones and Bartlett Publishers.

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Screening for Prostate Cancer

by Mikayo Streeter, RN

Should men get screened for Prostate Cancer?

Prostate cancer is the second leading cause of cancer death in U.S. males, with an estimate of over 186,320 new cases and 28,669 deaths in 2008” (Mauk 2010, p. 418) This cancer is known for its unusual behavior because the patients can go asymptomatic for awhile before the cancer has spread throughout the body. “The incidence of disease varies according to race, with Americans black having the highest risk in the world” (Granville 2006, p.53) According to the American Cancer Society, men especially African Americans should get screened at the age of 40. They often go to say that men who have a family history should consider discussing the option with their doctor. “Men with one close relative affected have more than a two-folded increased risk, and men with two close relatives affected have more than an eight-fold increased risk” (Granville 2006, p. 53). Studies have shown that it increases with age for the older population of men. “Over half of men 70 and older show some histologic evidence, though only a percentage die from this disease” (Mauk 2010, p. 418).

According to Mauk, she mentions that it is highly suggested that older men get screened because they are normally asymptomatic. Most men complain if symptoms are present that there is pain in the lower back, difficulty urinating, painful ejaculation, or blood in the urine/semen. There is two ways a screening can be done to detect prostate cancer: digital rectal exam (DRE) and PSA blood test. During the digital rectal exam the doctor inserts a glove fingered thru the rectum to feel for anything unusually hard or enlarged prostate that may exhibit lumps. The PSA test is used to detect a higher level of prostate cells thru the blood stream. “A PSA of less than 4ng/ml is considered normal for ages 60-69 years, whereas 7ng/ml may be normal in the 70-79 age group, because PSA rises with age” (Mauk 2010, p.418).

When the cancer is detected, it depends on the stages and growth of the cancer and the severity of the disease. The doctor discusses several options with the family and patient: surgery (radical prostatectomy), radiation/chemotherapy, or watchful waiting. “Surgery is considered the best option when the cancer is caught early; however, because a radical prostatectomy is major surgery and carries some inherent risks, all options should be considered with the older patient” (Mauk 2010, p. 143). The nurse responsibility after surgery is to explain the potential side effects to the patient: inform the patient they may experience urinary incontinence, loss of interest in sex, hot flashes, and impotence. “Sometimes, radiation is suggested where x-rays are passes through an external machine or through radioactive isotopes inside the body” (Moore 2007, p.1) Watchful waiting is recommended for the elderly men because of the complications after surgery. It is also recommended if they have other medical comorbidities. Older men should take a holistic approach by including a “low fat diet and the addition of vitamin E, selenium, and soy protein” (Mauk 2010, p. 418). The nurse should encourage the patient to consult with doctor before taking a holistic approach.

Prostate cancer is known as a chronic disease. That if it occurs in older men watchful waiting is the best decision for these patients. These patients need frequent monitoring but no treatment is needed. “Most prostate cancers are slow-growing and unlikely to be a cause of significant morbidity and mortality in older men” (Mauk 2010, p. 372). The pro of doing the screening is to early detect prostate cancer before it metastasize to other organs of the body. For older men, it will help to decrease the altered mental status changes if these men frequently develop urinary tract infections, urinary incontinence, or inability to urinate. The con is that majority of the older men that is diagnosed with prostate cancer usually die from the other medical comorbidities. “The greatest controversy regarding screening for prostate cancer is the inability to accurately predict which cancers will be aggressive and require treatment, and which are unlikely to metastasize” (Mauk 2010, p. 372).

References

Ginger, L. (2007). The Importance of cancer screening. Retrieved October 29, 2011, from http://cancerawarenesscenter.com
Granville, L. J. (2006). Prostate disease in later life. Chronic conditions in later life, , 51-56. Mauk, K. L. (2010). Gerontological nursing competencies for care (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers. Moore, K. (2007). Prostate cancer. Retrieved October 29, 2011, from http://cancerawarenesscenter.com

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Hypertension & It’s Harmful Affects!

by Shanta Spurlin, RN

Hypertension, known as high blood pressure is prevalent in the elderly population today. Many people in the world today have Hypertension and are unaware. Hypertension is a silent killer, and many diseases are caused secondary to it. HTN is characterized by an elevated blood pressures measuring 140/90 or greater.HTN increase the risk for the elderly to have heart disease, stroke, kidney or renal problems which can cause patient’s to go on dialysis if it goes untreated. This disease can be deadly. Risk factors for hypertension include family history, ethnicity, poor, diet, being overweight, excessive alcohol intake, a sedentary lifestyle, and certain medications (Mauk, 2010, p.384).
As healthcare providers we should teach our patients and raise awareness to this disease and its harmful affects. It is important to diagnose and treat hypertension to reduce the incidence of cardiac disease (Mauk, 2010, p.368). Blood Pressure screenings should be done regularly to assess for ones risk for this disease and to properly diagnosis it. Diagnosis of hypertension should be based on several readings at different times or visits to the primary healthcare provider (Mauk, 2010, p.384).

The Pros of HTN is that it can be treated, controlled and even prevented, by lifestyle changes and modifications. Exercising, weight loss and management, reading food labels to reduce sodium intake, and diet change can help prevent and control HTN.
There are also medications that can be prescribed by a physician to help lower ones blood pressure and manage HTN. Some examples are Diuretics, Beta-blockers, and Ace inhibitors. The Goal of medical treatment in older adults is to lower blood pressure to 120/80 or below (Mauk, 2010, p.385).

References
Mauk, K. L. (2010). Gerontological Nursing (2nd Ed.). Valpraraiso, Indiana: Jones and Bartlett Publishers.

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Preventing Obesity via CAM''s

by Lakeisa Perry, RN

It’s no secret that eating right and exercising are the best methods for shedding the pounds. They may also be the two most inexpensive ways to a healthier weight and state of mind. Obesity is defined as a medical condition where a surplus of body fat has gathered in a position where it can have an unfavorable effect on an individual’s health (Wikipedia, 2011).

When we speak of obesity there has to be a greater rationale for the crisis. The use of complementary and alternative medicine (CAM) has become widely used in our current population (Mauk, 2010). As healthcare professionals, when we are performing assessment we should also asses for the use of CAM (Mauk, 2010). Obesity is a disease that affects over 60 million people in the country (Ezine, 2011) and has a particular affect on women. Looking deeper into the issue of obesity there has to be a multifaceted underlying problem. Healthcare professionals should look to the subterranean explanations for this growing epidemic. In addressing the issue we should first remember that being overweight is different than being obese. To combat the dilemma we should address the psychosocial aspect of the problem i.e. depression, low self-esteem, lack of control or a possible fundamental health issue like thyroid anomalies or osteoarthritis. I would like to believe as Americans we do not wake from bed uttering “today is the day that I will do all I can to remain obese and unhealthy”. We’ll examine some interventions to oppose the problem of obesity.

When attempting to defeat your own personal demons I believe that the battle starts in your mind. Prepare yourself mentally to defeat the problem whether you have to say a chant or read a text to start your day. You also need to rate the importance of the CAM therapy in your life and believe that it will be effective to help fight your obesity. When exploring alternative modalities to weight lose some CAM’s that can be helpful are herbs, relaxation techniques (such as mediation and deep breathing exercise) and acupuncture. Acupuncture can be used to fight obesity by suppressing food cravings, appetite and boosting an individual’s mood (Kent, 2010). Acupuncture can help by increasing the stomachs smooth muscles tone and once the muscle tone has improved the hypothalamus then triggers the hypothalamus’ satiety center and stimulates the vagal nerve to increase the serotonin level (Kent, 2010) and as healthcare professionals we all know that an amplified serotonin level will cause a diminished desire to eat. It also can have a dual benefit because it alters our mood by fighting depression. Another alternative for fighting obesity can be the ingestion of herbs. Herbs can work in your body by improving your metabolism or suppressing your appetite. To name a few, Bee Pollen can stimulate metabolism and satisfy your cravings, Chromium can help the body use fat for energy and Brewer’s Yeast has been known to reduce various cravings for food and drink (Ezine.com, 2011). Herbs are not designed to replace your diet and there are some drawbacks to these alternative methods. For instance Bee Pollen should only be used for a short period of time (WebMD, 2011) and can cause an allergic reaction if taken without the knowledge of an allergy to the product. It has also been reported that Chromium can cause DNA damage (About.com, 2011) and should be used short term.

The benefit can sometimes out way the risk when attempting to combat obesity and by addressing the predicament known as obesity one can improve cardiovascular function, diabetes mellitus, kidney disorders, depression and hypertension.
Obesity can be precluded and is one of the major principles to death prevention for most individuals (Center for Disease Control and Prevention, 2011).

Always consult with your physician before attempting an alternative treatment.

References

Center for Disease Control and Prevention. (2011). Four specific health behaviors contributing to a longer life. Retrieved 10/30/2011 from http://cdc.gov/Features/LiveLonger/.
Kent, L.T. (2010). Acupuncture for obesity. Retrieved 10/30/2011 from http://www.livestrong.com/article/107364-acupuncture-obesity/
Mauk, K.L. (2010). Gerontological nursing competencies for care (2nd ed.).Sudbury, MA: Jones & Bartlett. Nick, D. (2007). Herbs to fight obesity. Retrieved 10/30/2011 from http://health.ezine9.com/herbs-to-fight-obesity-1381ca599f.html
WebMD. (2011). Bee pollen benefits and side effects. Retrieved 10/30/2011 from http://www.webmd.com/balance/bee-pollen-benefits-and-side-effects
Wikipedia. (2011). Retrieved 10/30/2011 from http://en.wikipedia.org/wiki/Anti-obesity_medication
Wong, C. (2007). Chromium pilcolinate side effects. Retrieved 10/30/2011 from http://altmedicine.about.com/od/herbsupplementguide/a/chromiumsideeff.htm

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Polypharmacy and the Elderly

by Patricia Elder, RN

Although the elderly population constitute on 12.7% of the U.S. population, they consume 34% of all prescription medication and 40% of all non prescription medication. The average person 65 to 68 years of age has an average of 14 prescriptions per year. (Mauk, 2010). Medications are meant to improve the health and well being of the elder person, by relieving pain, discomfort and treating underlined disease processes. When the elderly have many medications to take it results in non compliance due to medication regiment or expense. (Smeltzer, 2008). Polypharmacy occurs when multiple medication are taken, which increases medication interaction, multiple medication effects and incorrect dosages are used. With each medication a person takes it increases the drug interaction which is responsible for many emergency room and doctors visits. Some of the side effects of drug interaction are nausea, constipation, gastrointestinal bleedings, urinary incontinence, muscle aches, sexual dysfunction, and confusion. Dizziness and increase risk for falls (Mauk, 2010).

When patients come in it is imperative to see all medications, dosage and supplements to identify potential problems and identify medications that contraindicated. In addition to teaching intervention to enhance the elderly compliance with medication by:

1. Explain medication, purpose, adverse effects and proper dosage
2. Write medication schedule
3. Teach and show how to use medication dispenser
4. Destroy or remove old unused medication
5. Instruct patient to report over the counter medications, including herbal products
6. Instruct patient to keep list of all medication, over the counter and herbal supplements
7. Recommend the use of only one pharmacy to prevent duplications and contraindications in medication regiment
8. Remind the patient of the importance of taking medication as prescribed

It is imperative that we provide patient teaching on medication as a preventive measurement and to continue to add onto there knowledge base. The cost of non compliance often leads to morbidity and mortality among the elderly(Smeltzer, 2008).

References

Mauk, K. (2010) Gerontological Nursing 2nd Edition, Jones and Bartlett Publishers, Massachusetts
Smeltzer, S. (2008) Textbook of Medication- Surgical Nursing 11th Edition, Lippincott Williams and Wilkins, Pennsylvania

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Gingko Biloba and Dementia

by Carrington Carrington, RN

Dementia is a syndrome who signs and symptoms may be the result of several acquired, progressive, life-limiting disorders that erase memory and the person’s usual way of being in the world. (Tabloski, 2010, p. 740) The person with dementia has both a chronic illness and a terminal illness. Person’s with dementia losses the ability to perform activities of daily living and progressively become completely dependent in all aspects of care. There is no predictability of how or when the disease will progress. The greatest risk for developing dementia is older age even though a younger person may develop dementia as well. Although it is more common in older adults than in younger persons, dementia is not considered a normal part of aging.(Mauk, 2010, p. 531)

There is no cure available at the present time for dementia. Treatments for dementia are directed towards improving functioning and slowing down the progression of the disease. There are a number of pharmacological agents that are used to treat cognitive impairment but I will be focusing on a complementary and alternative therapy (CAM) form to treat dementia.
Complementary and alternative therapy according to Mauk is a group of diverse medical and healthcare systems, practices, and products that are not presently considered part of the conventional medicine in the United States. However there are many people who use herbal therapies they hear about along with their regular routine prescribed medications. Gingko Biloba will be our herbal therapy of choice for dementia.

Gingko biloba is one of the oldest living tree species and its leaves are among the most extensively studied herbs in use today. In Europe and the United States, ginkgo supplements are among the best-selling herbal medications. It consistently ranks as a top medicine prescribed in France and Germany. (University of Maryland Medical Center). Ginkgo has been used in traditional medicine to treat blood disorders and enhance memory. Scientific studies throughout the years have found evidence that supports these claims. Although not all studies agree, ginkgo may help prevent or treat dementia (including Alzheimer's disease). It also shows promise for enhancing memory in older adults. Because ginkgo inhibits platelets activation factor it is presumed to improve blood flow to the brain as well. (Tabloski, 2010, p. 747) Further studies suggest it may directly protect nerve cells that are damaged in dementia. (University of Maryland Medical Center)
Ginkgo biloba comes in tablets, capsules, and in liquid extracts. Dosages range from 120 to 240 mg daily.

Positive benefits of Ginkgo in a person with dementia are:
· Improvement in thinking, learning, and memory (cognitive function)
· Improvement in activities of daily living
· Improvement in social behavior
· Fewer feelings of depression
Negative benefits are:
· Inhibits platelet activation factor and can cause bleeding
· Increased blood pressure with thiazide diuretic
· Increased sedation with trazadone
· Can increase blood sugar
· Can cause headaches, dizziness, GI disturbances
Contraindicated in people who are:
· Diabetic
· Pregnant or breast feeding
· Have epilepsy
· Bleeding disorders

If you take gingkgo, you should stop taking it at least 36 hours before surgery or dental procedures due to the risk of bleeding. Tell your doctor or dentist that you take ginkgo.

Nursing considerations for Dementia
Dementia is a chronic illness and may require 20 years or more of home care, assisted living, or long term institutional care. The demented person will need acute care services to maintain independence, prevent excess disability, ensure safety, and manage medical complications. The family should be informed that even with the finest efforts of caregivers, the dieses will progress and create dependency in activities in daily living and ultimately result in death.

References
Mauk, K.L. (2010). Gerontological Nursing Competencies for Care, (2nd edition). Sudbury, MA:Jones and Barlett Publishers.
Tabloski, P. A. (2010). Gerontological Nursing, (2nd edition). Upper Saddle River, NJ: Pearson Education INC.
University of Maryland Medical Center. (2011). Ginkgo biloba. Retrieved from
http://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.