INSTRUCTIONS Managing herpes zoster in older adults: Prescribing considerations
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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.
- Older adults with HZ have difficulties with activities of daily living primarily due tocomorbidities.
pain and discomfort.
- Adverse events related to antiviral and pain medications are often related todecreased liver metabolism.
decreased kidney function.
- What percentage of older adults is affected by polypharmacy?39%
- Antiviral medications should be prescribed for HZ as soon as possible or within3 days.
- Antivirals can be used to do all of the following exceptdecrease acute pain severity.
decrease lesion duration.
- Which antiviral is the least expensive?acyclovir
- To best evaluate kidney function, NPs should determine the patient'screatinine level.
blood urea nitrogen.
- The primary goal of treatment for patients with HZ is to control pain andprevent PHN.
activate viral DNA synthesis.
- Medications useful for controlling mild HZ pain include NSAIDs andacetaminophen.
- Opioid use in older adults is associated withdecreased adverse reactions.
decreased therapeutic effects.
increased adverse reactions.
- Which opioid adverse reactions are most concerning for older adults?drowsiness and increased risk of falls
decreased appetite and nausea
increased GI motility and constipation
- Because of the high risk for adverse reactions in older adults, the authors recommend avoidingopioids.
- Which group of drugs is contraindicated in patients in the acute recovery phase after an MI?opioids
- Patients with PHN pain not controlled by first-line medications should bereferred to a pain management center.
prescribed complex drug combinations.
advised to rely on nonpharmacologic procedures.
- When prescribing opioid pain medications to an older patient, a prudent approach is toassess 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.
- When Ms. C returns for a follow-up visit, which test should be ordered?visual acuity
antiviral blood level
- Which medications should be avoided in patients with heart failure?antivirals
- Which statement about pregabalin is correct?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.