Geriatric Medicine and Pharm

Question 1

What are 3 causes of affected pharmacokinetics in elderly pt’s?

Answer 1

• Decrease 1st pass clearance in liver
• Decrease in body fat
• Serum protein levels (malnutrition or dietary issues)

Question 2

What are the 3 categories of the Beers Criteria?

Answer 2

• Meds to always avoid for older pt’s
• Meds that are potentially inappropriate for older pt’s with certain medical conditons
• Meds used with caution

Question 3

What are the STOPP and START criteria for medication in the geriatric population?

Answer 3

• STOPP = similar to Beers criteria but also includes drug-drug interaction and duplication of drugs within class
• START = consists of 22 evidence-based prescribing indicators in older pt’s

Question 4

Which 2 instances would warrant an opthalmologist referral for geriatric pt?

Answer 4

• Diabetic pt for monitoring of diabetic retinopathy
• Pt w/ ↑ risk glaucoma i.e., family hx, etc…

Question 5

What are the 2 assessment tools that can be used for functional ability of geriatric pt?

Answer 5

• Katz Index of Independence in Activities of daily living
• Lawton Instrumental Activities of Daily Living Scale

Question 6

What are 2 fall risk assessment tools available?

Answer 6

• Tinetti Balance and Gait Evaluation
• ‘Get Up and Go’ test

Question 7

What are 2 specific questions that can be asked to every pt in every office visit to screen for depression; when is use of a more detailed PHQ-9 questionnaire indicated?

Answer 7

• “During the past month, have you been bothered by feeling down, depressed, or hopeless?”
• “During the past month, have you been bothered by little interest or pleasure in doing things?”
• If “yes” to these quesitons prompts use of Patient Health Questionnaire-9 (PHQ-9)

Question 8

What is the USPSTF recommendation for using a DEXA scan to screen for osteoporosis?

Answer 8

• DEXA scan on woman 65 years or older
• Screening women <65 y/o whose 10-year fracture risk is high –> Use FRAX (Fracture Risk Assessment Tool)

Question 9

At what age are colonoscopy, pap smear, and mammograms stopped?

Answer 9

• Colonoscopy stopped after 75 y/o
• Pap smear and mammogram stopped after 65 y/o

Question 10

Pt’s 65 years and older should be up to date on which 4 vaccines?

Answer 10

• Tetanus or tetanus w/ pertussis vaccine
• Influenza vaccine
• Pneumococcal vaccine
• Herpes Zoster vaccine

Question 11

What contributes to loss of function in the elderly, aging or disorders?

Answer 11

disorders

Question 12

Does the USPSTF recommend automatically performing an in-depth fall-risk assessment?

Answer 12

No

the focus is on the balance of benefits and harms

Question 13

What combination of disorders can contribute to a fall risk?

Answer 13

Posture+Gait+Osteoporosis

Question 14

what is the MOCA?

What is the MMSE?

What is the MiniCog?

Answer 14

Montreal Cognitive Assessment

Minimental status exam

Clock drawing and 3 world recall (both part of the MMSE)

Question 15

Which mood disorders can have a late onset?

Answer 15

Depression, Bipolar Disorders

Depression can have more sleep/fatigue, motor involvement and hopelessness

Question 16

What factors can increase fall risk?

How can that be mitigated?

Answer 16

Bowel/Bladder incontinence

Depends, bedside commode, scheduled bathroom times, pelvic floor strengthening

Question 17

What is a DPOA?

Answer 17

Durable Power of Attorney

enables an individual to specify who they want to be the one to make decisions if they’re not able

*Does not automatically cover financial/business decisions

Question 18

What is an Advanced Directive?

Answer 18

indicate treatments/care that patient wants donenot done during end of life care

Is very difficult to discuss, pt may prefer to appoint a DPOA to make these decisions

Question 19

What is the rule of thumb for medications in the elderly?

Answer 19

Start Low and Go Slow

Question 20

What is the Beers criteria?

Answer 20

any prescribing should be with the patient goals/capabilities/prgnoses and QOL in mind in addition to the common sense of the physician

Question 21

What meds should be used with cuation in elders?

Answer 21

DOACs

Warfarin

Tramadol

Antipsychotics in Parkinson’s

Question 22

What are some BEERS revisions from 2019?

Answer 22

Avoid opioids with Benzos or gabapentinoids

Caution with Trim/Sulfa in pt’s on ACE/ARB

Avoid H2 antagonists in delirium

Avoid ASA in those 70+

Avoid SNRIs in those with fall hx

Avoid hypoglycemia (no sliding scale insulin)

Question 23

What is the “Brown Bag” review?

Answer 23

Have pt’s bring in EVERY medication and go over how they take each one (compared to how it is prescribed)