Geriatric Medication Considerations

Question 1

ADRs in Old People

Answer 1

Consequence of inappropriate drug prescribing
Most drugs not tested on olds or babies

Question 2

Big Study from 10 Years ago

Answer 2

90% of adults on one medication. 40% on 5 or more

Question 3

Olds Meds Number in Nursing Home

Answer 3

Average of 14 meds

Question 4

Polypharmacy

Answer 4

Use of multiple meds by a single patient
5+, 10+ 15+ meds.
Increases ADRs, drug interactions, problems with adherence

Question 5

BEERS Criteria

Answer 5

Most widely used criteria to assess inappropriate drug prescribing

Question 6

PIMS

Answer 6

Potentially Inappropriate Medications

Question 7

5 Categories of PIMs

Answer 7

1 Potentially Inappropriate
2 Typically avoided in certain conditions
3 Use with caution
4 Clinically significant drug interactions
5 Drug dose adjustments based on kidney function

Question 8

Nitrofurantoin

Answer 8

Anti-ineffective for UTIs, avoid in CrCl <30mL/min; risk of pulmonary toxicity

Question 9

CV drugs

Answer 9

High risk of orthostatic hypotension; alpha 1blockers (doxazosin, prazosin, terazosin) and central agonists (Clonidine)

Question 10

CNS agents

Answer 10

Benzos; increased sensitivity and decreased metabolism of long acting agents (diazepam)

Question 11

GI agents

Answer 11

Metoclopramide; extrapyrimidal effects in long term use
PPIs; increased risk of C. diff and bone loss/fractures

Question 12

Anticholinergic Agents

Answer 12

a/w multiple adverse effects
Cognitive: memory, confusion, hallucination
Somatic: Most common effects. Dry mouth, blurred vision, constipation, nausea, urine retention, tachyardia
Most significant: Amitriptyline, dicyclomine, doxepin, clozapine
Higher doses and additive effects of multiple agents is of particular concner

Question 13

NSAIDS

Answer 13

Risk of GI bleeding. More common >75 years old.

Question 14

Skeletal Muscle Relaxants

Answer 14

Combo of anti-cholinergic, sedation, risk of falls

Question 15

Heart Failure

Answer 15

Avoid NSAIDs, Thiazolidinediones, diltiazem and verapamil, dronedarone
All have potential to promote fluid retention and exacerbate heart failure

Question 16

Chronic Seizures

Answer 16

Buproprion and tramadol. Can lower threshold

Question 17

Delirium/dementia/cognitive impairment

Answer 17

Anticholinergics, antipsychotics, benzos, H2RAs.
Increased risk of CNS effects

Question 18

Parkinsons

Answer 18

Antipsychotics. Precipitate PD s/s

Question 19

Use with Caution

Answer 19

Aspirin; lacks benefit in pts over 80. Billy says its ok, especially if pt is in good health
Dabigatran: increased risk of GI bleed, especially over 75
Vasodilators: increased risk of syncope(hydralazine and nitro)