Geriatric Pharmacotherapy Flashcards
What percentage of the senior population has one or more chronic conditions?
80%
What percentage of individuals are limited in their ability to preform ADLs?
25%
T/F: older adults are more likely to have chronic conditions
True
What percentage of the elderly use atleast one medication?
80%
T/F: many of the elderly take in appropriate medications
?
For patients 75 years and older, what percentage of hospitalizations are due to adverse drug reactions?
1/3
What are most of the hospitalizations due to? (in regards to adverse drug reactions in the elderly)
adverse drug reactions (75%)
25% due to nonadherence, omission of treatment, or cessation of treatment
What percentage of adverse drug events are preventable?
30%, 50% of hospitalizations
What are the health-related quality of life?
patients perception of how health impacts their physical, social, and psychologic functioning and well-being
What is the definition of pharmacokinetics?
what the body does to the drug
What is the association between and and PK parameters?
Due to age-related changes PK parameters can change dramatically for some drugs
What are the parameters of pharmacokinetics?
Absorption, Distribution, Metabolism, and Elimination (ADME)
What is the greatest change with age that affects PK?
reduced renal function
How does absorption change with age?
Unchanged passive diffusion (most drugs) decreased active transport decreased bioavailability (some drugs) decreased first-pass metabolism increased bioavailability (some drugs)
How does distribution change with age?
Water-soluble: devreased Vd and increased plasma concentration
Lipid-soluble: increased Vd and increased t ½
How does metabolism change with age?
decreased hepatic metabolism and increased t ½ (some drugs)
How does elimination change with age?
decreased clearance and increased t ½ of renally eliminated drugs and/or active metabolites (many drugs)
How do we assess renal function?
cockcroft-gault equation
MDRD equation
What is the definition of pharmacodynamics?
What the drug does in the body
T/F: elderly may be more sensitive to the effects of medications
True
What side effects are the elderly more likely to experience from medications?
therapeutic and adverse side effects
What is a typical rule when prescribing medication to the elderly?
START LOW, GO SLOW
What is polypharmacy?
Use of multiple drugs or the administration of more medications than are indicated clinically
What are down falls of polypharmacy?
May lead to drug-drug and/or drug-disease interactions
Increase risk for side effects
Multiple providers
OTCs
Avoid treating side effects with another drug
Dietary supplements increase polypharmacy
T/F: vitamins, minerals, and herbal products are often not included on medication records?
True
What is the definition of underuse?
Omission of drug therapy that is indicated for the treatment or prevention of a disease and/or condition
What else can underuse be categorized as?
gap(s) in therapy
What does underuse depend on?
Highly dependent on comorbid disease states and PMH
What should be consider as a possible source of underuse?
non-adherence
How do we define inappropriate use in geriatric pharmacology?
Prescribing medications outside the bounds of acceptable medical standards
What can inappropriate drug use lead to?
Can lead to drug-drug or drug-disease interactions
What can help guide us on the selection of appropriate agents?
Renal function as well as Beers List and STOPP/START
Also look at OTC, herbal and other meds the pt is taking
What are the possible drug-drug interactions?
Can increase/decrease therapeutic effects or side effects (additive or synergistic)
What are the possible out comes of a Drug-disease interaction?
Side effect/therapeutic effect of one drug may worsen another disease
Most interactions are due to the therapeutic effects as opposed to rare side effects
What can help with compliance?
Combination tablets and long-acting formulations may overcome some compliance issues
Regular (re-)assessment essential
What does the Beers list help with?
Potentially inappropriate medications (PIMs) for older adults (> 65 years old)
Based on side effects and the risk/benefit profile compared to available alternatives
Lists medications to avoid as well as medications which can exacerbate specific disease states
What are the categories of the Beers list?
Three categories of recommendations
Medications to avoid regardless of indication
Medications to be avoided if certain disease(s) are present
Medications to be used cautiously in older adults
What is emphasized with the Beers list with medications in the elderly?
Emphasis on drugs with anticholinergic burden
Can cause sedation, confusion, mental clouding, delirium, memory problems, difficulty concentrating, urinary retention, constipation, dry-mouth, tachycardia, falls
What are medications to avoid?
1st gen antihistamines antispasmodics digoxin alpha blockers central alpha blockers
Compare the advantages of BEERS vs START/STOPP.
Both offer advantages
- Medications to avoid (both)
- START/STOPP also recommend alternatives
- Both relatively evidenced-based
- STOPP may better identify avoidable problems
- Beers List only requires medication review; -START/STOPP also require lab values
What should we keep in mind when using Beers or START/STOPP?
Use as a guide rather than the rule, no two patients are the same
Compare the disadvantages of BEERS vs START/STOPP.
Both have disadvantages
N-either has proven to improve overall outcomes (mortality)
-Neither discuss appropriate medications used inappropriately
How do geriatric patients respond to anticoag meds?
More sensitive; increasing age is risk factor for bleeding
Risk increases when combined with other agents that increase risk for bleeding (NSAIDs, antiplatelets, etc.)
How do geriatric patients respond to pain management?
Sensitive to constipating and sedating effects of opioids;
What is an adverse side effect of NSAIDs with the elderly?
worsen renal function, CHF, HTN, increase risk of bleeding and increase risk of CV events
T/F: Geriatric patients are less sensitive to BP lowering effects of HTN.
False more sensitive
What medications may exacerbate incontinence or lead to dehydration?
diuretics
Key factors to remember with pharmacotherapy with the elderly:
Common characteristics due to physiological changes
More sensitive to side effects and therapeutic actions
Reduced renal function, potentially reduced clearance
Agents with active metabolites may exert more effects or more toxic effects
What goes into the patient assessment for pharmacotherapy in geriatric patients?
-Assess age/renal status and determine treatment goals
-Obtain thorough history to include current disease states and medications, including OTCs
-Assess for interactions
-Allergies
-Assess for appropriatness of agents
-Assess for compliance
USE CLINICAL JUDGEMENT
