Geriatric Pharmacy Flashcards
Week 6
What is polypharmacy?
Use of 5+ medications or unnecessary meds.
Who is most affected by ADEs?
Many ADE-related hospitalizations occur in individuals over 80 years old
What are the top four medications implicated in ADE-related hospitalizations in older adults?
Warfarin (33%)
Aspirin, Plavix (13%)
Insulin (14%)
Oral hypoglycemics (11%)
What is an Adverse Drug Event (ADE)?
Harm resulting from the use of a drug.
Examples: Bone-breaking fall, disorientation, inability to urinate, GI bleed.
Note: ADEs also include medication errors.
What is an Adverse Drug Reaction (ADR)?
Unintended or unexpected harm caused by a drug at normal therapeutic doses.
Examples: Sedation or apnea following opioid use, hives after penicillin (PCN).
Note: ADRs are a subset of ADEs and occur even when the drug is prescribed and administered correctly.
What is the key difference between an ADE and an ADR?
ADE: Broad category, includes harm from medication errors or misuse.
ADR: Specific, unintended reaction occurring at normal doses, even with correct administration.
What is a geriatric syndrome?
Common conditions in older adults, especially frail individuals
Multifactorial – Caused by aging, chronic disease, & functional decline
How does aging affect absorption of medications?
- slowed
- increased pH
- decreased GI blood flow
- slowed GI transit
How does aging affect distribution of medications?
- decreased body water, muscle, and albumin
- increased body fat
How does aging affect metabolism of drugs?
- decreased CYP enzymes
How does aging affect elimination of drugs?
- decreased renal function
What cardiovascular effects can aging have on drug response?
Increased risk of orthostatic hypotension, sensitivity to beta-blockers, and prolonged QTc interval.
Why are older adults more prone to orthostatic hypotension?
Reduced baroreceptor sensitivity and impaired autonomic regulation.
How does aging affect beta-blocker response?
Older adults are more sensitive to beta-blockers, leading to an increased risk of bradycardia and hypotension
What is the risk of prolonged QTc interval in older adults?
Increased risk of arrhythmias
Why are anticholinergic drugs problematic for older adults?
They increase the risk of delirium, falls, and cognitive decline.
What are common atypical symptoms in elderly patients?
Confusion
Depression
Incontinence
Falling
Syncope
What is the leading cause of fatal and nonfatal injuries among older adults?
Falls
What are some high-risk medications found in the Beers Criteria?
Benzos
Anticholinergics
NSAIDs
Sulfonylureas
Muscle relaxants
What is the Beers Criteria?
A guideline that identifies potentially inappropriate medications for older adults
Why should older adults avoid or use caution with OTC cough and cold medications?
Many contain antihistamines like diphenhydramine or chlorpheniramine, which can cause
sedation, confusion, blurred vision, urinary retention/constipation, dry mouth/eyes
Why should older adults avoid medications with strong anticholinergic properties?
They can cause confusion, drowsiness, dry mouth, constipation, urinary retention, blurred vision, and increased fall risk.
What are some common medications with anticholinergic properties that should be avoided in older adults?
Diphenhydramine (Benadryl), amitriptyline, oxybutynin, typical antipsychotics, muscle relaxants
Why should PPIs be avoided for long-term use in older adults?
Long-term use (beyond 8 weeks) increases the risk of C. difficile infection, pneumonia, and fractures due to osteoporosis
What are some examples of PPIs to avoid?
Lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (AcipHex), esomeprazole (Nexium).
Why should benzodiazepines (BZDs) be avoided in older adults?
Increased sensitivity to BZDs + decreased metabolism → higher risk of cognitive impairment, delirium, falls, fractures, car accidents.
If Benzos are needed, which ones are safe to use?
“LOT” Benzos
Lorazepam, Oxazepam, Temazepam
Why were SSRIs added to the Beers Criteria?
Avoid in patients with a history of falls or fractures due to increased fracture risk
What is the prescribing cascade?
When a new medication is prescribed to treat the side effect of another medication, leading to potential polypharmacy and increased risk of adverse effects
