Final Lecture #3

Question 1

decreased in norm aging?

Answer 1

Baroreceptors response myocardial sensitivity to catecholamines (nor-epi-epi), response of a-adrenergic system.

Question 2

What is increased sensitivity to anticholinergic effects?

Answer 2

Can’t…
* SEE (blurry vision)
* PEE (urinary retention)
* SPIT (dry mouth)
* Poop (constipation)
* Also, confusion and dizzy

Question 3

What is the increased sensitivity to diuretics?

Answer 3

Reduce baroreceptor response, higher risk of orthostatic hypotension

Question 4

What is the increased sensitivity to beta agonists and antagonists?

Answer 4

Reduced effects due to alteration in adrenergic system activity

Question 5

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.

Answer 5

Echinacea

Question 6

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.

Answer 6

Garlic

Question 7

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.

Answer 7

ginkgo biloba

Question 8

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)

Answer 8

ginseng (root of plant)

Question 9

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

Answer 9

red yeast rice

Question 10

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.

Answer 10

st. johns wart

Question 11

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

Answer 11

Glucosamine sulfate

Question 12

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.

Answer 12

Coenzyme Q 10 (CoQ10)

Question 13

Pre-OP implications with herbs/supplements?

Answer 13

 Garlic: stop 2 weeks before surgery
 Ginkgo: 2 weeks
 Ginseng: 2 weeks
 St. John’s Wart: 5 days

Question 14

What are some food drug interactions?

Answer 14

 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

Question 15

What is the psychotherapeutics in late life?

Answer 15

Antidepressants (SSRIs and SNRIs), anxiolytic agents, mood stabilizers, and antipsychotics

Question 16

SSRIs

Answer 16

 Neurotransmitter: serotonin
 First line, work well with older, small doses effective, often have sensual side – switch to SNRIs

Question 17

SNRIs

Answer 17

 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.

Question 18

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.

Answer 18

serotonin syndrome

Question 19

ends in “am”, highly effective, fast onset but long half-life. SE: drowsiness, confusion, dizzy, impaired coordination (falls), depression, and increased anxiety.

Answer 19

BENZOs

Question 20

used to treat psychosis (sometimes as mood stabilizer) blocks dopamine. SE: sedation, hypotension, anticholinergic effects, ESP (dystonia, akathisia, Parkinsonian symptoms, and tardive dyskinesia.)

Answer 20

Antipsychotics

Question 21

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.

Answer 21

malignant syndrome

Question 22

Movement disorders?

Answer 22

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.)

Question 23

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.

Answer 23

herbs/supplements

Question 24

most common and most feared symptom of people at end of life. Comprehensive and multifactorial assessment by interdisciplinary team is key to management.

Answer 24

pain end of life

Question 25

temporary, post-op, procedural, and traumatic pain. Easily controlled by analgesic.

Answer 25

acute pain

Question 26

no time frame, persistent at varying levels of intensity, and more difficult to control.

Answer 26

persistent pain

Question 27

non pharm measures for pain?

Answer 27

Energy/touch therapies, TENS, acupuncture and acupressure, relaxation, meditation, guided imagery, music, hypnosis, activity, and cog behavioral therapy.

Question 28

study of the movement and actions of a drug in the body: absorption, distribution, metabolism, and excretion.

Answer 28

Pharmacokinetics

Question 29

increased gastric pH. Decreased surface for absorption, blood flow to spleen, GI activity.

Answer 29

absorption

Question 30

increased body fat. Decreased: CV output, total body H20, LEAN body mass, serum albumin, and protein binding.

Answer 30

distribution

Question 31

increased body fat. Decreased hepatic mass, blood flow, enzyme activity, and enzyme indictability

Answer 31

metabolism

Question 32

decreased renal blood flow, GFR, tubular secretory function, and kidney size (think toxicity)

Answer 32

excretion

Question 33

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.

Answer 33

pharmacodynamics

Question 34

taking multiple medications at the same time. More meds taken in LTCF, increased risk for drug interaction and risk of adverse events.

Answer 34

polypharmacy

Question 35

BEERS criteria

Answer 35

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”