[GDA33-34]Geriatric Syndromes and Polypharmacy Flashcards
What part of medicare coverage: HMOs, PPOs PFFS or Medicare advantage types?
Part C
What type of Medicare Coverage: physician services, outpatient, durable medical, preventive?
Part B
Under the Beers Criteria, what was the number of diseases/conditions that when a patient has one, specific drugs should be avoided?
20 diseases
How do fat soluble drugs pharmacokinetics change in the aging population?
There is an increase in the volume of distribution
What is Beers Criteria?
Original report in 1997 used expert panels (Delphi method) to develop criteria for prescribing recommendations for geriatric patients. Updated in 2003.
What blood/immune changes can you contribute to aging?(2-3 points)
decrease in bone marrow reserve, decrease in T-cell function, increase in autoantibodies
Can you contribute decrease hepatic function to aging? Can you contribute cirrhosis to aging? Can you contribute a decrease in T-cell function to aging?
yes; no; yes
Older persons represent what percentage of the population? They represent what percentage of the consumers for prescription drugs?(range)
12%; 25-30%
What drug classes usually contribute to polypharmacy?(2-6 points
analgesics/antiarthtritics; antiacids and histamine-2 receptor antagonists; cardiovascular drugs; laxatives; nutritional supplements; psychotropics
What nervous system changes can you contribute to aging?( 3-6 points)
brain atrophy; decrease in brain catechol syntehesis, decrease in DA synthesis; decrease in righting reflexes, decrease in stage 3 sleep ; decrease in thermoregulation
Does Medicare cover nursing home care?
Yes, but only for 90 days max after hospitalization
Does Medicaid cover nursing home care?
Yes
What musculoskeletal changes can you contribute to aging?(2 points)
decrease in muscle, decrease in bone density
What is a specific example of a non-presentation seen among the elderly?
A patient with pneumonia who present without a fever
What is the general rule use when considering pharmacotherapy for an older patient?
Start low and go slow
As a physician, you should watch out for delayed signs of drug-related toxicity for drugs with age-related decrease effects. What are examples of those drugs?(a group of drugs and a specific name for another drug?)
β-blockers and tolbutamide
What are specific drugs you should watch out for due to the fact that they impair renal function?(3-7 points)
allupurinol, digoxin, many cephalosporins, cirpofloxacin, histamine receptor antagonists(cimetidine, ranitidine, famotidine), venlafaxine and morphine
Can you contribute decrease cough reflex to aging?
yes
Why is polypharmacy more likely in older populations?(2-4 points)
increase symptoms resulting from increase prevalence of the disease; prescribers, one prescription used to deal with the side-effect of another prescription and drug advertising
ADL or IADL: paying bills, dressing; playing games; ambulation; traveling out of neighborhood?
IADL, ADL, IADL; ADL; IADL
What is a major concern when considering adverse drug reactions in the older population?
May be undetected in older adults because they can miic the characteristics of problems, disease, or symptoms commonly preset in the elderly
What are age related changes yo use when considering metabolism?
Decrease liver mass and liver blood flow plus contaminant disease, nutritional status and genetics leading to a potential for decrease in hepatic function
What changes in the eyes and the ears and be attributed to aging?(2-3 points)
Presbyopia, lens opacification, decrease in high frequency acuity
What are examples of geriatric syndromes?(6-11 points)
dementia, delirium, weight loss, urinary incontinence, falls; gait abnormalities, behavorial changes, weight loss, dizziness, poor nutrition, feeding impairment and sleep disorders
What are specific examples of drugs have a change in volume distribution due to age related changes?(1-3 points)
there is a decrease unbound fraction of propranolol, there is an increase psychotropic distribution into fat and an increase free concentration of meperidine, phenytoin due to decrease binding to RBCs
Persons greater than 60 years of age represent what proportion of drug-related deaths?
1/2
How do highly protein-bound drugs pharmacokinetics change in the aging population?
Highly protein bound drugs have the potential for greater (active) free concentration until metabolic excretory compensation occurs
What treatment factors should you as a physician consider when dealing with non-adherence?(3-5 points)
duration of treatment, number of medications, complexity, dosing frequency and types of medications
What is the percentage of persons older than 60 years of age don’t take drugs as directed?
~40%
Polypharmacy may increase what adverse events in older persons when considering their phamacological use?
predispositions to taking medications incorrectly; increase overlapping or antagonistic pharmacologic agents; adverse drug reactions: drug-disease, drug- drug or patient non-compliance
How do you assess adherence?(2-4 points)
observation of home environment, ask client to gather all medications, direction question related to the specific use of medication and pay attention to pharmacy refill patterns
What are the causes of urinary incontinence in older people?(4-7 points)
D elirium I nfection–urinary (symptomatic) A trophic urethritis and vaginitis P harmaceuticals P sychologic disorders, especially depression E xcessive urine output (eg, from heart failure or hyperglycemia) R estricted mobility S tool impaction
What general differences in presentation in diseases do you see with older patients?(2-3 points)
Non-specific presentation, no presentations and altered presentations
What are specific examples of altered presentations seen among the elderly population?(3-6 points)
depression without sadness; infection without fever, leukocytosis, tachycardia; MI without chest pain, pulmonary edema without dyspnea, silent surgical abdomen; silent malignancy
How is elimination changed in the aging population?(1-2 points)
There is a decrease in renal function primarily GFR leading to increase drug interactions
What type of persons get covered under Medicaid?( 2 points)
poor and disabled
The adverse drug reactions can cause what major issues in the elderly?(organ, general category or mental status)
damage cognitive status; cause accident and falls; renal toxicity; hepatic toxicity
What urogenital changes can you contribute to aging?(2 points)
vaginal/urethral mucosal atrophy, prostate enlargement
Ambulatory older adults use how many prescription drugs regularly (range)
2-4
Does medicare pay for assisted living facilities cost?
No
Medicare part B pays for what portion of physician services?
80%, the last 20% must be covered by the patient as an out-of-pocket expense or through MEDIGAP
Can you contribute and increase in hip fractures to aging? Can you contribute dementia to aging? Can you contribute decrease in catechol synthesis to aging? Can you contribute an increase incidence in hypo-hyperthermia to aging?
No; No; Yes; No
Can you contribute syncope to aging? Can you contribute increase blood pressure to aging? Can you contribute presbyopia to aging?
No; yes; yes
What is a collection of syndromes that is very common in the elderly?
Geriatric Syndromes
What are intermediate causes of frailty?(3-7points)
Loss of reserve( prolong reaction time, loss of strength, poor vision, osteoporosis) and polyphamcy
What are the proximate causes of frailty?(2-3 points)
multiple comorbid conditions, falls/fractures
Persons greater than 60 years of age misuse of drugs represent what leading cause of death for that population?
fifth
Where do people receive care?(3-6 points)
patient’s home, physician’s office, outpatient clinic, hospital, assisted living facilities, nursing homes and hospice
Is it possible to qualify for medicare if you fall into a group that wouldn’t qualify?
Yes, you can buy into a Medicare plan for you to use once you enter retirement.
Most medicaid patients are in what general age category?
children
What are the different letter designations for Medicare?(4 points)
Medicare Part A, Medicare Part B, Medicare Part C and Medicare Part D
How is distribution affected when considering age-related changes?(3-5 points)
Increase in the percentage of fat, decrease in total body water, decrease in plasma protein concentration, decrease in lean muscle muscle and decrease in blood flow to organs and tissues
Long-term care residents use how many prescription drugs regularly?(range)
2-10
ADL or IADL: toilet use
ADL
What is the usual time frame for adverse drug reactions?
sudden or may take days
What changes in absorption are normal in an aging population?(2-3 points)
Decrease number of absorptive cells, decrease in gastric acidity and decrease in GI blood flow leading to decrease motility
What is least affected by normal aging: absorption, distribution, metabolism and excretion?
Absorption
Under the Beer Criteria, how many medications were identified to avoid in older adults?
48 medications
What cardiovascular changes can you contribute to aging?(3-5 points)
decrease arterial compliance, decrease beta-adrenergic responsiveness, decrease baroreceptor sensitivity, decrease SA node automaticity and increase blood pressure
What are the outcomes of frailty?(2-6 points)
prolonged or repeated hospitalizations & long or limited recovery
Do older persons generally gain weight when they age?
No
What are examples of drug that you can provide at lower doses but still have a therapeutic effect?
Morphine can provide prolonged pain relief at lower doses, benzodiazepines can have increase sedation and postural instability and warfarin due to increase sensitivity to anticoagulant effect
What type of drugs should you watch out for when dosing considering the changes it could have on elimination?
Drugs that are known to impair renal function
What is MEDIGAP?
A private insurance plan regulated by the government that covers copays, coinsurance and other cost incurred through doctor visits that aren’t covered by Medicare.
Are drug interactions sen in older patients more likely due to a decrease in metabolism or just aging?
a decrease in metabolism
Does the VA cover nursing home care?
Yes
Does MEDIGAP cover nursing home cost after 90 days for the elderly?
No
Older people are the consumers of what percentage of the OTC drugs?
40%
What are the specific results of decreased metabolism?(general drug names)(2-4 points)
increase concentations of long acting benzodiazepines, β-blockers, tricyclic antidepressants and narcotic analgesics
Use of more than one than one chemical agent to effect a therapeutic endpoint?
polypharmacy
What drugs should a doctor be cautious about due to the fact that they have serious side effects?(2-5 points)
morphine, warfarin, ACE inhibitors, diazepam (especailly parenteral route) and levodopa
What type of person or group of people wouldn’t qualify for Medicare?
A citizen of the United States that never had a job that put money into the medicare plan
How do most elderly people pay for their health care?
Medicare
What respiratory changes can be contributed to aging?(2 - 3 points)
decrease in cough reflex, decrease lung elasticity, increase chest wall stifness
What part of Medicare pay for these types of coverages: hospital, hospice & short term nursing home after hospitalization?
Medicare Part A
Does medicaid pay for assisted living facilities cost?
No
What are the general changes that are associated with aging?( 2 points)
There is a decrease in total body water and there is a decrease in body fat
What is an initial cause of frailty?
altered endocrine function
What type of Medicare Coverage: Prescription drugs (so called donut hole changed with ACA)
Part D
Generally speaking, how much is the rate & extent of absorption affected by normal age-related changes?
No change
What changes can you contribute to the GI system?(2-3 points
decrease in hepatic function, decrease in acidity, decrease in colonic motility, decrease anorectal function?
Persons greater than 60 years of age represent what proportion of drug-related hospitalizations?
1/3
Can you contribute anemia to aging?
No
