Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Geriatrics > Geriatric Medication Critique (online) EXAM 2 > Flashcards

Geriatric Medication Critique (online) EXAM 2 Flashcards

1
Q

Name the implicit and explicit criteria that assess PIMs (potentially inappropriate medications).

A

Implicit: gives questions to critique the meds, but doesn’t tell exactly if its right or wrong to use the drug
-Medication Appropriateness Index (MAI)
-V.I.O.N.E

Explicit:
-Beer’s criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the Medication Appropriate Index?

A

ask a series of questions about each drug to check if its use is appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the criteria in the VIONE assessment tool?

A

-drugs are being categorized into: VIONE
Vital
Important
Optional
Not indicated

Every medication has a diagnosis/indication

-developed by the Veterans Association

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The Medication Appropriate Index and V.I.O.N.E. are considered implicit or explicit?

A

implicit

bc it doesn’t tell if the drug use is right or wrong but gives a direction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The Beers Cirtertia is consiered implicit or expliocit?

A

explicit

clear recommendations on which drugs are appropriate in patients older than 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Table 2 PIMS in all older adults

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which anti-infective is amongst the PIMs in the Beer criteria?

A

Nitrofurantoin

avoid if CrCl < 30 ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which CCB is amongst the PIMs in the Beer criteria?

A

Nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which drugs should be avoided for Afib in the elderly?

A

Amiodarone
Dronedarone
Digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Antidepressants with strong anticholinergic effects that should be avoided

A

TCAs:
Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin >6 mg/day
Imipramine
Nortriptyline

Paroxetine (SSRI) !!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why should Barbiturates be avoided?

A

-High rate of physical dependence
-tolerance of sleep benefits
-greater risk of overdose at low dosages

Butalbital
Phenobarbital
Primidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why to avoid Sulfonylureas?

A

-higher risk for CV events, mortality, hypoglycemia
-higher risk for CV death, stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why should Metoclopramide be avoided in the elderly?

A

EPS: tardive dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why should muscle relaxants be avoided?

A

anticholinergic effects
sedation
increased risk of fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why should the treatment of nocturia with Desmopressin be avoided?

A

high risk for hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which NSAID has the greatest risk for adverse effects?

A

Indomethacin

also CNS effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Table 3 PIMS in elderly with specific diseases

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the concern of Dextromethorphan-quinidine in older patients with HF?

A

QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the concern of NSAIDs and NHD-CCB in older patients with HF?

A

fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which drugs are associated with bradycardia in patients who suffer from syncope?

A

AChEIs (acetylcholinesterase inhibitors)
Donepezil
Rivastigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the concern of antipsychotics and TCAs in patients who suffer from syncope?

A

orthostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Antipsychotics should be avoided in elderly patients with Parkinson’s. Which antipsychotics are an exception?

A

clozapine
pimavanserin
quetiapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Table 4 Drugs to use with caution in elderly

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which drugs are known to cause hyponatremia or SIADH?

A

Mirtazapine
SSRI
SNRI
TCA

Oxcarbazhepine
Carbamazepine

Diuretics
Tramadol

Antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Which drugs can cause hyperkalemia when used with ACE/ARB or ARNI when CrCl is low?
Bactrim
26
Table 5: DDI that should be avoided in elderly
27
Table 6 Meds with renal dosing or avoidance in elderly
28
At what CrCl is dose adjustment required with Dofetilide?
<60
29
At what CrCl is dose adjustment required with Edoxaban?
reduce if CrCl is 15-50 ml/min avoid if CrCl is less <15 and more than 95 ml/min
30
At what CrCl is dose adjustment required with Baclofen?
<60
31
Dose adjust if <50 with wich drugs?
Cimetidine Famotidine Nizatidine also Edoxaban
32
Which Antibiotic needs dose adjustment?
Ciprofloxacin Nitrofurantoin Bactrim all <30
33
Which anticoagulants need dose adjustments?
Enoxaparin <30 Fondaparinux <30 Rivaroxaban <50 Edoxaban 15-50 ml/min
34
Which antidepressant need dose adjustment?
Duloxetine <30
35
Table 7 Drugs with strong anticholinergic effect
36
What are the 3 major categories that contribute to falls in elderly patients?
-Environment: stairs, slip rugs, loose cords, lack of assistive device, low lighting -Medication -Diseases
37
What are the environmental risk factors that can lead to falls?
-stairs -slip rugs -loose cords -lack of assistive device -low lighting
38
Which disease states can lead to falls?
Arthritis Depression Orthostatic hypotension impaired cognition impaired vision gait or balance impairment muscle weakness
39
Which drug classes are more likely to lead to falls?
-Psychoactive -Antidepressants -Antiepileptics -Opioids -Anticholinergic -Sedative: Benzos, Z-drugs (zolpidem, zaleplon) -more than 4 meds
40
Which of the categories of fall are intrinsic, and which ones are extrinsic?
Extrinsic: Environment, Medications Intrinsic: Diseases
41
Older patients have increased sensitivity to which drug class?
Benzos + decreased metabolism -> leads to physical dependence, cognitive impairment, delirium, falls
42
What is the maximum number of fall risk-inducing and CNS-active drugs that elderly patients should take?
older patients should not have -2 or more FRIDS -3 or more CNS agents -not more than 4 meds in general
43
Which SSRI is more anticholinergic than other antidepressants?
Paroxetine
44
Which second-gen antipsychotic has the highest anticholinergic effect?
Olanzapine
45
What are two examples of adverse drug withdrawal events (ADWEs)?
caused by the removal of a drug -withdrawal from benzos (not tapered) -rebound tachycardia from a Beta-blocker (not tapered)
46
Drug classes that are known to cause side effects in eldery pateitns.
-Psychoactive: Anticholinergic, Antipsychotics, Benzos -Cardio: Anticoagulants and antiplateltes, HTN meds and diuretic -Hypoglycemic: Insulin and Sulfonylureas -Pain meds: NSAIDs and Opioids
47
Which drugs are known to cause Hyperkalemia in elderly patients?
ACEi/ARB, ARNI, spironolactone, Aliskiren (renin inhibitor), potassium supplement high risk to cause hospitalization for hyperkalemia
48
Which drug interactions are known to cause overdose leading to sedation, CNS depression, and respiratory depression in elderly patients?
Opioids + Benzos Opioids + Gabapentin
49
Known DDI with CNS agents
Benzos and Z-drugs
50
Which drugs have a higher risk of causing lithium toxicity when used in combination with Lithium?
Lithium + ACEi/ARB, ARNI, loops (cause sodium and water loss -> more Lithium reabsorption -> toxicity) need sufficient salt and fluid intake when taken with Lithium
51
Loop diuretic combined with which drug is known to cause urinary incontinence? (especially in women)
Loops + peripheral alpha blocker (doxazosin, prazosin)
52
Combining Phenytoin with which drug has a higher risk for Phenytoin toxicity?
Phenytoin + Bactrim close monitoring for signs of toxicity is needed
53
Which drugs can cause Theophylline toxicity when used together?
Theophylline (xanthine, for asthma, emphysema, bronchitis) + Cimetidine (H2blocker) Theophylline + Ciprofloxacin
54
Which drugs increase the risk of bleeding when used with Warfarin?
Warfarin + Digoxin Antimicrobials Hypoglycemic agents Fab5: Flagyl, Flucanozole, FQ, amiodarone, bactrim
55
There is a higher risk for Digoxin toxicity with which drug?
Digoxin + Macrolides (clarithromycin, erythromycin)
56
Macrolides and which antihypertensive drug increases the risk for hypotension and shock?
Macrolide + CCB
57
Which drugs increase the risk for hypoglycemia when used with antidiabetics?
especially sulfonylureas with antibiotics (fluconazole, bactrim, macrolides) -multiple antidiabetics: sulfonylureas + insulin
58
Which drug interactions increase the risk for GI bleeding or peptic ulcers?
NSAIDs with corticosteroids, anticoagulants, antiplatelets -also avoid NSAIDs with hyperkalemic agents if can't be avoided use GI protection (H2 blocker, PPI)
59
How should the Cockcroft-Gault equation be used for elderly average-weight patients to calculate CrCl?
exclude the weight and don't divide by 72 from the equation
60
How to calculate CrCl in geriatrics and overweight or underweight patients
overweight: Adjusted body weight, multiplied with a 0.3 or 0.4 underweight: use IBW
61
Renal dose adjustment drugs
-Colchicine, Duloxetine, and Enoxaparin check video 37:00
62
Reasons for underused drugs in geriatrics
Untreated conditions -might be a condition that was missed -the team may have decided not to treat -unused preventive care (immunizations, vitamins, statins, BP control) -nonadherent (intended (cost, due to ADE; non-intended: too complex, forgotten refills, patient not knowing)
63
What are non-pharmacological ways to prevent diseases?
-ear and eye exams -prevent DDIs and ADEs, falls -improve diet and exercise, social interactions -vitamins -immunizations
64
Which vaccines should be considered at the age of 65 or older or based on comorbidities
COVID-19: fully boosted influenza: Annually RSV (respiratory virus): in 60 and older: COPD, asthma, HF, CVD (clinical judgment) Tdap Zoster Pneumococcal
65
What is the recommended dose of calcium for elderly patients?
Men: 51-70: 1000 mg older than 70: 1200 mg Women: 51 and older: 1200 mg -start with diet then supplement the rest
66
Which calcium formulation is more appropriate in patients with achlorhydria, constipation/gas, PPI/H2 blocker use, and risk for renal stones?
calcium citrate formulation
67
What is the recommended dose of vitamin D for elderly patients?
Men and women 51-70 yoa: 600IU daily 70 and older: 800 IU daily start with diet, more sun exposure
68
How much Vitamin D is recommended in patients with osteoporosis?
800-1000 IU daily -may get Vitamin D levels and supplement the deficiency 50,000 IU weekly of ergocalciferol (D2) or !! 5000-6000 IU daily of cholecalciferol (D3) - more efficient !! after the deficiency is replenished -> 2000 U per day !!
69
When should Vitamin B12 supplementation be considered?
-Neurological concerns -Metformin long-term use get a Vitamin B12 level and treat based on the level
70
When might Aspirin be indicated and when contraindicated?
-don't use it for primary prevention -may use it for secondary prevention -avoid in patients with bleeding risk
71
What is the recommended use of statins for primary and secondary prevention in elderly patients?
-primary prevention: initiate based on risk assessment and continue once older than 75 also based on risk assessment and clinician discussion -secondary prevention: -moderate to high-intensity statin if coronary, cerebral, or vascular disease unless older than 85 or end-of-life care -continue until the risk is greater than the benefit

Geriatrics (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions