Geriatric Medication Management (online video) EXAM 2

Question 1

What is the BP goal for patients older than 65 (living in the community, non-institutional)?

Answer 1

SBP: <130 mmHg
DBP: > 60 mmHg
-when treating: be careful to not get lower than 60 DBP

may be adjusted based on comorbidities

Question 2

What is the goal BP of an older patient with very complex health including multiple comorbidities and severe impairment?

Answer 2

<140/90

-consider stopping statin if they are using one

Question 3

What is the most common form of hypertension in patients older than 65?

Answer 3

isolated systolic hypertension

can be caused by artery stiffness, heart valve problems, hypothyroidism, diabetes, obesity

Question 4

Which antihypertensive drugs are helpful for isolated systolic BP?

Answer 4

-DHP-Calcium-channel blocker (amlodipine) bc it helps against reduced elasticity of blood vessels

-also thiazides

Question 5

What is considered orthostatic hypotension

Answer 5

a drop of BP (within 3 min of standing) by:
>20 mmHg of SBP
> 10 mmHg of DHP

-dizziness upon standing or walking

Question 6

How long does it take to see the benefits of treating diabetes?

Answer 6

5-10 years

-reconsider aggressive therapy in patients who may be too old to see the benefit

-consider hypoglycemia when treating diabetes in older patients

Question 7

Which antidiabetic drugs should be considered for deprescribing due to the risk of hypoglycemia?

Answer 7

-sulfonylureas
-meglitinides
-insulin

Question 8

What is the A1c goal of a healthy older patient with few chronic illnesses and intact cognitive and functional status?

Answer 8

<7-7.5%

if multiple illnesses, 2 or more ADL (activities of daily living) impairment, mild to moderate cognitive impairment
-> 8%

Question 9

What is the normal blood glucose level of a healthy older patient with few chronic illnesses and intact cognitive and functional status?

Answer 9

80-130 mg/dl

with impairments: 90-150 mg/dl

very complex: 100-180 mg/dl

Question 10

Which drugs are commonly considered to be deprescribed?

Answer 10

-Benzos
-Antipsychotics
-Opioids
-NSAIDs
-Hypoglycemic agents
-PPIs (bone loss and fractures)

Question 11

What are the roles of different healthcare professionals?

Answer 11

-PCP: coordinates care, diagnose

-specialists: focus on their area of expertise and collaborate with PCP

-pharmacists: med experts, dosing, timing, appropriate meant, regimen, alternatives

-nurses: social and physical factors, provide direct care

Question 12

Roles of pharmacists in different settings

Answer 12

-community: has more patient contact, if they are community-dwelling

-ambulatory: collaborates with community pharmacist to work on drug regimen

-Hospital: med rec, approving, dispensing meds, rounding with teams

-rehab center: medication critique and adjustments

Question 13

Which vaccines should be given to older patients?

Answer 13

Influenza (every year in the fall)
-COVID 19
-Pneumococcal vaccine
-Shingles (2 doses, preferably 2-6 mo after the first)
-Tetanus/diphtheria (once every 10 years)
-RSV

Question 14

Study Guide Start

Question 15

What are the factors to consider when setting a goal for an older patient?

Answer 15

-comorbidities
-orthostasis
-cognitive status
-ADL impairments

Question 16

List 4 categories of medications that are commonly targeted for deprescribing.

Answer 16

-Insulin Simplification
-Proton pump inhibitor (PPI)
-Antihyperglycemic
-Antipsychotic
-Benzos

Question 17

What are 3 steps to use when conducting medication regimen review in geriatric patients?

Answer 17

-Review current meds
-Identify target meds
-Eliminate & Optimize Regimen

Question 18

Name 3 resources that you may cite in making evidence-based recommendations for
geriatric patients.

Answer 18

-Beers Criteria
-Guidelines
-Trials
-LexiComp®, MicroMedex®