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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
what is the adverse effect of using psychotropics in dementia pts?
confusion, delirium
26
what is the adverse effect of using antimuscarinics in glaucoma?
acute glaucoma
27
what is the adverse effect of using beta-blockers, verapamil with CHF?
acute decompensation
28
what is the effect of using NSAIDs with HTN?
increased BP
29
What is the adverse effect of using beta-blockers with peripheral vascular disease?
intermittent claudication
30
what is the adverse effect of using beta-blockers with COPD?
bronchoconstriction
31
what is the adverse effect of using NSAIDs, contrast agents, aminoglycosides in pts with chronic renal impairment?
acute renal failure
32
what is the adverse effect of using diuretics, prednisode with DM?
hyperglycemia
33
what is the adverse effect of using beta-blockers, central anti-hypertensives, alcohol, BNZs, steroids with depression?
precipitation or exacerbation of depression
34
what is the adverse effect of using digoxin in hypokalemia?
cardiac arrhythmias
35
what is the effect of using NSAIDs, anticoagulants in PUD?
gastrointestinal hemorrhage
36
what are 6 major classes of drugs that have strong anticholinergic activity?
``` antihistamines antiparkinson agents skeletal muscle relaxants antimuscarinics-urinary incont. antidepressants antipsychotics ```
37
what is the AE of using RCAs in dysrhythmias?
QT prolongation
38
what happens if you use beta-blockers or long-acting BNZs in COPD pts?
resp. depression
39
what happens if you use disopyramide, drugs with high Na+ content (bisphosphate, citrate, salicylate) with pts who have heart failure?
fluid retention, increased heart failure
40
what happens if you use CCBs, anticholinergics in pts with chronic constipation?
increased constipation, impaction, obstruction
41
what happens if you use SSRIs in pts with hyponatremia?
more hyponatremia
42
what happens if you use diuretics, alpha-blockers, vasodilators in pts with orthostatic hypotension?
near syncope/syncopye, falling--> pot'l for injury
43
all ________ drugs have a high severity rating on the beers criteria?
psychoactive drugs | -pot'l for addiction abuse, over sedation, resp. depression, confusion
44
which benzos should be used in old people?
short and intermediate BNZ such as alprazolam, temazepam and lorazepam
45
what things do you need to watch out for in using BNZs in old people?
-prolonged half life -increased vulnerability to CNS effects & resp. depression -linked to falls & long-term use can lead to tolerance use reduced dosing
46
in the elderly, you should avoid antidepressants with strong anticholinergic and sedative properties like _______________
amitriptyline
47
which class of antidepressant is typically safer for use in elderly?
SSRIs (citalopram & escitalopram) | -decreased cardiotoxicity, orthostatic hypotension, and anticholinergic effects
48
which TCA with a low anticholinergic profile and other atypical antidepressant can be used?
nortriptyline | trazodone
49
if you use sedative hypnotics in elderly, how should they be prescribed?
use short term highly addictive and have long half life big risk of confusion and sedation greatly increased risk of falls
50
why is disopyramide contraindicated in old people?
anticholinergic properties | contra- with common elderly ailments like: glaucoma, urinary reten'n, BPH
51
what are some of the adverse effects of disopyramide that may be mistaken for aging?
``` sedation confusion blurred vision agitation nervousness ```
52
what are the top 3 drugs that often cause emergency dept. visits?
warfarin digoxin insulin
53
what is the major pot'l harm for insulin and sulfonylureas?
hypoglycemia | -aggressive glycemic control may be harmful
54
what is the pot'l harm with warfarin?
GI & intracranial bleeding
55
what is the pot's harm with digoxin (P-gp interactions)?
impaired cognition, heart block | -suboptimal choice for rate control in atrial fibrillation
56
prescribing for the elderly should focus on what?
remaining life expectancy time until treatment benefit goal of care treatment targets
57
MASTER is mnemonic for what?
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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