Geriatric Pharmacology Flashcards
Polypharmacy
Use of 5+ medications concurrently
Risks of polypharmacy
Can lead to increased risk for falls, depression, and hospitalization
Causes of polypharmacy
Can be caused by prescriptions from multiple doctors, inappropriate prescribing, self-medicating, and a prescribing cascade (treating only side effects)
How does body composition changes in older adults impact medication effects?
Decreased total body water, lean mass, and bone density and increased body fat leads to medications distributing differently
How does cardiac changes in older adults impact medication use?
Decreased cardiac output and increased total peripheral resistance leads to an increased risk for heart failure and hypertension
Increases the need to monitor blood pressure and heart rate
How does respiratory changes in older adults impact medication use?
Decreased strength of muscles for respiration, decreased maximal breathing capacity, and decreased gas exchange increases the likelihood of respiratory complications
Need to monitor respiration rate and shortness of breath
How do digestive changes impact medication effects?
Increase in gastric pH due to decreased acid production and decrease in rate of gastric emptying leads to medications being absorbed differently
Need to monitor for constipation and heartburn
How do urinary changes in older adults impact medication effects/use?
Decreased renal blood flow and glomerular filtration rate leads to medications being eliminated slower
Need to monitor for urine output and color
How do liver changes in older adults impact medication effects/use?
Decreased size of liver and hepatic blood flow leads to medications being metabolized differently
Need to monitor for jaundice
Changes in absorption of medication in older adults
Increased permeability at blood-brain barrier leads to medications entering the CNS more easily
Need to monitor for excessive sedation, confusion, changes in sleep habits, and changes in mood
How do changes in vision affect medication use?
Cataracts, macular degeneration, glaucoma, and diabetic retinopathy lead to visual deficits which increase likelihood of taking medications incorrectly.
Pharmokinetics
How the body affects medication
Pharmokinetic changes of oral medications
Slower rate of absorption and delayed peak effect of medication
Medications may stay in body due to poor kidney function which increases duration of medication action, and increase toxicity
Pharmokinetic changes of transdermal medication
Less medication is absorbed due to decreased blood flow to skin
Pharmodynamic changes
How medication affects the body
Anticholinergic effects
Dry eyes
Dry mouth
Blurred vision
Fatigue
Disorientation
Constipation
Urinary retention
CNS side effects
Confusion
Sedation
Dizziness
Agitation
Irritability
Hallucination
Gastrointestinal side effects
Constipation
Diarrhea
Mucosal damage such as ulcerations and GI bleeding
Effect of NSAIDs in older adults
May irritate mucosal lining of stomach and may lead to GI bleed
Medication for mild to moderate pain relief
Tylenol/acetaminophen is good for elderly patients at lower doses (max 2 grams/day)
Good for mild-moderate pain releif
Medication for severe pain relief
Narcotics
May cause sedation, dizziness, confusion, hallucination, and fall risk
Respiratory depression is possible in high doses
Side effects of calcium-channel blockers
Increases risk of orthostatic hypotension
Side effects of anti-arrhythmia medication
Increased risk of toxicity in older adults
Side effects of anticoagulant/antiplatlet medications
Increased risk of bleeding and brusing
Hypertension
Persistently elevated arterial blood pressure
Essential or primary hypertension
Unknown or idiopathic cause (90% of cases)
Secondary hypertension
Results from another condition (10% of cases)
Antihypertensives
Any medication that lowers blood pressure
May cause orthostatic hypotension
May precipitate a gout attack due to hyperuricemia
Side effects of sleep medications
Benzodiazapines and non-benzodiazepines may cause daytime sedation and confusion
Very habit forming
Antihistamines may cause daytime sedation, confusion, and constipation
Side effects of skeletal muscle relaxants
May cause sedation, dizziness, and fall risk
Side effects of anti-spasmodics
May cause sedation and dizziness
Alzheimer’s Disease
Most common cause of dementia
Effect of Alzheimer’s Medications
Cholinesterase inhibitors may cause sedation, nausea, vomiting, diarrhea, anorexia, and weight loss
NMDA-receptor antagonists are generally well tolerated
Side effects of urinary incontinence drugs
May cause dry mouth, dry eyes, blurred vision, constipation, fatigue, dizziness, confusion, and hallucination
Are colace and miralax safe?
Yes
Antihistamines to avoid
Avoid use of Benadryl, Unisom, Tylenol PM, Advil PM due to containing diphenhydramine
Use of Asprin
Low does may help thin blood to decrease risk of stroke or heart attack
Side effects may include increased risk of bleeding and ulcers
Call physician if you notice unprovoked bruises, unnatural bleeding, or black tarry stools
Medications that create a minor fall risk
Antidepressants
Anticonvulsants
Antihypertensives
Antihistamines
Antipsychotics
Anti-alzheimer’s agents
Anti-Parkinson’s agents
Narcotic analgesics
Medications that create a major fall risk
Hypnotics
Anxiolytics
Narcotic analgesics
Muscle relaxants
Medication management for OT
Create a pill schedule card that is in large, plain font
- Lamination and bright white paper may make it more difficult to read
Arrange medication by TV schedule
