Geriatric Considerations

Question 1

Older adults (65 & older) are more ____ to drugs and more ____ occur

Answer 1

• sensitive
• ADR’s

Question 2

Objective is to ____ symptoms and improve _______

Answer 2

• reduce
• quoality of life

Question 3

How is abortion altered in older adults?

2 answers

Answer 3

• rate is slower d/t delayed gastric emptying
• reduced gastric acidity

Question 4

How is distribution altered?

4 answers (1 increased, 3 decreased)

Answer 4

• increased body fat %
• decreased lean body mass %
• decreased total body water
• reduced serum albumin

Question 5

How is metabolism altered with age?

2 answers

Answer 5

• hepatatic drug metabolism declines
• half-life may be increased

Question 6

How is excretion altered with age?

1 answer

Answer 6

• progressive decline in early adulthood

Question 7

Pharmacodynamics in older age

Answer 7

• receptor alterations (beta andrenergic agents less affective)

Question 8

ADR is ____x more common in older adults

Answer 8

• 7

Question 9

Predisposing factors not directly related to age

6 answers

Answer 9

• drug accumalation
• polypharmacy
• severe illness
• comorbidities
• individual drug variation (adr)
• poor patient adherence (59% do not take as prescribed )

Question 10

Avoid dabigatran for long term treatmetn of nonvalvular afib or VTE d/t

Answer 10

• increase risk GI bleed

Question 11

Avoid prasurgel and ticagrelor d/t

Answer 11

• increae of major bleeding compared to clopidogerl (75 and older)

Question 12

Avoid antidepressants:
Mirtazipine, SNRI, SSRI, TCA
Antiepileptics:
carbamazepine, oxacarbaxepine
Antipsychotics, Diuretics, Tramadol d/t

3 answers

Answer 12

• exacerbation
• cause SIADH
• hyponatremia
  * monitor na levels

Question 13

Avoid dextromethorphan-quinidine

Answer 13

• limited efficinecy w/ behavioral sx of dementia
• increase risk of falls

Question 14

Avoid trimethoprim-sulfamethoxazole

Answer 14

• increased risk of hyperkalemia when used w/ ACEI, ARB and ARNI when decreased CrCL

Question 15

Avoid sodium glucose cotransporter-2 (SGLT2) inhibitors: canigliflozin, dapagliflzoin, emplaglifozin, ertugliflozin d/t

Answer 15

• increased urofenital infections
• diabetic ketoacidosis

Question 16

Factors that increase risk of ADR’s

8 answers

Answer 16

• multiple chronic disorders, prescriptions, doses
• difficult drug packaging
• multiple prescribers
• drug regimen changes
• cognitive or physical impariement
• recent hospital discharge
• inabilty to pay/ thinks drugs is uncessary
• SE

Question 17

Measures to reduce ADR’s

6 answers

Answer 17

• ask provider to simplify drug regimen and dose
• clear, concise treatment: oral/written plan and explantion
• suggest pill diary, calendar, counter
• ask pharamsit to incrase label font and provide easy package
• ask patient about finace, refer to GoodRx
• monitor for ADR, Therapetic response, plasma drug level

Question 18

End of life goal

Answer 18

• shifts from disease prevention to comfort measure

Question 19

End of life therapy should ____ unnecessary medications

Answer 19

• decrease

Question 20

Pharmacological considerations

5 answers

Answer 20

• constipation: osmotic lax
• Delerium: antipsychotics (haloperidol/ olanzapine)
• Dyspnea: o2 (hypoxia); opiods (1st line tx)
• Pain: fentanyl or methadone SCHEDULED
• Respiratory secretions: anticholinergics

Question 21

adult medication adminstration: put, crush, place

Answer 21

• Put: put pills in applesauce or pudding
• Crush: crush/half pills into tbls of applesause (1st check if med can be crushed!)
• Place: place pills on tongue, tilt chin toward chest, swallow with water while head is bent