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PHARM3 > Geriatric-final > Flashcards

Geriatric-final Flashcards

1
Q

What changes in the GI tract happen in the elderly?

A

(1) Increased gastric emptying time 
(2) Decreased salivary flow
(3) Decreased absorptive capacity of intestinal cells
(4) Decreased gastric acid secretion
(5) Reduced gastrointestinal motility. 
(6)Reduced splanchnic blood flow.

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2
Q

How do these changes affect drug absorption?

A

there is little change in drug absorption with age. The rate of absorption may change, but the extent does not.

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3
Q

What distribution changes happen in the elderly?

A

(1) Decrease in lean body mass (muscle).
(2) Decrease in total body water (10-15%)
(3) Decrease in serum albumin (0.5-1 g/dl change)
(4) Increase in alpha-1 glycoprotein
(5) Increase in total body fat.
(6) Protein binding may be altered.

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4
Q

What in one of the main routes of drug elimination?

A

LIVER

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5
Q

What changes occur in the liver that can affect drug metabolism?

A

(1) Liver mass decreases
(2) Hepatic blood flow decreases
(3) Decreased first pass metabolism
(4) Phase I metabolic reactions decline.

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6
Q

What agents have been known to decrease hepatic clearance in the elderly?

A

acetaminophen, antiarrhymics, anticonvulsants, antidepressants, antipsychotics, benzodiazepines, indomethacin, theophylline, warfarin, some beta blockers.

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7
Q

What might an elderly person who has a normal serum creatinene actually have a decreased creatinine?

A

D/T increased creatinine production and an increased glomerular filtration rate (GFR)

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8
Q

What are clinically significant changes in the renal system that effect elimination?

A

(1) Decrease in renal mass (10-20% between ages 40 and 80)
(2) Decrease in renal blood flow (1-2% decline/year after age 40)
(3) Decrease in glomerular filtration (50% decline between 50 and 90 years of age.)
(4) Decreased tubular secretion and absorption (@ 7% decrease each decade) Drugs eliminated by tubular secretion include cimetidine and procainamide.
(5) Decreased creatinine clearance.

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9
Q

What commonly used drugs in the elderly require dosage adjustments for creatinine clearance?

A

allopurinol, amantadine, most antibiotics, atenolol, carteolol, digoxin, lithium, gabapentin, H2-blockers, procainamide, quinidine, sotalol.

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10
Q

What can anticholinergic drugs cause?

A

confusion, hallucinations, sleepiness, blurred vision, difficulty urinating, dry mouth, and constipation in older adults

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11
Q

What are anticholinergic drugs common used in elderly populations?

A
  • Antihistamines
  • Antiparkinsons drugs
  • Antispasmodics
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12
Q

What are the 2 antiparkinsonian drugs that should be avoided?

A
  • Benztropine

* Trihexphenidyl

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13
Q

What antispasmodics should be avoided unless used for short term comfort care?

A

•Belladonna alkaloids
•Dicyclomine
•Hyoscyamine
Scopolamine

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14
Q

What short acting antithrombotics should be avoided?why? when can they be used as an injection?

A

Short acting dipyridamole (antiplatelet) –orthostatic hypotension
•Injected form can be used during stress test

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15
Q

When should nitrofurantoin not be used?

A

Avoid long term use and in patients with CrCl

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16
Q

What should be avoided for HTN tx alone in oldies?

A

Alpha-1 blockers
Doxazosin, Prazosin, Terazosin- orthostatic hypotension- falls
CLONIDINE

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17
Q

What cardio meds may slow HR and cause dizziness?

A

Alpha Agonists

Clonidine, Guanabenz, Guanfacine, Methyldopa, Reserpine

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18
Q

When should digoxin be avoided?

A
  • doses higher than 0.125 mg per day

* In older patients with HF higher doses appear to offer no benefit but increased risks of dangerous ADR

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19
Q

What drug should be avoided bc it can lower BP and cause heart issues?

A

Nifedipine

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20
Q

When should spironolactone be avoided?

A

Avoid higher doses in patients with HF or decreased kidney function, risk of hyperkalemia

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21
Q

What are potential side effects of TCAs?

A
  • confusion, drowsiness, blurred vision, difficulty urinating, dry mouth and constipation (anticholinergic)
  • They can also cause a drop in BP and dizziness
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22
Q

What can all antipsychotics do?

A

increase risk of confusion, sleepiness, blurred vision, difficulty urinating, dry mouth, constipation, stroke and death in people with dementia

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23
Q

What antipsychotics should be avoided?

A

Mainly all all them unless that are a threat to themselves or others or other meds have not worked….

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24
Q

What 2 antipsych drugs have anticholinergic effects AND increase the risk of arrythmias?

A

Thioridazine and Mesoridazine

25
Q

What should be avoided when treating insomnia, agitation, or delerium?

A

BENZOS

26
Q

Why should benzos be avoided in the above conditions?

A

increase risks of mental decline, delerium, falls, fractures, and car accidents

27
Q

When might benzos be appropriate?

A

treating seizures, certain sleep disorders, anxiety disorders, withdrawl from other drugs, and end-of-life care.

28
Q

What are the long acting benzos?

A
  • Chlordiazepoxide
  • Flurazepam
  • Diazepam
  • Clonazepam
29
Q

What are the short acting benzos?

A
  • Alprazolam
  • Lorazepam
  • Oxazepam
  • Temezapam
  • Triazolam
30
Q

Why should barbs be avoided?

A

can be addictive, over time less effective in helping sleep, more likely to cause overdose than other choices

31
Q

What are specific drugs that should be avoided for sedation? Why?

A
  • Chloral hydrate- High risk of overdose-AVOID
  • Meprobamate- Causes drowsiness and addiction-AVOID
  • Sedative Hypnotics- Can cause confusion, falls, and fractures ( z hypnotics)
32
Q

Why should meperidine be avoided?

A

Long half life and may induce seizures

33
Q

What are the non-steroidal anti-inflamm drugs that increase the chance of GI bleed?

A
  • Aspirin at doses > 325mg/ day
  • Naproxen
  • Ibuprofen
34
Q

What can pentazocine cause?

A

Confusion, hallucination

35
Q

What do all skeletal muscle relaxers cause? Which ones should specifically be avoided?

A

Drowsiness and increase risk fractures
•Carisoprodol
•Cyclobenzaprine

36
Q

What drugs should be avoided if you have an elderly pt with heart failure?

A
  • NSAIDs/COX-2 inh
  • Pioglitazone/Rosiglitazone
  • Dronedarone
37
Q

What drugs should be avoided if it is systolic heart failure?

A

Diltiazem/Verapamil

38
Q

What drugs should be avoided in DM?

A

Sulfonylureas- Dangerously low Blood sugar

Glyburide

39
Q

What drugs should be avoided in epilepsy and why?

A 
•Buproprion
•Chlorpromazine
•Clozapine
•Olanzapine
•Thioridazine
•Tramadol
*** These meds may increase frequency of seizures-Avoid unless seizures are well controlled and other meds do not work
40
Q

Why do elderly have the highest rate of suicide?

A

Diminished cognitive function, sleep disruptions, poor social interactions, inattention by primary caregivers

41
Q

What is more frequently the presenting symptom in depressed elderly pts?

A

Somatic or physical

42
Q

What is the drug of choice for depression?

A

SSRI

43
Q

What are some drugs that might exacerbate depression?

A
  • Long-term benzodiazepine use

* Sympatholytic agents

44
Q

Drugs that block what can worsen AD?

A

Acetylcholine

45
Q

What drugs can exacerbate dementia?

A 
•Anticholinergic Medications
•Benzodiazepines
       Lorazepam, Oxazepam, Buspirone
•Antidepressants
       Sertraline, Citalopram
•Antipsychotics
      Haloperidol, Risperidone
46
Q

What drugs are thought to have CNS altering effects?

A 
•Barbiturates
•Anticholinergics
•Antispasmodics
•Muscle relaxants
CNS stimulants
47
Q

What meds are approved to treat BPSD?

A

NONE

48
Q

What drugs are used to tx BPDS?

A

Antipsychotics, antidepressants, mood stabilizers, benzos

49
Q

What drugs can exacerbate insomnia?

A

Decongestants, Theophylline, methylphenidate, amphetamines, and MAOIs can exacerbate insomnia

50
Q

What are some concerning ADRS of antihistamines?

A

Confusion, sedation, anticholinergic effects

51
Q

What are some concerning ADRS of barbs?

A

Dependence, High risk of ADE (falls, fractures, confusion)

52
Q

What are some concerning ADRS of benzos?

A

Sedation, falls, accumulation

53
Q

What are some reasons for accidental or unintended misuse of drugs in the elderly?

A
  • Difficulty reading a prescription label
  • Problems hearing and understanding verbal directions
  • Hoarding old or unused medications
  • Just in case medications
54
Q

What are age related factors that predispose older pts to iatrogenesis?

A

•Diminished physiologic reserve
•Impaired compensatory mechanisms
•Atypical presentation of illness, which complicates accurate diagnosis and treatment.
•More co-morbid, chronic medical conditions, that require more diagnostic procedures and medications
Polypharmacy
•Increased cognitive and functional impairment

55
Q

What are the guidelines for tx elderly?

A

1) start low and go slow
2) d/c meds ASAP
3) consider drug “holidays”
4) chose meds that can tx more than one symptom!

56
Q

What 2 conditions can CCB cover for?

A

both hypertension and angina.

57
Q

What 2 conditions can ACE-I cover for?

A

hypertension and congestive heart failure.

58
Q

What are non adherent bx seen in the elderly?

A
  • Failure to take medications
  • Premature discontinuation of a medication
  • Excessive consumption of a medication
  • Use of medications not currently prescribed
59
Q

What are strategies you can use to improve med adherence in your elderly population?

A
  • Limit the number of different medications
  • ↓ dose frequency
  • Simplify dosage instructions
  • Tailor the regimen to the patient’s schedule
  • Use compliance aides and telephone reminders
  • Provide information on financial assistance programs
  • Enlist help from family members and friends

PHARM3 (16 decks)

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