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Geriatrics > Dr. Shane McWhorter > Flashcards

Dr. Shane McWhorter Flashcards

1
Q

what are the pharmacokinetic changes of aging?

A

absorption, distribution, metabolism, and excretion

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2
Q

what are the pharmacodynamic changes of aging?

A

receptor or NT changes

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3
Q

from a pharacologic standpoint, what should you be doing with your elderly patients?

A
  • regularly review and organize drug regimen
  • provide education about the drugs
  • tell patients to take all medication/product bottles to provider visits
  • coordinate care with all providers
  • provide an up-to-date med list at each visit
  • be aware of brand vs. generic names
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4
Q

T or F:

with elderly patients, you should use nonpharmacological treatments if possible

A

true

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5
Q

___ is the most commonly-used tool for medication iformation

A

beer’s criteria

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6
Q

what type of drug information does beer’s criteria provide?

A
  • rationale, recommendations, quality of evidence, and strength of recommendations
  • information on potentially inappropriate medication use
  • drug-disease state interactions
  • correct dosage (recommendations for renally-cleared medications)
  • avoidance of drug-drug interactions
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7
Q

what are some important considerations when using antihistamines (diphenhydramine) in the elderly population?

A
  • toxicity known in elderly
  • somnolence and anticholinergic effects (mydriasis, flushing, fever, urinary retention, decreased bowel sounds)
  • agitation, confusion, hallucinations, seizures
  • cardiac effects
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8
Q

when evaluating a patient’s med/problem list, what is something you should always do?

A

evaluate each problem, one at a time, to determine status of each problem and appropriateness of medications

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9
Q

what are some issues with OTC product use?

A
  • correct usage? how many read the label?

- combining different multi-ingredient products

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10
Q

___% of the elderly population uses OTCs, which accounts for ___% of total OTC usage

A

40%, 30%

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11
Q

what are the top 5 OTC categories?

A
  • respiratory
  • oral care
  • gastrointestinal
  • internal analgesics
  • eye care
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12
Q

___ is a product taken by mouth that contains a dietary ingredient intended to supplement the diet

A

dietary supplement

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13
Q

what are some examples of dietary supplements?

A

vitamins, minerals, herbs or botanicals, amino acids, other substances

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14
Q

the national center for health statistics claims that ___ million people are taking dietary supplements. ___% are men, ___% are women

A
  • 72 million

- 44% males, 53% females

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15
Q

dietary supplements are a ___ billion dollar/year industry

A

$30 billion

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16
Q

what are some reasons for dietary supplement use?

A
  • “natural”
  • baby boomers
  • interested not only in longevity but wellness
  • certain products used - supplements, multivitamins/multiminerals, probiotics, turmeric
  • disease modulation - omega 3 fatty acids ($5 billion/year, fish oil, krill, algae, flax, chia)
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17
Q

what are some reason for caution of dietary supplements?

A
  • product variability
  • adverse effects
  • drug interactions
  • surgery precautions
  • quality issues
  • recalls
  • illegally sold treatments (false claims)
  • confusing labeling and misinformation
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18
Q

what are the main supplement types that warrant caution?

A
  • weight loss products
  • body building products
  • men’s health products
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19
Q

what are some concerning beliefs associated with dietary supplements?

A
  • supplements are natural and thus, safe

- substitute for healthy nutrition/exercise

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20
Q

what are some common added ingredients in dietary supplements that warrant caution?

A

laxatives, diuretics, prescription appetite suppressants, thyroid hormones, drugs to mask side effects (beta blockers)

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21
Q

how many ER visits per year are due to adverse drug reactions from dietary supplements? what are the most common products to blame?

A
  • 23,000 visits per year

- weight loss and energy products (72%) - cardiovascular effects

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22
Q

what is kratom used for?

A

pain, energy, and relaxation (has opioid-like effects)

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23
Q

what are the adverse drug reactions associated with kratom?

A

aggression, irritability, sedation, nausea, constipation, pruritis

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24
Q

what are 7 concerning dietary supplement products to be wary of?

A
  • kratom
  • iodine-containing products (thyroid disease)
  • red-yeast rice (contain >4mg lovastatin)
  • st. john’s wort (reduces SDCs of many drugs)
  • gingko (possible bleeding with other drugs)
  • CoQ10 (may reduce INR)
  • turmeric (possible bleeding)
25
Q

what is white horehound?

A
  • perennial member of mint family
  • bitter tonic for common cold; cough/cold preps
  • vasodilator, diaphoretic, diuretic, hypoglycemic effects
  • side effects: cardiac irregularities (large doses), avoid use during pregnancy (abortive properties)
26
Q

what is the mechanism of echinacea?

A
  • immunostimulant

- HOWEVER, continued basis can result in immunosuppression

27
Q

what is echinacea used for?

A
  • GI, allergies, dizziness
  • no serious toxicity
  • interacts with immunosuppressants
28
Q

what is the method of action of cranberry juice/tablets?

A

-prevents adherence of bacteria to urothelial tract (used for UTI’s)

29
Q

what are the side effects and cautions of cranberry?

A
  • side effect: palatability

- caution: patients on warfarin, recurrent calcium oxalate stones

30
Q

what is ivy leaf used for?

A

respiratory diseases accompanied by cough

31
Q

what active ingredients does ivy leaf contain? what is the method of action?

A
  • contains flavonoid glycosides, phenolic acids, saponins

- MOA: increase lung beta cell/bronchial muscle cell responsiveness; decreases bronchospasms

32
Q

what are the side effects and cautions of ivy leaf?

A
  • side effects: GI, allergies
  • cautions: children <2, gastritis, opioid combo
  • safety/benefit of chronic use is unknown
33
Q

what are the uses of turmeric?

A
  • arthritis and other inflammatory disorders (COX-2 inhibition, anti-inflammatory)
  • cancer (apoptosis of some cancer cell lines, inhibits angiogenesis)
  • diabetes or pre-diabetes
34
Q

what are the side effects and interactions of turmeric?

A
  • side effects: GI, nephrolithiasis, decreased BG

- interactions: antiplatelets (excess bleeding)

35
Q

what is black cohosh used for?

A

menopausal symptoms and menopausal anxiety (when combined with st. johns wort)

36
Q

what are the side effects of black cohosh?

A

GI, HA, BP, liver?

37
Q

what are the uses of garcinia cambogia?

A

culinary, weight loss, purgative, antiparasitic

38
Q

what are the mechanisms of garcinia cambogia?

A
  • decrease fatty acid synthesis
  • increase glucagon production (increase satiety)
  • increase serotonin release (well-being)
39
Q

what are the side effects of garcinia cambogia?

A

HA, GI (hepatotoxic)

40
Q

what are the drug interactions with garcinia cambogia?

A
  • DM meds

- SSRIs (prozac, lexapro)

41
Q

what are the uses of flaxseed?

A

lipids, BP, DM, women’s health (estrogenic/antiestrogenic effects)

42
Q

what is the mechanism of action of flaxseed?

A
  • fiber, alpha-linolenic acid (omega 3 FA), lignans

- antioxidant effects

43
Q

what are the side effects of flaxseed?

A

-GI, high doses may increase risk of bleeding in patients on warfarin

44
Q

gingko biloba contains ___ and ___

A

flavonoids and terpenoids

45
Q

what are the methods of action of flavonoids and terpenoids found in ginkgo biloba?

A
  • flavonoids - antioxidant activity, platelet inhibition
  • terpenoids - ginkgolides improve circulation, inhibit platelet activation factor; bilobalides have neuroprotective properties
46
Q

what are the uses of ginkgo biloba?

A

dementia, intermittent claudication, tinnitus, improved retinal capillary blood flow

47
Q

what are the side effects of gingko biloba?

A

HA, GI, bleeding, topical reactions, seizures

48
Q

what are the drug interactions with ginkgo biloba?

A

warfarin, ASA or botanicals (ginger, garlic, dong quai, red clover)

49
Q

describe glucosamine

A
  • stimulates metabolism of cartilage cells in joint cartilage and synovial tissues
  • required for synthesis of glycoproteins
  • may have anticoagulant effects and interact with blood thinners
  • many salt forms - unknown which is most beneficial (sulfate or hydrochloride)
50
Q

describe chondroitin

A
  • large glycosaminoglycan found in joint cartilage
  • substrate for joint matrix structure
  • may have anti-inflammatory effects
  • may have anticoagulant effects and interact with blood thinners
  • pharmaceutical grade as single ingredient found in europe and compared favorably to celevoxib
51
Q

for both glucosamine and chondroitin, benefits may not be seen for ___ months

A

3

52
Q

what are the problems with st. john’s wort?

A
  • serious phototoxicity
  • may cause cataracts
  • increases narcotic or paroxetine induced sedation
  • serotonin syndrome
53
Q

what are the uses for CoQ10?

A
  • increase ATP production, scavenges OFTs, membrane stabilizer
  • slight decrease in FBG and A1C
  • symptomatic HF improvement, may reduce BP, improve angina, parkinson’s, reduce statin-induced myopathy, DM
54
Q

what is the long-term safety of CoQ10?

A

6 years

55
Q

what are the side effects of CoQ10?

A

GI, rash, increased LFTs

56
Q

what are the drug interactions with CoQ10?

A

warfarin, statins, BP meds, adriamycin

57
Q

what is the dosage of CoQ10 when using it for DM?

A

100-200 mg/day

58
Q

what are some important considerations when counseling patients on dietary supplement use?

A
  • be respectful of patient’s beliefs
  • provide evidence-based information
  • discuss target goals, evidence
  • assess potential side effects and drug interactions
  • be informed and supportive

Geriatrics (4 decks)

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