ADEs of old ppl drugs Flashcards
constipation = new symtom
what is the drug responsible?
narcotics
renal failure, hearing loss =new symtom
what is the drug responsible?
aminoglycosides
new symptom = dry mouth, constipatio, urinary retention, and deliriumtom
what is the drug responsible?
anticholinergic
diarrhea(quinidine); urinary retetion(disopyramide) = new symtom
what is the drug responsible?
antiarrhythmics
dehydration, hyponatremia, hypokalemia, incontience = new symtom
what is the drug responsible?
diuretics
delirium, sedation, hypotension, extrapyramidal disorders=new symtom
what is the drug responsible?
antipsychotics
excessivve sedation, delirium, gait disturbance=new symtom
what is the drug responsible?
sedative-hypnotic
interference w/drug absorption
antacid
polypharmacy: drug-drug interaction
consequence: protein binding displacemen
ex: oral hypoglycemics, aspirin, chloral hydrate
warfarin
consequence: altered metabolism
affects: propanoll
theophylline
phenytoin
cimetidine
altered extrection
drug inovlved: lithium
diuretics
consdquence = increased bioavilability;
drugs: dextromethorpham, midazolam, imatinb
culprit?
grape fruit juice = CYP inducer
disease: dementia
**drug: **
**ADE: 2 **
drug: psychotropics
ADE: confusion and delirium
disease: glaucoma
drug:
ADE:
drug: antimuscarinic
ADE: acute glaucoma
disease: CHF
drug: 2
ADE:
beta blockers, and verapamil = drugs
ADE: acute decompression
disease: conduction disordrs
drug:
ADE:
DRug: TCAs
ADE: heart block
disease: HTN
drug:
ADE:
drug: NSAIDs
effect: increase BP
disease: peripheral vascular disease
drug:
ADE:
drug: beta blockers
effect: intermittend claudication
disease: COPD
drug:
ADE:
drug: beta blockers
ADE: brochoconstriction
disease: chronic renal impairment
drug: 3
ADE:
disease:
drug: NSAIDs, contrast, aminoglycosides
ADE: acute renal failure
disease: DM
drug: 2
ADE:
disease:
drug: diuretics, prednisone(cortisol enchanes gluconeogenesis)
ADE: hyperglycemia
disease: BPH
drug:
ADE:
disease:
drug: antimuscarinic agents
ADE: urinary retention
disease: depression
drug: 5
ADE:
drugs: beta blcokers, central antihypertensives, alochol, benzos, steroids
effect: precipitation or exacerbation of depression
disease: hypokalemia
drug:
ADE:
disease:
drug: digoxin
ADE: cardiac arrhythmias
PUD
disease: Peptic ulcer disease
drug: 2
ADE:
disease:
drug: NSAIDs, anticoagulant
ADE: GI hemorrhage
what are the 7 classes of drugs with strong anti-cholinergic activity
Anti-histamine
Anti-parkisnonia
skeletal muscle relexants,
antimuscarinics - urinary incontinence
anti-depresants
anti-psychotics
condition: dysrhtymia
high risk med(s):
effect:
condition:
high risk med(s): TCAs
effect: prolonged QT
condition: COPD
high risk med(s): 2
effect:
condition:
high risk med(s): beta blockers, long acting benzodiazepines
effect: respiratory depression
condition: heart failure
high risk med(s): 2
effect:
condition
meds:
inotrope effects(disopyramide), drugs with high Na+ content(bisphosphanate, citrate, salicylate)
effect: fluid retention, increase heart failure
condition: chronic constipation
high risk meds: 2
effect:
high risk meds: CCBs, anticholinergics
effect: increase constpation, impaction, obstruction
condition: hyponatremia
high risk med:
effect:
condition:
high risk med: SSRI
effect: hyponatremia
condition: orthostatic hypotension
high risk med: 3
effect:
condition:
high risk med: diuretics, alpha blockers, vasodilators
effect: near syncope, syncope falling–>potential for injury
3 drug classes with high Beers criteria
anxiolytics
anti-depressants
sedative-hypnotics
also at risk for: addition, abuse, oversedation, respiratory depressin, confusion
many old ppl on benzos will become dependent and sudden termination –>emergence of withdrawal symptoms.
which two short acting benzos should be used?
alprazolam
temazepam
lorazepam
which anti-depressant with strong anti-cholinergic and sedative properties should be avoided in old ppl?
amitriptyline
which depression drugs are safer for older ppl with a decreased riks for cardiotox, orthostatic hypotension, and anticholinergic effects?
SSRIs (citalopram, escitalopram)
which anti-arrhythmic drug in C/I in older patients by BEERS criteria b/c of significant anticholinergic properties?
IT can induce heart block especially in patients with congestive heart failure.
DISOPYRAMIDE
according to BEERS criteria, 33% of ED visits in geriatric pts were due to an ADE of: (3 drugs here IDW)
Insulin
warfarin
digoxin
comment: although appropriate, aggresssive glycemic control may be harmful
potential harm:
drug:
potential harm: hypoglycemia
drug: insulin and sulfonylureas (CYP and plasma protein binding)
potential harm: GI and intracranial bleeding
comment: altough a risk drug, careful control of INR in therapeutic range tightly linked to risk/benefit ratio
drug: WARFARIN!! (S-warfarin & CYP2C9)
note: S-warfarin = 2-5x more potent
drug:
potential harm: impaired cognition and heart block
comment; may have 3rd line role in systolic heart failure, suboptimal choice for rate control in atrial fibrillation
drug: digoxin
potential harm: i
what does the mnemonic MASTER stand for?
start low, go slow
add one, take one away
M- minimize the number of drugs used
A- alternatives should always be considered, especially non-drug therapies
S-start low, go slow
T- titrate therapy; adjust dose on an individual basis
E- educate the pt and family; provide clear writen instructions
R- review regularyy - remember that the older paiten will need closer monitoring
which 3 drug classes will caused SIADH in old ppl?
VPS
vinka alkaloids
sulfonylureas
psychotropics (SSRIs, TCA, haloperidol)
what disease would most likely give rise to orthostatic hypotension in an elderly patient?
diabetes. why?
think: peripheral neuropathy –> alpha receptors on vasculature unable to respond to decrease in BP
