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WRAP UP > GERIATRIC PHARM > Flashcards

GERIATRIC PHARM Flashcards

1
Q

what should you first think of if an elderly pt becomes cognitively impaired, falls or describes N/V along with weight loss?

A

drug effects

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2
Q

why don’t serum creatinine levels in the elderly give an accurate picture of renal function?

A

there is a decrease in creatinine production with declining muscle mass

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3
Q

drugs and doses that wouldn’t normally be assoc. w/ significant CNS effects may produce increased effects in the geriatric patient how?

A

by virtue of change in BBB function

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4
Q

what happens to the BBB with age?

A

breaks down and drugs may have increased CNS access

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5
Q

decreased gastric acidity can have what impact on drugs?

A

affect absorption

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6
Q

first pass metabolism is impacted via what 2 mechanisms in the geriatric pt?

A

decreased gastric emptying, decreased splanchnic blood flow

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7
Q

distribution in geriatric pts is affected via what mechanisms?

A

increased body fat
decreased lean body mass
decreased body weight

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8
Q

the binding of drugs in geriatric pts is affected by what mechanism?

A

decreased serum albumin

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9
Q

the drug metabolism of geriatric pts is decreased via what 2 mechanisms?

A

decreased liver volume

decreased liver bloodflow

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10
Q

the renal excretion in old people is decreased via what 3 mechanisms?

A

decreased GFR
decreased renal plasma flow
decreased renal tubular function

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11
Q

how are effects of drugs affecting the CNS more heterogenous in older adults?

A

related to decreased blood supply
changes in BBB
increased monoamine oxidase
decreased ACh, DA, 5-HT–potentiating ADRs

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12
Q

explain the mechanism that results in declines in NT function and increased sensitivity of older adults to ADRs resulting from psychotropic meds

A

number and sensitivity of receptor sites are altered

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13
Q

which drug class could cause new symptom like constipation?

A

narcotics

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14
Q

which drug class can cause new symptoms like renal failure, hearing loss?

A

aminoglycosides

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15
Q

which drug class can cause new symptoms like: dry mouth, constipation, urinary retention, delirium

A

anticholinergics

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16
Q

quinidine can cause what new symptom?

A

diarrhea

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17
Q

disopyramide can cause what new symptom?

A

urinary retention

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18
Q

antipsychotics can cause what new symptoms in old people?

A

delirium
sedation
hypotension
extrapyramidal disorders

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19
Q

which drug class can cause these new symptoms: excessive sedation, delirium, gait disturbances?

A

sedative-hypnotics

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20
Q

what is the consequence of using antacids with digoxin, isoniazid, or antipsychotics?

A

interference with drug absorption

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21
Q

what is the consequence of using warfarin with oral hypoglycemics, aspirin, chloral hydrate?

A

protein binding displacement

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22
Q

what is the effect of using cimetidine with propanolol, theophylline, phenytoin?

A

altered metabolism

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23
Q

what is the effect of using lithium with diuretics?

A

altered excretion

24
Q

what is the effect of drinking grapefruit juice with dextromethorphan, midazolam, imatinib?

A

increased bioavailability

25
Q

what is the adverse effect of using psychotropics in dementia pts?

A

confusion, delirium

26
Q

what is the adverse effect of using antimuscarinics in glaucoma?

A

acute glaucoma

27
Q

what is the adverse effect of using beta-blockers, verapamil with CHF?

A

acute decompensation

28
Q

what is the effect of using NSAIDs with HTN?

A

increased BP

29
Q

What is the adverse effect of using beta-blockers with peripheral vascular disease?

A

intermittent claudication

30
Q

what is the adverse effect of using beta-blockers with COPD?

A

bronchoconstriction

31
Q

what is the adverse effect of using NSAIDs, contrast agents, aminoglycosides in pts with chronic renal impairment?

A

acute renal failure

32
Q

what is the adverse effect of using diuretics, prednisode with DM?

A

hyperglycemia

33
Q

what is the adverse effect of using beta-blockers, central anti-hypertensives, alcohol, BNZs, steroids with depression?

A

precipitation or exacerbation of depression

34
Q

what is the adverse effect of using digoxin in hypokalemia?

A

cardiac arrhythmias

35
Q

what is the effect of using NSAIDs, anticoagulants in PUD?

A

gastrointestinal hemorrhage

36
Q

what are 6 major classes of drugs that have strong anticholinergic activity?

A 
antihistamines
antiparkinson agents
skeletal muscle relaxants
antimuscarinics-urinary incont.
antidepressants
antipsychotics
37
Q

what is the AE of using RCAs in dysrhythmias?

A

QT prolongation

38
Q

what happens if you use beta-blockers or long-acting BNZs in COPD pts?

A

resp. depression

39
Q

what happens if you use disopyramide, drugs with high Na+ content (bisphosphate, citrate, salicylate) with pts who have heart failure?

A

fluid retention, increased heart failure

40
Q

what happens if you use CCBs, anticholinergics in pts with chronic constipation?

A

increased constipation, impaction, obstruction

41
Q

what happens if you use SSRIs in pts with hyponatremia?

A

more hyponatremia

42
Q

what happens if you use diuretics, alpha-blockers, vasodilators in pts with orthostatic hypotension?

A

near syncope/syncopye, falling–> pot’l for injury

43
Q

all ________ drugs have a high severity rating on the beers criteria?

A

psychoactive drugs

-pot’l for addiction abuse, over sedation, resp. depression, confusion

44
Q

which benzos should be used in old people?

A

short and intermediate BNZ such as alprazolam, temazepam and lorazepam

45
Q

what things do you need to watch out for in using BNZs in old people?

A

-prolonged half life
-increased vulnerability to CNS effects & resp. depression
-linked to falls & long-term use can lead to tolerance
use reduced dosing

46
Q

in the elderly, you should avoid antidepressants with strong anticholinergic and sedative properties like _______________

A

amitriptyline

47
Q

which class of antidepressant is typically safer for use in elderly?

A

SSRIs (citalopram & escitalopram)

-decreased cardiotoxicity, orthostatic hypotension, and anticholinergic effects

48
Q

which TCA with a low anticholinergic profile and other atypical antidepressant can be used?

A

nortriptyline

trazodone

49
Q

if you use sedative hypnotics in elderly, how should they be prescribed?

A

use short term
highly addictive and have long half life
big risk of confusion and sedation
greatly increased risk of falls

50
Q

why is disopyramide contraindicated in old people?

A

anticholinergic properties

contra- with common elderly ailments like: glaucoma, urinary reten’n, BPH

51
Q

what are some of the adverse effects of disopyramide that may be mistaken for aging?

A 
sedation
confusion
blurred vision
agitation
nervousness
52
Q

what are the top 3 drugs that often cause emergency dept. visits?

A

warfarin
digoxin
insulin

53
Q

what is the major pot’l harm for insulin and sulfonylureas?

A

hypoglycemia

-aggressive glycemic control may be harmful

54
Q

what is the pot’l harm with warfarin?

A

GI & intracranial bleeding

55
Q

what is the pot’s harm with digoxin (P-gp interactions)?

A

impaired cognition, heart block

-suboptimal choice for rate control in atrial fibrillation

56
Q

prescribing for the elderly should focus on what?

A

remaining life expectancy
time until treatment benefit
goal of care
treatment targets

57
Q

MASTER is mnemonic for what?

A

models for safe & effective prescribing
M-min. # of drugs used
A-altern. should be considered, esp. non-drug
S-start low, go slow
T-titrate therapy; adjust on individ. basis
E-educate pt & family
R-review regularly, old people need close monitoring

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