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401 - Toxicology, Drug Abuse, Pharmacology > 22: Geriatrics > Flashcards

22: Geriatrics Flashcards

1
Q

what are the top 10 drug classes used in seniors

A

HMG-CoA reductase inhibitors > PPIs > dihydropyridine derivatives > ACEi > BB > thyroid hormones > angiotensin 2 antagonists > biguanides > other ADs > SSRIs

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2
Q

3 priority actions in medication safety include

A

high risk situations (children, elderly)
polypharmacy
transitions in care

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3
Q

list 2 RFs for ADRs

A

age (esp >85yrs)
comorbidities
caregiving (dependent)
# of meds (esp =>15) and doses/ day (MRCI)
high risk meds
nonadherence (then ↑ issues when forced to adhere in hospital)
recent start of new meds
# of pharmacies used
# of prescribers involved
recent hospitalizations in past year

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4
Q

why is nonadherence an issue when a patient is admitted in hospital

A

may increase drug levels unknowingly due to mandatory adherence in hospital

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5
Q

MRCI is

A

medication regimen complexity index: ↑ # = ↑ risk of mistake/ AE

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6
Q

3 main populations at risk of ADRs

A

people with multiple chronic conditions
women
>65yrs

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7
Q

4 drugs most commonly implicated in ADRs

A

antibiotics
anticoagulants
antineoplastics
analgesics
NSAIDs

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8
Q

which of the following is false
1. Seniors have the highest mortality rate from toxicologic exposures
2. ⅓ of elderly who experience an ADE never fully recover
3. 30-80% ADE in elderly are preventable
4. seniors are more prone to type D ADRs

A

4- type C

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9
Q

literal definition of polypharmacy

A

=>2 meds

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10
Q

most commonly accepted definition of polypharmacy

A

=>5 meds

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11
Q

what is the clinically meaningful definition of polypharmacy

A

when a medication is not needed

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12
Q

describe a polypharmacy prescribing cascade

A

use of one drug to treat the AEs of another

NSAID for arthritis → NSAID causes HPTN → CCB tx HPXN → CCB causes ankle swelling → diuretic to treat swelling → diuretic causes gout → allopurinol to tx gout → falls due to postural hypotension, restricted activity, loss of confidence, indigestion

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13
Q

3 proposed definitions of polypharmacy
The use of 2 or more drugs without_____________ or ________
The use of a drug to treat the _____________
The use of 2 or more drugs from the ___________________

A

without indication or for the same purpose
AEs of another drug
same class to treat different indications

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14
Q

drug- disease interactions are 2-3x _______ (less/ more) common than drug-drug interactions

A

more

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15
Q

Risk of interaction with 2 meds

A

low

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16
Q

risk in intx with 5-7 meds

A

4x risk

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17
Q

risk of intx with 8-10 meds

A

8x risk

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18
Q

list 3 pt risk factors for drug interactions in older adults

A

PK/PD changes
decreased organ system reserve,
nutrition status,
comorbidities,
aged heterogeneity (lifelong habits, environment, genetics),
atypical disease presentation, or
assumption that it is an aging problem,
masks detection of interactions,
communication (ex- not informing providers of meds taken)

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19
Q

what are 4 factor categories that are RFs for drug interactions

A

pt factors
prescriber factors
HCS factors
regimen factors

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20
Q

use of evidence based medicine and attitudes like agism is an example of _______ factor as a RF for drug interactions

A

prescriber

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21
Q

the use of a 70kg male patient as the research prototype for drugs is an example of _______ as a RF for drug intx

A

HCS

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22
Q

what is a PIM?

A

potentially inappropriate medication

A medication/ class where harm outweighs benefit, and there are safer alternatives available

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23
Q

which of the following is true
1. men care consistently affected more by PIM than women
2. all antipsychotics are PIMs
3. the BEERs criteria is used to identify PIMs in older adults
4. 2+3

A

4

24
Q

what are the 7 classes of PIM

A

BZDs
nonBZD hypnotics
antipsychotics
sulfonylurea oral hypoglycemics
TCAs
1st gen antihistamine
cardiovascular/ diuretic drugs

25
Q

3 reasons why ADR/ ADE are common but underdetected in elderly

A

lack of recognition
attitudes/ ageism
atypical presentation

26
Q

what is physiologic aging

A

measurement of level of development, health, or deterioration of pt in terms of functional norms for various body systems

27
Q

physiological aging changes typically start in

A

5th decade (40-49)

28
Q

4 things one might see in 5th decade of physiological aging

A

↓ tissue/ organ function
Functional decline
↑ susceptibility to disease
Δ in behaviour and PK/PD

29
Q

describe changes in taste with aging

A

Loss of lingual papillae
↓ of ability to taste
↓ Salivation
Use of dentures
↓ interest in food
↓ taste of salt- may use salt excessively

30
Q

which of the following is not a change that occurs with aging
1. ↓ of ability to taste
2. ↑ salivation
3. ↓ depth perception
4. ↑ fat
5. ↑ gastric emptying time

A

2- decreased salivation

31
Q

those =>85yrs old typically have the following hearing condition

A

presbycusis

32
Q

general phys changes with aging include
Body composition: ↑ ___
CV: ↓ _______________
GI: ↓ _____, ↑ __________
Renal: ↓ __________
Hepatic: ↓ _____________

A

↑ fat
↓ CO, beta sensitivity
↓ H+, ↑ gastric emptying time
↓ GFR, nephrons
↓ size, blood flow

33
Q

general phys changes with aging include
Nervous: ↓ ___________
Pulmonary: ↓ _______
Endocrine: ↓ ___________

A

Nervous: ↓ blood flow to CNS
Pulmonary: ↓ cilia
Endocrine: ↓ hormonal secretions

34
Q

loss of muscle mass starts at ___yrs and accelerates in ___. by the time a person is 90 years old, they have lost ___________ their muscle mass

A

40s
50s
half

35
Q

with aging, ___ gastric pH and _____ gastric acid secretion, GI blood flow, gastric SA, and GI motility

A

increased pH
decreased all else

36
Q

rate of absorption of drugs will be _______ in elderly

A

delayed

37
Q

in the elderly, there is
1. minimal impact of aging on passively absorbed drugs
2. minimal impact of aging on actively absorbed drugs
3. potential for increase in absorption due to delayed gastric emptying
4. 1+3

A

1

38
Q

in the elderly, there is typically _____ absorption of topical steroids

A

higher

39
Q

lipophilic drugs see ____ in Vd in elderly

A

increase

40
Q

T or F: protein changes with aging often impact drug tx

A

F- rarely impact, are often insignificant

41
Q

how does CYP content change in elderly

A

decreases

42
Q

how does aging affect phase 2 metabolism

A

not much effect- conversion stays intact
may decrease if pt is frail

43
Q

in the elderly, drugs metabolized by ___________ are preferred

A

phase 2

44
Q

knowing characteristics of metabolism in the elderly, the following adjustments should be made (select all that apply)
1. reduce doses of drugs that are metabolized by conjugation
2 .be aware that acute illness may dramatically affect metabolism
3. doses should be lowered for high and low hepatic extraction ratio drugs
4. drugs that are primarily metabolized by phase 2 metabolism should have a dose adjustment if the pt is frail
5. none of the above

A

2, 3, 4

45
Q

_________________ is the single most clinically important change in PK due to aging

A

↓ renal elimination

46
Q

the majority of drug dose adjustments in elderly are due to

A

renal function

47
Q

due to decreased muscle mass in older adults, __________ is an estimate

A

CrCL

48
Q

what is the paradox of exposure

A

↑ exposure = ↑ sensitivity

Ex- postural control, orthostasis, thermoregulation, visceral muscle function, cognition, anticoagulation, TD, arrhythmias

49
Q

CNS changes in elderly

A

neuronal loss, receptor downreg

50
Q

what is the MOA in postural control changes in the elderly

A

fewer dopamine (D2) receptors in striatum

51
Q

what is the MOA in change of movement control with aging

A

impaired or decreased dopamine synthesizing neurons

52
Q

orthostasis in elderly is due to

A

blunting of b response, receptor down regulation, changes in vascular tree and ANS

53
Q

arrythmias in elderly is due to

A

cardiac hypersensitivity

54
Q

coagulation in elderly is due to

A

poor hepatic production of coagulation factors, dietary intake

55
Q

what is the MOA in difficulties with thermoregulation in elderly

A

poor temp regulating mechs like shivering, ↓ metabolic rate, ↓ vasoconstriction, ↓ thirst response, ↓ awareness of temp

56
Q

list 4 ways to reduce risk of ADE in elderly

A

BPMH
Med reviews
Time to discuss and SDM
Integration of RPh
Flagging for # of meds, PIMs (use of software)
Rational/ rationing prescribing (preventing polypharmacy, minimizing PIMs, DeRx)

401 - Toxicology, Drug Abuse, Pharmacology (32 decks)

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