Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Geriatric > Geriatric Pharmacotherapy > Flashcards

Geriatric Pharmacotherapy Flashcards

1. Present the general implications and several specific examples of the physiologic changes of aging and pharmacotherapeutics. 2. Detail Beer’s criteria and the major classes of medications that should be cautiously used or avoided when treating elderly patients. 3. Define polypharmacy and its relevance to the geriatric patient.

1
Q

Pharmacokinetic Changes in the Elderly in regards to Absorption

A
  • Unchanged Passive Diffusion (most drugs)
  • Decreased Active Transport
  • Decreased Bioavailability (some drugs)
  • Decreased First-Pass Metabolism
  • Increased Bioavailabilty (some drugs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pharmacokinetic Changes in the Elderly in regards to Distribution

A

Water-soluble:

  • Decreased Volume of Distribution(Vd)
  • Increased Plasma Concentration

Lipid-soluble:

  • Increased Vd
  • Increased half-life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pharmacokinetic Changes in the Elderly in regards to Metabolism

A
  • Decreased Hepatic Metabolism

- Increased Half Life (Some drugs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pharmacokinetic Changes in the Elderly in regards to Elimination

A
  • Decreased Clearance
  • Increased Half-Life of Renally Eliminated Drugs
  • Increased Half-Life of Active Metabolites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most important thing to check in the elderly patients?

A
  • Assess GFR!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In terms of pharmacodynamics, what should be known about elderly patients?

A

May be more sensitive to the effects of medications (therapeutic and side effects)

  • Such as anticoagulants, antiplatelets, sedatives, antihypertensives, antidiabetics, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In terms of pharmacodynamic properties with the elderly, how should we start medications.

A

Start at a lower dose and then titrate up slowly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

This is the use of multiple drugs or the administration of more medications than are indicated clinically.

A

Polypharmacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Polypharmacy and the Elderly

A
  • Occurs in approx. 50-60% of older outpatients
  • May lead to drug/drug or drug/disease interactions (inc. risk of SE, multiple providers, OTCs)
  • Avoid treating SE with another drug
  • Dietary Supplements increase polypharmacy (and often not noted)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What types of medications are avoided because they are potentially inappropriate medications (PMI)

A
  1. First generation antihistamines
  2. Antispasmodics
  3. Digoxin
  4. Alpha 1 Blockers
  5. Central Alpha Blockers
  6. Tertiary TCA
  7. Antipsychotics
  8. Barbituates
  9. Benzodiazepine
  10. Non-benzzo hypnotics
  11. Insulin - Sliding Scale
  12. NSAIDs
  13. Sulonylureas
  14. Muscle Relaxants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the three categories of recommendations in Beer’s List?

A
  1. Meds to avoid regardless of indication
  2. Meds to avoid if certain disease(s) are present
  3. Meds to be used cautiously in older adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can anticholinergics cause that the elderly should avoid is possible

A
  • Sedation
  • Confusion
  • Mental Clouding
  • Delirium
  • Memory Problems
  • Difficulty Concentrating
  • Dry mouth
  • Tachycardia
  • Falls
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Medications with Dz Interactions:

Heart Failure

A
  • NSAIDs
  • Verapamil/diltiazem
  • Pioglitazone/Rosiglitazone
  • Dronedarone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Medications with Dz Interactions:

Syncope

A
  • Alpha blockers
  • Tertiary TCAs
  • Chlorpromazine
  • Olanzapine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Medications with Dz Interactions:

Delirium

A
  • TCAs
  • Anticholinergics
  • Benzodiazepines
  • H-2 Blockers
  • Sedatives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medications with Dz Interactions:

Dementia and Cognitive Impairment

A
  • Anticholinergics
  • Benzodiazepines
  • H2 blockers
  • Zolpidem
17
Q

Medications with Dz Interactions:

Hx Fall or Fx

A
  • Anticonvulsants
  • Benzodiazepines
  • Sedatives
  • TCAs
  • AntiHTN
  • Hypoglycemic Agents
18
Q

Advantages of Beers

A
  • Lists Meds to Avoid
  • Relatively evidence-based
  • Only needs med review
19
Q

Disadvantages of Beers

A
  • Hasn’t prove to improve overall outcomes (mortality)

- Doesn’t discuss appropriate medications

20
Q

Why do we avoid Anticoagulants?

A
  • More sensitive; increasing age is risk factor for bleeding

- Risk increases when combined with other agents that increase risk for bleeding (NSAIDs, antiplatelets, etc.)

21
Q

Why do we avoid meds in Pain Management?

A
  • Sensitive to constipating and sedating effects of opioids; exacerbated by concomitant anticholinergic medications
  • Many have active metabolites (morphine) which are renally cleared
  • NSAIDs can worsen renal function, CHF, hypertension, increase risk for bleeding, and increase risk for cardiovascular events (almost all agents)
22
Q

Why do we avoid meds in HTN?

A
  • Risk for orthostatic hypotension higher with specific agents and/or classes
  • More sensitive to blood-pressure lowering effects
  • Diuretics may exacerbate incontinence issues or lead to dehydration
23
Q

Why do we avoid meds in Depression/Anxiety?

A
  • Certain agents have high anticholinergic burden

- Certain agents can be strongly sedating

24
Q

Why do we avoid meds in Heart Failure?

A
  • Metoprolol succinate may be better option vs. carvedilol

- Diuretics may cause hypotension and/or electrolyte abnormalities

25
Q

Why do we avoid meds in Osteoporosis with fall risk?

A
  • Proper treatment essential (bisphosphonate, calcium and vitamin D) to reduce future risk
  • Minimize risks for additional falls/fracture by avoiding medications which increase risk for falls
26
Q

Why do we avoid meds in DM?

A
  • Sliding scale insulin and glyburide (Beers List); start at lower insulin doses
  • Hypoglycemia increases risk for syncope, falls
  • Metformin and SCr cutoffs
27
Q

Why do we avoid meds in Allergies?

A
  • Antihistamines: 1st generation vs. 2nd generation

Geriatric (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions