Geriatric Medicine and Pharm Flashcards
What are 3 causes of affected pharmacokinetics in elderly pt’s?
- Decrease 1st pass clearance in liver
- Decrease in body fat
- Serum protein levels (malnutrition or dietary issues)
What are the 3 categories of the Beers Criteria?
- 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
What are the STOPP and START criteria for medication in the geriatric population?
- 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

Which 2 instances would warrant an opthalmologist referral for geriatric pt?
- Diabetic pt for monitoring of diabetic retinopathy
- Pt w/ ↑ risk glaucoma i.e., family hx, etc…
What are the 2 assessment tools that can be used for functional ability of geriatric pt?
- Katz Index of Independence in Activities of daily living
- Lawton Instrumental Activities of Daily Living Scale

What are 2 fall risk assessment tools available?
- Tinetti Balance and Gait Evaluation
- ‘Get Up and Go’ test

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?
- “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)

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

At what age are colonoscopy, pap smear, and mammograms stopped?
- Colonoscopy stopped after 75 y/o
- Pap smear and mammogram stopped after 65 y/o
Pt’s 65 years and older should be up to date on which 4 vaccines?
- Tetanus or tetanus w/ pertussis vaccine
- Influenza vaccine
- Pneumococcal vaccine
- Herpes Zoster vaccine
What contributes to loss of function in the elderly, aging or disorders?
disorders
Does the USPSTF recommend automatically performing an in-depth fall-risk assessment?
No
the focus is on the balance of benefits and harms
What combination of disorders can contribute to a fall risk?
Posture+Gait+Osteoporosis
what is the MOCA?
What is the MMSE?
What is the MiniCog?
Montreal Cognitive Assessment
Minimental status exam
Clock drawing and 3 world recall (both part of the MMSE)
Which mood disorders can have a late onset?
Depression, Bipolar Disorders
Depression can have more sleep/fatigue, motor involvement and hopelessness
What factors can increase fall risk?
How can that be mitigated?
Bowel/Bladder incontinence
Depends, bedside commode, scheduled bathroom times, pelvic floor strengthening
What is a DPOA?
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
What is an Advanced Directive?
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
What is the rule of thumb for medications in the elderly?
Start Low and Go Slow
What is the Beers criteria?
any prescribing should be with the patient goals/capabilities/prgnoses and QOL in mind in addition to the common sense of the physician
What meds should be used with cuation in elders?
DOACs
Warfarin
Tramadol
Antipsychotics in Parkinson’s
What are some BEERS revisions from 2019?
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)
What is the “Brown Bag” review?
Have pt’s bring in EVERY medication and go over how they take each one (compared to how it is prescribed)