10: Falls and Polypharmacy Flashcards
_____ and _____ are most cited as etiologies in falls with analgesics.
Psychotropics and CV agents
Average elder fills _____ prescriptions per year.
13
_____ of those who lie on the floor for more than 1 hour after fall die within 6 months of fall regardless of injury.
50%
Concurrent use of multiple medications.
Polypharmacy
Extrinsic factors for falls (8).
- Environmental hazards
- Home situations: Lighting
- Stairs
- Uneven surfaces
- Old, unstable furniture
- Low beds
- Rugs
- Ground frost/ice
NSAIDs: Some authors recommend concurrent use of _____ to prevent side effects.
H2RAs
Regarding SSRIs: _____ can be very pronounced in some elders.
GI side effects
T/F The “Get-Up and Go” test helps identify people who may be at risk for falls.
True. Measures gait and balance. However, the issue of polypharmacy must be added to the testing.
What 2 fall risk factors emerged in a London study?
- Polypharmacy
2. Living in shelters/long-term care settings
What 2 fall features are found to be most predictive?
- Not being able to get up after a fall.
2. Previous overall functional decline.
Concerns with CCBs usually arise when coadministered with what 2 meds?
- BBs
2. Digoxin
Risk factors for falls (6).
- Hx of falls
- Cognitive impairments
- Visual impairments
- Gait/balance disorders (Parkinson’s, dementia, DM)
- Lower extremity dysfunction
- Psychotropic meds
7 rules for geriatric prescribing.
- Start slow and increase slowly.
- Remember the half-life of many drugs is prolonged in the elderly.
- Increase doses slowly since it may take longer to reach a steady state.
- Use the fewest number of drugs possible.
- Watch for toxicity.
- Remember adverse drug events may be manifested atypically in the elderly.
- Know that CNS changes may be a marker for toxicity.
Regarding SSRIs: _____ can increase agitation in some elders.
Prozac
T/F Use caution in tapering dosage of SSRI d/t risk of discontinuation syndrome.
True
These are most frequently used for angina, migraines, dysrhythmia, HTN.
CCBs
When does warfarin peak?
Shows effect on PT in 2-3 days, but takes 7-10 days to peak.
T/F Important to consider OTCs in all medical histories. Aspirin, acetaminophen, and antihistamines most commonly used.
True. Laxatives and antacids are also common categories.
T/F Narcotic choices often underutilized in the elderly.
True (such as Tylenol with codeine).
What percentage of hip fractures die within 1 year if the fall occurred in a nursing home?
50% (and 4% of falls in nursing homes result in hip fractures).
Underprescribing often occurs in these 7 categories.
- Beta-blockers
- ACE inhibitors
- Anticoagulants
- Statins
- Antihypertensives
- HTR
- Antidepressants
Major pathway for excretion of this OTC drug is renal.
NSAIDs
If you put a patient on digoxin, what are 3 meds that could interact?
- Quinidine
- Amiodarone
- Verapamil
Why are elders more susceptible to drug adverse effects (2)?
- Age-related changes in homeostasis, pharmacokinetics
2. Number of drugs consumed (10 drugs = 100% chance of ADR)