Geriatric Medication Management Study guide

Question 1

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

Answer 1

-must be evidence-based and patient-specific
-goals may change at age 75-80
-consider the quality of life vs remaining life
-lag time before seeing a benefit of treatment
-meds must be as safe as possible

Question 2

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

Answer 2

-Benzos
-Antipsychotics
-Opioids
-NSAIDs
-Hypoglycemic agents
-PPIs

Question 3

Annie is an 87-year-old female who you are working with on medication use. PMH: T2DM, mild Alzheimer’s, walks with a cane, orthostasis, falls, SAR, agitation, Osteoarthritis.

What should Annie’s goal blood pressure be?

Answer 3

-Healthy: <130/80

Right answer: multiple chronic illnesses, 2 or more ADL (activities of daily living) impairments, mild to moderate cognitive impairment: <130/80

-LTC or end-of-life, 2 or more ADL impairments, moderate to severe cognitive impairment: <140/90

Question 4

What, if any, adjustments do you make to her
hypertension regimen

Answer 4

may d/c or reduce the dose of Valsartan

Question 5

What should Annie’s goal A1c be?

Answer 5

-Healthy: <7 - 7.5%

-Right answer: multiple chronic illnesses, 2 or more ADL (activities of daily living) impairments, mild to moderate cognitive impairment: <8%

-LTC or end-of-life, 2 or more ADL impairments, moderate to severe cognitive impairment: just try to avoid hypoglycemia and symptoms of hyperglycemia

Question 6

What, if any, adjustments do you make to her insulin regimen?

Answer 6

May d/c or decrease the dose of basal and bolus insulin

Question 7

What agents in Annie’s regimen should be targeted for deprescribing?

Answer 7

Valsartan, keep CCB to improve systolic BP
Insulin - hypoglycemia
Olanzapine - fall risk
Pantoprazole

Question 8

Annie (from case above) complains of SAR symptoms that have worsened recently with the
season change. What do you recommend?

Answer 8

-inhaled corticosteroids, lowest possible dose

-2nd gen antihistamines: Fexofenadine (Allegra), no sedation

Question 9

Annie (from case above) complains of worsened OA symptoms that are no longer controlled
by PRN acetaminophen. What do you recommend?

Answer 9

1. Nonopioids (Tylenol, NSAIDs)
2. mild opioids (hydrocodone)
3. stronger opioids (morphine)
4. Adjuncts/alternatives:
   calcitonin; TCA, SSRI/SNRI, anticonvulsants;
   corticosteroids; topicals; nerve blocks;
   radiotherapy; radiofrequency ablation

Question 10

What else should be assessed if an older patient presents with constipation?

Answer 10

first line: stimulant laxatives (Senna)

-look for drugs that cause constipation: opioids, anticholinergics

-recommend: mobility, hydration, fiber intake

Question 11

What preventive care is Annie (from the case above) missing?

Answer 11

vaccines: Tdap (every 10 years, pneumococcal)
caclium: 1200 mg
Vitamin D: 800-1000 IU

Question 12

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

Answer 12

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

Question 13

What are roles that the patient/family, pharmacist, and primary care provider (PCP) may
play in implementing a care plan?

Answer 13

-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 14

How does the implementation of a care plan differ if the patient is living in the community
versus inpatient? How do transitions of care impact implementation?

Answer 14

community: make sure she is able to perform ADL, no environmental risk factors in the house

inpatient:

Question 15

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

Answer 15

-Beers Criteria
-Deprescribing.org
-Canadian Deprescribing Network
-HealthinAging.org
-LexiComp