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801 > 801e Polypharmacy Use in Older Adults > Flashcards

801e Polypharmacy Use in Older Adults Flashcards

1
Q

geriatric syndromes

A

polypharmacy, dementia, imbalance, functional decline, urinary incontinence, malnutrition, and frailty

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2
Q

medication related problems (MRPs)

A

untreated indication, med w/out indication, over/under dose, drug allergies, ADRs, drug interactions, non adherence, duplicate therapy

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3
Q

polypharmacy

A
  • administration of many meds together
  • 4,5, 9 or more chronic meds
  • prescription, OTC, vitamin, supplement, herbal products
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4
Q

consequences of polypharmacy

A

ADR, inc errors, dec adherence, drug-drug interactions, inc cost, poor outcomes

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5
Q

adverse drug reactions

A

-elderly 2-3x more likely to have ADR from any 1 drug

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6
Q

prescribing cascade

A

Prescribing a new drug to treat the side effects of a previously prescribed drug; the symptoms of the first drug may be evaluated as part of the medical problem

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7
Q

changes that can alter drug absorption

A
  • dec in SA of intestinal epithelium
  • dec gastric acid secretion
  • dec splanchnic blood flow
  • delayed gastric emptying
  • slowed transit rate
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8
Q

impact on medication absorption

A
  • 1st dose & PRN use (may have delay in absorption)
  • chronic use (no change in extent of absorption, no changes in steady state)
  • dec absorption of nutrients
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9
Q

altered PK skin absorption

A
  • atropy of dermis and epidermis
  • dec tissue blood perfusion
  • dec rate of transdermal drug absorption
  • variable rate of drug absorption from SC/muscular tissue
  • avoid IM injections if possible
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10
Q

absorption of chronic medications given orally to older patients results in…

A

no changes in stead state level in general

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11
Q

altered PK distribution

A
  • dec lean muscle mass & inc adipose tissue
  • inc VD, tissue conc, & half like of fat soluble drugs
  • risk of overmedication w/chronic use (inc ADR, lower dose should be used)
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12
Q

fat soluble drugs

A

diazepam, amiodarone, verapamil, narcotics, antipsychotics

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13
Q

total body water (TBW)

A
  • by age 80, TBW down by 10-15%

- dehydration & diuretic use inc risk of drug toxicity

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14
Q

water soluble drugs

A
  • dec volume of distribution, inc serum drug concentration

- aspirin, lithium, ethanol, ahminoglycosides

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15
Q

drug distribution, tissue concentration, and half life will be increased for which of the following?

A

lipophilic medications

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16
Q

metabolism of drugs in the elderly

A
  • dec first pass extraction
  • dec liver mass
  • dec blood flow
  • dec liver’s ability to recover from injury
  • inc bioavailability
17
Q

drugs that have high metabolism

A

atorvastatin, propanolol, simvastatin, verapamil

18
Q

drugs that have medium metabolism

A

metoprolol, amiodarone, labetalol, amitriptyline

19
Q

drugs that have low metabolism

A

desipramine, imipramine, morphine, diazepam

20
Q

elimination

A
  • dec renal blood flow
  • dec renal mass & functional glomeruli
  • dec glomerular filtration rate
  • effects of age are variable
21
Q

serum creatinine

A

may remain normal despite reduction in creatinine clearance

22
Q

meds that need renal dosing

A

allopurinol, digoxin, cimetidine, antibiotics, gabapentin, magnesium products, lithium, meperidine, phenytoin, metformin, atenolol, glyburide, ranitidine, thiazide diuretics, nitrofurantoin

23
Q

CNS

A
  • inc sensitivity to CNS drugs
  • BBB more permeable
  • dec dopamine receptors
  • inc susceptibility to drug induced delirium
  • start low go slow
24
Q

cardiovascular

A
  • inc risk of QT prolongation & torsades

- inc susceptibility to orthostatic hypotension w/drugs that lower BP

25
Q

glucose metabolism

A
  • inc age=inc incidence of DM

- inc incidence of hypoglycemia

26
Q

which is NOT a drug response in older adults resulting from pharmacodynamic changes?

A: inc CNS effects from benzodiazepine use

B: inc orthostatic hypotension from antihypertensive use

C: inc dehydration from diuretic use

D: inc autonomic response to hypoglycemia from sulfonylurea use

A

D: inc autonomic response to hypoglycemia from sulfonylurea use

27
Q

underused meds for older adults with acute MI

A

nitrates, aspirin, beta blockers

28
Q

underused meds for older adults with COPD

A

inhaled anticholinergic bronchodilators

29
Q

underused meds for older adults with depression

A

SSRIs

30
Q

underused meds for older adults with diabetes

A

ACE-inhibitors

31
Q

underused meds for older adults with heart failure

A

ACE-inhibitors

32
Q

underused meds for older adults with osteoporosis

A

calcium

33
Q

which drugs to deprescribe?

A
  • risk associated with continued use
  • questions about ongoing indication or benefit
  • prevelence of overuse, challenge in stopping

801 (9 decks)

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