exam 3 Flashcards
ANY NEW SYMPTOM IN AN OLDER ADULT IS A MEDICATION SIDE EFFECT UNTIL PROVEN OTHERWISE
Constant Differential
Pharmacokinetics
absorption
distribution
metabolism
excretion
Impacts speed at which a drug can become available
Least affected by aging
absorption
Movement of drug thru the circulatory system to the target area
Affected by age
distribution
3 changes in older adults that effect distribution
Decrease of body water
Decreased plasma protein
Changes in fat distribution
Biotransformation
Metabolite/Isoenzymes-pharmacogenetics
Enzyme changes
Metabolism
what are the 3 key elements of STEADI
Screen, Assess, and Intervene
decreased physiologic reserve in multiple systems that are interdependent
Accumulation of losses
Inability to compensate for other systems
Difficulty maintaining homeostasis
frailty
Is frailty a progressive process of aging?
Primary Frailty
Is frailty the result of an accumulation of geriatric syndromes, aging changes and chronic health problems ?
Secondary frailty
Frailty theory defined clinical symptoms
Fried
Frailty theory research –accumulation of deficits
Rockwood
5 identifiers with cycle of frailty
chronic under nutrition sarcopenia decreased strength and power walking speed decreased activity
Age related loss of lean body mass
Sarcopenia
freid definition of frailty is the presence of 3 or more of the following 5 things:
Unintended weight loss Exhaustion Slow walking speed Low physical activity Weakness
Screening for frailty
Assessment
AGS Frailty tool
Chief complaint-absent
S&S do not point to one organ system or one disease
Any stressor can become a risk for health outcomes
Impact on function
assessment issues with frailty
5 domains of cognition
memory executive functioning (ability to make decisions) attention language visual spatial perception
Does NOT interfere with independence
IADL’s are intact
NOT delirium or other mental disorder
mild cognitive impairment
Disrupted Alpha-synuclein protein inside the cell destroying the neuron
Motor deficits
visual hallucinations/delusions
Parkinsonism
Fluctuating changes in alertness & attention
Lewy Body Dementia
Blocked or reduced blood flow to brain
often occurs after a stroke
will not change or get worse unless another stroke occurs
Vascular Dementia
Average age of onset is 50-60
Group of disorders caused by progressive nerve cell loss in frontal lobes or temporal lobes
Behavior type-change in personality/behavior, angry, hyperorality, impulse control issues, executive function
Frontotemporal Lobe Dementia
Accumulation of extracellular protein plaques
Prevents communication between neurons
Alzheimer’s disease
7 Sensory Changes with Alzheimer’s
Decreased contrast sensitivity Tunnel vision Motion blindness Depth perception Touch (hot and cold)
Auditory processing
(Sensitivity to sounds)
(Speech issues)
(Loud noises)
AD where:
genetic mutations-apolipoprotein E4 (APOE4) gene
Are heart and brain health related?
Women?
Late onset
AD where
associated with mutated gene APP (amyloid precursor proteins)
Rare accounts for approx. 3% of all AD cases
Early onset familial AD (FAD)
before age 60
8 questions to ask the family members for AD
AD8
6 diagnostic labs to rule out dementia
CBC, TSH, u/a, LFT, Vit B12, ECG,
stage in AD where
Measurable changes of biomarkers in brain, cerebrospinal fluid and blood
(Only used for research purposes)
NO noticeable symptoms of AD
preclinical
Mild impairment in memory or one cognitive domain without impact on function
mild cognitive impairment
% of patients with MCI convert to AD annually
12%
stage of AD where
Occasional forgetfulness, misplacing objects, difficulty planning, speech i.e. trouble finding the right word
mild
stage of AD where
Forgetting own history, inappropriate clothing, wandering, behavioral and psychological symptoms (BPSD)
moderate
stage of AD where
Continuous assistance with ADL’s, physical decline i.e. immobility, dysphasia, inability to communicate meaning fully, increased susceptibility to infection
severe
Slow break down of neurotransmitter acetylcholine
(Acetylcholine is related to memory)
Modest delay in cognitive decline in early to moderate dementia
(AD & Lewy body hallucinations)
Cholinesterase inhibitors
Reduces glutamate- mediated excitability
Modest beneficial effects on cognition, ADL’s and behavior in moderate to advanced dementia
Memantine
6 Behavioral & Psychological Symptoms of Dementia
aggression mania agitation psychosis depression apathy
What the drug does to the body
PHARMACODYNAMICS
why should you start low with medications in older adults
Changes in volume of distribution, protein binding and pharmacodynamics
why should you go slow with medications in older adults
Changes in metabolism and excretion
Polypharmacy
> __ meds
5
4 common side effects of Anticholinergics
Sedation
Confusion
Urinary retention
Constipation
unfavorable & unexpected medical event r/t drug
May need to be reported to FDA
Unpredictable
adverse drug event
can cause harm even if drug dosage was within normal limits
Known adverse drug reaction
adverse drug reaction
2 most common underused drugs
Anticoagulants in afib
Anti-platelet therapy in arterial disease
5 beers criteria tables
- potentially inappropriate meds in general
- drugs to avoid in older adults with certain diseases
- medications to use with caution
- meds to be avoided based on kidney function
- list of common drug drug interaction
Addresses PIMs associated with ADR’s
STOPP criteria (Screening Tool of Older Persons’ Prescriptions)
Addresses prescribing omissions
START (Screening Tool to Alert to Right Treatment)
4 steps in deprescribing
Assess all meds and indication for use
Consider risk/benefit of medication
Prioritize meds to discontinuation
Implement and monitor discontinuation plan
2 screening tools for depression
PHQ-2 (patient health questionnaire)
Geriatric Depression Scale
