Dr. Shane McWhorter Flashcards
what are the pharmacokinetic changes of aging?
absorption, distribution, metabolism, and excretion
what are the pharmacodynamic changes of aging?
receptor or NT changes
from a pharacologic standpoint, what should you be doing with your elderly patients?
- 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
T or F:
with elderly patients, you should use nonpharmacological treatments if possible
true
___ is the most commonly-used tool for medication iformation
beer’s criteria
what type of drug information does beer’s criteria provide?
- 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
what are some important considerations when using antihistamines (diphenhydramine) in the elderly population?
- toxicity known in elderly
- somnolence and anticholinergic effects (mydriasis, flushing, fever, urinary retention, decreased bowel sounds)
- agitation, confusion, hallucinations, seizures
- cardiac effects
when evaluating a patient’s med/problem list, what is something you should always do?
evaluate each problem, one at a time, to determine status of each problem and appropriateness of medications
what are some issues with OTC product use?
- correct usage? how many read the label?
- combining different multi-ingredient products
___% of the elderly population uses OTCs, which accounts for ___% of total OTC usage
40%, 30%
what are the top 5 OTC categories?
- respiratory
- oral care
- gastrointestinal
- internal analgesics
- eye care
___ is a product taken by mouth that contains a dietary ingredient intended to supplement the diet
dietary supplement
what are some examples of dietary supplements?
vitamins, minerals, herbs or botanicals, amino acids, other substances
the national center for health statistics claims that ___ million people are taking dietary supplements. ___% are men, ___% are women
- 72 million
- 44% males, 53% females
dietary supplements are a ___ billion dollar/year industry
$30 billion
what are some reasons for dietary supplement use?
- “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)
what are some reason for caution of dietary supplements?
- product variability
- adverse effects
- drug interactions
- surgery precautions
- quality issues
- recalls
- illegally sold treatments (false claims)
- confusing labeling and misinformation
what are the main supplement types that warrant caution?
- weight loss products
- body building products
- men’s health products
what are some concerning beliefs associated with dietary supplements?
- supplements are natural and thus, safe
- substitute for healthy nutrition/exercise
what are some common added ingredients in dietary supplements that warrant caution?
laxatives, diuretics, prescription appetite suppressants, thyroid hormones, drugs to mask side effects (beta blockers)
how many ER visits per year are due to adverse drug reactions from dietary supplements? what are the most common products to blame?
- 23,000 visits per year
- weight loss and energy products (72%) - cardiovascular effects
what is kratom used for?
pain, energy, and relaxation (has opioid-like effects)
what are the adverse drug reactions associated with kratom?
aggression, irritability, sedation, nausea, constipation, pruritis
what are 7 concerning dietary supplement products to be wary of?
- 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)
what is white horehound?
- 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)
what is the mechanism of echinacea?
- immunostimulant
- HOWEVER, continued basis can result in immunosuppression
what is echinacea used for?
- GI, allergies, dizziness
- no serious toxicity
- interacts with immunosuppressants
what is the method of action of cranberry juice/tablets?
-prevents adherence of bacteria to urothelial tract (used for UTI’s)
what are the side effects and cautions of cranberry?
- side effect: palatability
- caution: patients on warfarin, recurrent calcium oxalate stones
what is ivy leaf used for?
respiratory diseases accompanied by cough
what active ingredients does ivy leaf contain? what is the method of action?
- contains flavonoid glycosides, phenolic acids, saponins
- MOA: increase lung beta cell/bronchial muscle cell responsiveness; decreases bronchospasms
what are the side effects and cautions of ivy leaf?
- side effects: GI, allergies
- cautions: children <2, gastritis, opioid combo
- safety/benefit of chronic use is unknown
what are the uses of turmeric?
- arthritis and other inflammatory disorders (COX-2 inhibition, anti-inflammatory)
- cancer (apoptosis of some cancer cell lines, inhibits angiogenesis)
- diabetes or pre-diabetes
what are the side effects and interactions of turmeric?
- side effects: GI, nephrolithiasis, decreased BG
- interactions: antiplatelets (excess bleeding)
what is black cohosh used for?
menopausal symptoms and menopausal anxiety (when combined with st. johns wort)
what are the side effects of black cohosh?
GI, HA, BP, liver?
what are the uses of garcinia cambogia?
culinary, weight loss, purgative, antiparasitic
what are the mechanisms of garcinia cambogia?
- decrease fatty acid synthesis
- increase glucagon production (increase satiety)
- increase serotonin release (well-being)
what are the side effects of garcinia cambogia?
HA, GI (hepatotoxic)
what are the drug interactions with garcinia cambogia?
- DM meds
- SSRIs (prozac, lexapro)
what are the uses of flaxseed?
lipids, BP, DM, women’s health (estrogenic/antiestrogenic effects)
what is the mechanism of action of flaxseed?
- fiber, alpha-linolenic acid (omega 3 FA), lignans
- antioxidant effects
what are the side effects of flaxseed?
-GI, high doses may increase risk of bleeding in patients on warfarin
gingko biloba contains ___ and ___
flavonoids and terpenoids
what are the methods of action of flavonoids and terpenoids found in ginkgo biloba?
- flavonoids - antioxidant activity, platelet inhibition
- terpenoids - ginkgolides improve circulation, inhibit platelet activation factor; bilobalides have neuroprotective properties
what are the uses of ginkgo biloba?
dementia, intermittent claudication, tinnitus, improved retinal capillary blood flow
what are the side effects of gingko biloba?
HA, GI, bleeding, topical reactions, seizures
what are the drug interactions with ginkgo biloba?
warfarin, ASA or botanicals (ginger, garlic, dong quai, red clover)
describe glucosamine
- 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)
describe chondroitin
- 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
for both glucosamine and chondroitin, benefits may not be seen for ___ months
3
what are the problems with st. john’s wort?
- serious phototoxicity
- may cause cataracts
- increases narcotic or paroxetine induced sedation
- serotonin syndrome
what are the uses for CoQ10?
- 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
what is the long-term safety of CoQ10?
6 years
what are the side effects of CoQ10?
GI, rash, increased LFTs
what are the drug interactions with CoQ10?
warfarin, statins, BP meds, adriamycin
what is the dosage of CoQ10 when using it for DM?
100-200 mg/day
what are some important considerations when counseling patients on dietary supplement use?
- 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
