GERI-RX

Question 1

How was AGS BEERs criteria found?

Answer 1

MD Beers, started research and found inappropriate med. More people in SNF than acute care. Ask the questions? is this the right drug?

Question 2

Mrs. Jones 75 yo complains of n/v since starting fuoresmide and her BP is still 150/85? What are concerns regarding absorption?

Answer 2

Absorption- dfx will lower the drug levels.

reduced stomach acidity
reduced gastric motility
reduced first pass biotransformation
reduced dermal absorption

Question 3

What question should you ask Mrs. Jones?

Answer 3

Due to impaired absorption.
Ask about:
altered nutritional habits-less meals

increased use of OTCs, antacids, laxatives etc (block drug absorption)

Question 4

Ms. Jones has lowered body water and higher body fat? What does this affect?

Answer 4

Distributions altered:
Dec msk
lipophilic drugs remain in fat longer
altered albumin levels -increased free drug levels

Question 5

What is most important aspect of drugs and elimination?

Answer 5

***PA good at this
OUR DUTY
FOCUS
DONT MULTITASK
START LOW GO SLOW
ALLERGY
CREATINE CLEARANCE
PREV DRUG
PMH

Question 6

This phase is ideal for elderly due to unaffected biotransformation?

Answer 6

PHASE II reactions

Question 7

what are factors that DEC metabolism in elderly and IMC?

Answer 7

DEC capacity of Phase I (MFO) enzymes

decreased blood flow to the liver

nutritional deficiency alters liver function

Question 8

What do CYP inhibitor due to drugs?

Answer 8

INC toxicity

Question 9

What do CYP induces due to drugs?

Answer 9

DEC serum level

Faster clearance

Question 10

How does the t1/2 affect the elders if their CC is decreased overtime?

Answer 10

Risk of accumulation and toxic

GFR dec w/ age
CC dec- creatine almost 100% cleared. IF creatine is high, then renal failure

Question 11

How do you adjust dose if CC 50%?

Answer 11

50% reduced renal fx.
if drug is 200mg/day
Give 100/day
Find chart in drugs or CC and dose
Creatine Clearance- Crockcroft Gault
wt, age, creatine-
<28 Marked poor CC
CC RI- Ideal 100mL/min is

Question 12

What changes in receptor affinity in elderly can lead

to adverse response to CNS drugs?

Answer 12

Receptor affinity and/or receptor numbers can change

Question 13

What are the ADR of Geriatrics that is important for HCP?

Answer 13

Elderly death nearly 20K/yr

• more drugs, Avg. 6-8 compared to younger population.
• Prescription errors due to lack of consideration of pharmacokinetic changes in the elderly.
• Multiple physicians treat same patient unaware of all the drugs
• INC OTC use
• drug compliance poor, more drugs less compliance
• INC dosing req = inc errors
• SNF 50% have and ADR, not legal or OK

Question 14

What are the ideal Benzodiazepines?

Answer 14

Lorazapam and oxazepam

Other biotransformed into active metabolites which adds to potential of toxicity
SE of toxic- ataxia, falls, fractures.
Check Benzo dose

Question 15

Which drugs should be avoided?

Answer 15

OPIOIDs

Question 16

Which drug reduces clearance of LI?

Answer 16

thiazides-clothalidone
Be careful
Lot of drugs

Question 17

What are newer less toxic CNS AchE inhibitors for Alzheimer’s?

Answer 17

Donepezil, rivastigmine and galantamine

Avoid azole with d/t CYP

Question 18

What are cleared through renal mechanisms and CC dose adjustment is required?

Answer 18

beta lactams aminoglycosides- ototoxcity
nephrotoxicity-rise in CC
Gram neg- Ecoli., sepsis
IV, QD

Question 19

Which drug causes osteoporosis which results in fractures?

Answer 19

Corticosteroids

Question 20

Which drug cause cell necrosis in renal tubules may result from dec. production of prostaglandins (PGs)
and thus impairs kidney fx?

Answer 20

NSAIDs- act cyclooxygenase 1 and 2 (COX 1 &2) to block synthesis of inflammatory prostaglandins.

PGs- are potent vasodilators, lack of results in vasoconstriction which results in ischemia and cell death

use Tylenol

Question 21

75-year old female who winters in Arizona from the mid-west. Presented with forgetfulness, intermittent disorientation, depression. She was weak and suffered palpitations. What is considered

Answer 21

DDX- digoxin toxicity
hyponatremia
hypokalemia
renal failure d/t NSAID

TX:
withdraw digoxin and ibuprofen
reduce diuretic
switch from aspirin to acetaminophen

Question 22

When writing RX for elderly what should be considered?

Answer 22

1- lower cost alternative drugs- but SAFE
2- Caution stopping an antibiotic early
3- AVOID ADR. Integrate prescription drug choices with other HCP
4-Ask about CAM, still a drug. 70% of patients will not disclose taking
5- “Child proof” containers are often “patient proof”
6- Patients with tremor, arthritis, visual problems can not self-administer correctly.
7- 1 pill/day 1x/day co-ordinate their dosing requirements to reduce number of different times required.

Question 23

Describe step to write a RX for elderly?

Answer 23

Ultimate responsibility is with the PA or MD who wrote the prescription.

1-“Start low and go slow” 1/2 the usual adult dose and titrate to the desired effect.
2-fewest and simplest dosing regimen.
3) Patient education dose
(4) income and limited or no insurance.
(5) Review patient’s drug list periodically/yr
(6) Provide patient with a portable prescription record to take to other physicians.
(7) Make home health aides aware of ADRs observed

Question 24

What has a long t1/2, used for irregular HR, takes months to resolve especially with Increased body fat in geriatric patient? Takes long to reach steady state.

Answer 24

Amiodarone
ADRs d/t CYP enzymes
MAJOR DI- Warfarin

Question 25

If adding Amiodorone for palpitations, which DOAC is ideal?

Answer 25

Dabigatran- no drug monitoring