Final Lecture #3 Flashcards
decreased in norm aging?
Baroreceptors response myocardial sensitivity to catecholamines (nor-epi-epi), response of a-adrenergic system.
What is increased sensitivity to anticholinergic effects?
Can’t…
* SEE (blurry vision)
* PEE (urinary retention)
* SPIT (dry mouth)
* Poop (constipation)
* Also, confusion and dizzy
What is the increased sensitivity to diuretics?
Reduce baroreceptor response, higher risk of orthostatic hypotension
What is the increased sensitivity to beta agonists and antagonists?
Reduced effects due to alteration in adrenergic system activity
risk of bleeding; digoxin level altered. Cold and flu therapy, taken in tea form, but can be used as tincture. Contraindications: allergy to daisy, plant, HIV, autoimmune disease.
* SE: fever, sore throat, N/V/D, and abd pain.
Echinacea
risk of bleeding; monitor glucose. To prevent stroke and atherosclerosis. Mixed results from research (reduced blood clots, reduced LDL and 2 meta-analyses show it lowers BP). Contraindications: use with anticoagulants, should be approved by HCP.
* SE: flatulence, bleeding risk, nausea, heart burn, hypotension, and hypoglycemia.
Garlic
risk of bleeding; several med contraindicated; monitor glucose. Used to improve memory, no evidence showing it improves memory. Contraindications: use with anticoagulants, antihypertensives, antidepressants, pts with seizure disorders, should be approved by HCP.
* SE: bleeding risk, GI upset, HA, heart palpitations, dizzy, weakness, constipation, and hypotension.
ginkgo biloba
risk of bleeding; sever med contraindications. Reduces stress, lowers LDL, lowers glucose, immune stimulant, erectile dysfunction research is weak. Contraindications: use with anti-diabetics, antihypertensives, immunosuppressants, stimulants, MAOIs, should be approved by HCP.
* SE: HTN, risk of bleeding, edema, diarrhea, mania (bipolar)
ginseng (root of plant)
risk of bleeding; monitor glucose. Used to lower LDL, evidence leans toward supporting efficacy. Contraindications: liver dysfunction or elevated LFTs. Use with other hepatotoxic meds.
* SE: muscle pain, liver damage, heartburn, bloating, flatulence, dizzy
red yeast rice
several med contraindicated. Mostly used to treat depression, evidence is mixed. Contraindications: use with triptans, MAOIs, digoxin, and antidepressants. AVOID USE IN OLDER ADULTS, should be approved by HCP.
* SE: photosensitivity, rash, GI upset, restlessness, anxiety, HA, severe reactions: mania, hypomania, and suicidal/homicidal ideations.
st. johns wart
reduce joint pain, improve function of knees with OA, often used in conjunction with chondroitin, evidence leans toward supporting efficacy, well tolerated. Contraindications: shellfish allergy and glaucoma, use with caution with antidiabetics and HTN.
* SE: GI upset, HA, insomnia, rash, hypoglycemia
Glucosamine sulfate
powerful antioxidant, to reduce risk of MI, improve HF and BP, most common use: along with statins and statins reduce natural levels of this. Some GI upset, but well tolerated. Increased effectiveness of antihypertensives (monitor BP), reduce effectiveness of anti-coagulants.
Coenzyme Q 10 (CoQ10)
Pre-OP implications with herbs/supplements?
Garlic: stop 2 weeks before surgery
Ginkgo: 2 weeks
Ginseng: 2 weeks
St. John’s Wart: 5 days
What are some food drug interactions?
Ca+ binds to come meds (reduces absorption)
Grapefruit (increased or decreased bioavailability)
Green leafy veggies (contain vit. K, antidote to warfarin, keep intake consistent)
High K+ diet (K+ sparing diuretics, risk of hyperkalemia, keep intake consistent) may affect absorption
What is the psychotherapeutics in late life?
Antidepressants (SSRIs and SNRIs), anxiolytic agents, mood stabilizers, and antipsychotics
SSRIs
Neurotransmitter: serotonin
First line, work well with older, small doses effective, often have sensual side – switch to SNRIs
SNRIs
Neurotransmitter: serotonin and nor-epinephrine
Second line, less sensual side effects. Bupropion (Wellbutrin): reduces nicotine dependency as well. Trazodone: also used as a sleep aid.
Excessive amts of serotonin can cause this. It is characterized by an altered mental status, high fever, sweating and clonus. Clonus is an involuntary muscle CTX.
serotonin syndrome
ends in “am”, highly effective, fast onset but long half-life. SE: drowsiness, confusion, dizzy, impaired coordination (falls), depression, and increased anxiety.
BENZOs
used to treat psychosis (sometimes as mood stabilizer) blocks dopamine. SE: sedation, hypotension, anticholinergic effects, ESP (dystonia, akathisia, Parkinsonian symptoms, and tardive dyskinesia.)
Antipsychotics
Meds affect hypothalamus and thermoregulation, increased temp: intolerant to warm temps, assess temp regularly, keep hydrated, cool baths, fan potential for liver damage and heat stroke.
malignant syndrome
Movement disorders?
Pseudo-parkinsonism (stooped posture, shuffling gait, rigidity, bradykinesia, tremors at rest, pill-rolling motion of the hand)
acute dystonia (facial grimace, involuntary upward eye movement, muscle spasms of the tongue, face, neck and back, laryngeal spasms)
akathisia (restless, trouble standing still, paces, feet in constant motion, and rocking back and forth)
tardive dyskinesia (protrusion and rolling of tongue, sucking and smacking movements of the lips, chewing motion, facial dyskinesia, and involuntary movements.)
overall considered dietary supplement (much less scrutiny the meds), manufactures may not say that herbs and supplement prevent disease, treat or cure disease. Often believe that they are natural and safe, higher use when unsatisfied with medical care, and grossly under reported.
herbs/supplements
most common and most feared symptom of people at end of life. Comprehensive and multifactorial assessment by interdisciplinary team is key to management.
pain end of life
temporary, post-op, procedural, and traumatic pain. Easily controlled by analgesic.
acute pain
no time frame, persistent at varying levels of intensity, and more difficult to control.
persistent pain
non pharm measures for pain?
Energy/touch therapies, TENS, acupuncture and acupressure, relaxation, meditation, guided imagery, music, hypnosis, activity, and cog behavioral therapy.
study of the movement and actions of a drug in the body: absorption, distribution, metabolism, and excretion.
Pharmacokinetics
increased gastric pH. Decreased surface for absorption, blood flow to spleen, GI activity.
absorption
increased body fat. Decreased: CV output, total body H20, LEAN body mass, serum albumin, and protein binding.
distribution
increased body fat. Decreased hepatic mass, blood flow, enzyme activity, and enzyme indictability
metabolism
decreased renal blood flow, GFR, tubular secretory function, and kidney size (think toxicity)
excretion
physiological processes between drug and body the older a person gets, the more likely they will have an alteration or unreliable response to drug less reliable and more unpredictable.
pharmacodynamics
taking multiple medications at the same time. More meds taken in LTCF, increased risk for drug interaction and risk of adverse events.
polypharmacy
BEERS criteria
not an absolute, can’t always be avoided. Collab with DR to reduce or change to other options when possible.
- Drugs identified to have higher than usual risk when used in older people
- Overwhelming benefit vs. risk documentation when prescribing these drugs considered a standard of practice.
- Use as a guide not absolute direction
- “Safety alert: do not use list”
