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Managing herpes zoster in older adults

Prescribing considerations

doi: 10.1097/01.NPR.0000520486.54287.39
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INSTRUCTIONS Managing herpes zoster in older adults: Prescribing considerations

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PROVIDER ACCREDITATION

Lippincott Williams & Wilkins, publisher of The Nurse Practitioner journal, will award 1.0 contact hour for this continuing nursing education activity.

Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.0 contact hours. Lippincott Williams & Wilkins is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida CE Broker #50-1223.

Your certificate is valid in all states. This activity has been assigned 1.0 pharmacology credits.

Managing herpes zoster in older adults: Prescribing considerations

General Purpose: To provide NPs with information about safe and effective care for patients with pain from HZ and PHN. Learning Objectives/Outcomes: After completing this continuing-education activity, you should be able to: 1. Recognize issues such as adverse reactions related to prescribing medications to older adults with pain from HZ or PHN. 2. Identify safe prescribing practices for older adults with pain from HZ or PHN.

  1. Older adults with HZ have difficulties with activities of daily living primarily due to
  2. comorbidities.
    problems sleeping.
    pain and discomfort.
  3. Adverse events related to antiviral and pain medications are often related to
  4. decreased liver metabolism.
    decreased kidney function.
    drug interactions.
  5. What percentage of older adults is affected by polypharmacy?
  6. 39%
    55%
    over 60%
  7. Antiviral medications should be prescribed for HZ as soon as possible or within
  8. 3 days.
    5 days.
    7 days.
  9. Antivirals can be used to do all of the following except
  10. decrease acute pain severity.
    decrease lesion duration.
    prevent PHN.
  11. Which antiviral is the least expensive?
  12. acyclovir
    famciclovir
    valacyclovir
  13. To best evaluate kidney function, NPs should determine the patient's
  14. creatinine level.
    estimated CrCl.
    blood urea nitrogen.
  15. The primary goal of treatment for patients with HZ is to control pain and
  16. prevent PHN.
    restore function.
    activate viral DNA synthesis.
  17. Medications useful for controlling mild HZ pain include NSAIDs and
  18. acetaminophen.
    antiseizure adjuvants.
    tricyclic antidepressants.
  19. Opioid use in older adults is associated with
  20. decreased adverse reactions.
    decreased therapeutic effects.
    increased adverse reactions.
  21. Which opioid adverse reactions are most concerning for older adults?
  22. drowsiness and increased risk of falls
    decreased appetite and nausea
    increased GI motility and constipation
  23. Because of the high risk for adverse reactions in older adults, the authors recommend avoiding
  24. opioids.
    antiseizure adjuvants.
    tricyclic antidepressants.
  25. Which group of drugs is contraindicated in patients in the acute recovery phase after an MI?
  26. opioids
    antiseizure adjuvants
    tricyclic antidepressants
  27. Patients with PHN pain not controlled by first-line medications should be
  28. referred to a pain management center.
    prescribed complex drug combinations.
    advised to rely on nonpharmacologic procedures.
  29. When prescribing opioid pain medications to an older patient, a prudent approach is to
  30. assess how the patient has tolerated pain medications in the past.
    avoid opioids unless the patient reports pain greater than 8 on the pain scale.
    start with a low dose and quickly increase the dose to see if adverse reactions develop.
  31. When Ms. C returns for a follow-up visit, which test should be ordered?
  32. visual acuity
    CrCl
    antiviral blood level
  33. Which medications should be avoided in patients with heart failure?
  34. antivirals
    antiseizure adjuvants
    NSAID analgesics
  35. Which statement about pregabalin is correct?
  36. Pregabalin is indicated for pain management in acute HZ and PHN.
    Dose adjustments of pregabalin are needed based on kidney function.
    Pregabalin is contraindicated in patients with impaired liver function.
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