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239B > Beers Criteria- Geriatric Meds > Flashcards

Beers Criteria- Geriatric Meds Flashcards

1
Q

ACE-I and K

A

hyperkalemia

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2
Q

BB and AChE-I

A

Bradycardia

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3
Q

CCB/nitrate/alpha-blocker

A

hypotension

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4
Q

Diuretic and Diuretic

A

e-ltyle disturbance, dehydration, hypotenision

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5
Q

Benzo, sedative hypnotic, GI antispasmodics, muscle relaxants, 1st generation antihistamines

A

sedation, confusion, falls, cognitive impairment

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6
Q

Pharmacodynamics

A

“what drug does to the body”

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7
Q

benzo, opioids, warfarin, dig ,anticholinergic’s

A
  • increases SENSITIVITY in changes in receptor/affinity- pharmacodynamic
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8
Q

BB and B- agonists

A

DECREASE sensitivity in changes in receptor/affinity- pharmacodynamic

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9
Q

Change in homeostatic Response

A

orthostatic BP- decreases barorectpor response
NA and water conserve
mobility and balance issues

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10
Q

Pharmacokinetics -Lipid Soluble drugs i.e. Diazepam

highly bound drugs i.e. phenytoin

A

stay in the body longer because there is increased body fat and decreased serum albumin

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11
Q

pharmacokinetics-

A

what body does to the drug

ADME

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12
Q

creatine clearance

A

volume of the body fluid from which the drug is removed per unit time
- lower muscle mass- low serum crt - Scr level round to 1.0 (not overestimatE)

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13
Q

GI

A

increase stomach pH, decrease GI blood flow, slowed gastric emptying, GI tranist
decrease drug absorption, decrease first pass metabolism, rate of absorption prolonged
i.e. ulceration with ASA, NSAIDS, iron/b12/ca with achlorhydria

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14
Q

Body Composition

A

decreased TBW, lean body mass, serum albumin, increase body fat
increases lipid soluble drugs and decrease water soluble
i.e. benzo like diazepam (lipid soluble high half life)
i.e. phenytoin (highly aluminum bound)

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15
Q

Liver

A

decreased liver mass, liver flow, CYP enzymes
first pass effect increase high t1/2
i.e. morhpine, propranolol- first pass

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16
Q

Renal

A

decreased GRF, tubular secretion, renal blood flow, renal mass

  • renal emlimination of meds decreases, t 1/2 increases
    i. e. numerous drugs
17
Q

Strategies to increase adherence to meds

A 
simplify dosing regimens
use pill box
have family/friends help
explain benefits to adherence
discuss SE in context of med benefits
use monitoring to motivate and educate
write clear written instructions
have pt carry list of medications
put indication on RX and label
18
Q

Types of Non-adherence to meds

A

intentional (se, lack of benefit)

unintentions (forgot, financial issues)

19
Q

bio-availability

A

fx of drug dose reaching systemic circulation

20
Q

metabolism

A

conversion of drug to pharmacological active or inactive compound.

21
Q

body compositiion in agigin

A

lean body mass, decrease serum albumin, increase body fat leads to
lipid soluble meds- long t1/2-benozo
or highly albumin bound drugs i.e. phenytoin (increase free fx)

22
Q

highly albumin bound drugs

A

phenytoin- increase free fx

23
Q

cr CL in elderly

A

lower muscle mass, lower serum level = Scr 1.0

24
Q

polypharmacy

A

> 6 meds- more medications than clinically necessary- increase risk of cognitive impairment, falls, functional status, costs

25
Q

non-adherence

A

half pts d/c tx after 6 months with statins

50% of pts d/c anti-htn after 1 year

26
Q

sertraline, venlafaxine, paroxetine -non-adh

A

withdrawal syndromes with non-adherence

27
Q

atenolol- non-adh

A

1 missed dose - rebound HTN

28
Q

interventions to help with NON-adh

A 
simply doses
pill box for reminders
enlist family, friends, community service
benefits of adherence of regimen
SE of medication education
use of monitoring to motivate/edu
clear written instruction
carry list of meds
indication of medication on RX and label
29
Q

PIM- NSAID, non-DHP CCB(verapamil, diltiazem), rosiglitazone

A

heart failure exacerbated AVOID

30
Q

PIM- AChE-I (donepezil), alpha blockers (doxazosin, terazosin, prazosin),TCA

A

ortho hypotension - AVOID

31
Q

PIM- anticholinergics, H2B, Benzo, Zolpidem

A

increase CNS AE- i.e. dementia nad cognitive impairment AVOID

32
Q

PIM- anti-psychotics, benzo, non-benzo, TCA, SSRI

A

ataxia, falls, syncope- AVOID if multiple falls and depression

33
Q

PIM- antimuscarinics for UI (oxybutynin, tolterodine), non-dhp CCB (verapamil, dilitazem), Anticholinergics, 1st gen antihistamines

A

add to chronic constipation

AVOID

34
Q

PIM- NSAIDS, triamterene

A

increase risk of kidney injury AVOID if CKD 4 or 5

35
Q

> 80 YO avoid primary prevention

36
Q

PIM- antipsychotics, SNRI, SSRI< TCA, vasodilators

A

hyponatremia- monitor- see how quickly it drops if acute or chronic drop
*can be used to their benefit if hypernatremia)

37
Q

start slow go slow

A

celexa 10mg Daily (with normal QT only) then increase if tolerated - no more FDA alert
mirtazaine 7.5mg qhs increase to 15mg

239B (14 decks)

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