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GDA > Geriatric & Polypharmacy > Flashcards

Geriatric & Polypharmacy Flashcards

1
Q

What does Part A of Medicard Cover?

A

Hospital, hospice, and short term nursing home afer hospitalization

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2
Q

How long will Medicare Part A pay for nuring home care after hospitalization?

A

90 Days

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3
Q

What does Medicare Part B cover?

A

Physician services, outpatient, durable medical and preventive

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4
Q

What does Medicare Part C cover?

A

MEdicare advantage( HMOs, PPOs, PFFs)

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5
Q

What does Medicare Part D cover?

A

PRescription drugs

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6
Q

What is MEDIGAP?

A

A supplementary plan to cover gaps between parts A and B

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7
Q

Who is ineligible for Medicare?

A

Persons who were never in the workforce or a non-working spouse of person who does work

***You can buy into it later on

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8
Q

Who does Medicaid cover?

A
  1. Poor- “Aiding your broke ass!”
  2. Disabled
  3. Covers extended nursing home stays
  4. Waiver for home health care
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9
Q

How man prescriptons does Tenncare, the medicaid on TN cover before out-of-pocket payment?

A

5

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10
Q

Drug coverage under Medicaid is a state benefit.

True/ False

A

True

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11
Q

Outside of Medicaid and Medicare, how do people pay for care?

A

VA(includes long term care)

Long term care insurance

Family Savings

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12
Q

Where do people receive care?

A

Patient’s home
Physician’s office or outpatient clinic
Hospital
Assisted living facilities
Nursing Homes
Hospice

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13
Q

Are assisted living facilities coverd by medicare/medicaid?

A

No

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14
Q

What are some scenerios that are a part of normal aging?

A

1/4-misuse problem(football leads to knee injury)

1/4 due disease

1/4-disuse(sedentary lifestyle)

1/4 due to

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15
Q

Normal Aging changes

General: ↑ Body fat; ↓ TBW (NOT OBESITY)
Eyes/Ears: ** Presbyopia, lens opacification, ↓ high frequency acuity. (NOT BLINDNESS)

Respiratory: ↓ cough reflex; ↓ lung elasticity; ↓ DLco; ↑ chest wall stiffness (NOT PNEUMONIA, DYSPNEA, HYPOXIA)

Cardiovascular: ↓ Arterial compliance; ↓ B-adrenergic responsiveness; ↓ baroreceptor sensitivity and SA node automaticity; ↑ BP (NOT SYNCOPE, HEART FAILURE OR HEART BLOCK)

A

GI: ↓ Hepatic function; ↓ acidity; ↓ colonic motility; ↓anorectal function (NOT CIRRHOSIS, FECAL IMPACTION OR INCONTINENCE)

Blood/Immune: ↓ Bone marrow reserve; ↓ T-cell function; ↑ autoantibodies (NOT ANEMIA, AUTOIMMUNE DISEASE)

Urogenital: Vaginal/urethral mucosal atrophy; prostate enlargement (NOT UTI, URINARY INCONTINENCE OR RETENTION)

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16
Q

Normal Aging Changes

Musculoskeletal: ↓ muscle; ↓bone density (NOT HIP FRACTURE)

  • *Nervous system:** Brain atrophy; ↓Brain catechol & DA synthesis; ↓ righting reflexes; ↓Stage 4 sleep; ↓thermoregulation (NOT DEMENTIA, DELIRIUM, DEPRESSION, PARKINSONS, FALLS, SLEEP APNEA, HYPO- HYPERTHERMIA)
  • *Endocrine:** See Dr. Clark’s lecture
A
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17
Q

What is considered a non-presentation in Hx taking?

A

When the patient is sick but the pathology(signs/symptoms) may not be present.

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18
Q

What is considered a nonspecific presentation?

A

When a patient comes in with vague symtoms.

i.e confusion, apathy, self-neglect, anorexia, falling, incontinence, fatigue, dyspnea)

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19
Q

What are some examples of an altered presentation?

A
  • Depression without sadness
  • Infection without fever, leukocytosis, tachycardia
  • MI without chest pain
  • Pulmonary edema without dyspnea
  • Silent surgical abdomen
  • Silent malignancy
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20
Q

Define Frailty.

A

“Feeble Fallers are Frail”

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21
Q

What are ADLs?

A

Activities of daily living; Things that you have to do everyday to maintain yourself

i.e Toilet, feeding, dressing, grooming, ambulation, bathing

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22
Q

How many daily functions must be lost before consideration into the nursing home?

A

2 of the following

i.e toilet, feeding, dressing, grooming, ambulatory, bathing

23
Q

What are IADLs?

A

Instrumental activities of daily living

i.e
Paying bills; keeping records, shopping alone, playing games/hobbies; cooking & meal preparation; TV, books, radio & current events; traveling out of neighborhood.

24
Q

What are some examples of Geriatric syndromes?

A
  • Dementia, Delirium
  • Urinary incontinence
  • Falls & Gait Abnormalities
  • Behavioral changes
  • Weight loss
  • Dizziness
  • Poor nutrition or feeding impairment
  • Sleep disorders
25
Q

Approximately what percentage of the population are older adults consumers of prescription drugs?

A

25-30%

26
Q

Approximately what percentage of the population are older adults consumers of OTC drugs?

A

40%

27
Q

About how many prescription drugs are used by ambulatory adults?

A

2-4

28
Q

How many prescription drugs do long-term residents use on a daily basis?

A

2-10

29
Q

About how many people over >60 are hospitalized from the use of prescription drugs?

A

1/3

30
Q

How many people over the age of 60 die due to prescription drugs?

A

1/2

31
Q

Misuse is the 5th leading cause of death.

True/False

A

True

32
Q

What percentage of people over 60 yrs do not take meds as directed?

A

~40%

33
Q

What are some things that should be considered when prescribing meds to people over 60?

A

•Polypharmacy (& associated risks)

  • Age and disease-related changes in pharmacokinetics and pharmacodynamics
  • Adverse drug reactions

•Compliance issues

34
Q

What is polypharmacy?

A

Use of more than 1 chemcial agent to effect a therapeutic endpoint(TD)

35
Q

Why is there a greater prevalence of polypharmacy in older adults?

A
  • Inc. symptoms resulting from Inc. prevalence of disease
  • Drugs prescribed to treat side effects of other drugs
  • Prescribers
  • Drug advertising (…pills to cure all…stay young..)
36
Q

Polypharmacy predisposes the patient to taking medication incorrectly.

True/ False

A

True: Pt may take wrong dose, wrong time, wrong purpose.

***IT is imperative to explain to your patient the purpose of the drug before they leave the office!!

37
Q

What increases the probablity of taking medications incorrectly?

A

•Overlapping (“additive”) or antagonistic pharmacologic effects

•Adverse drug reactions:
—-drug-disease, drug-drug

•Patient non-compliance

38
Q

Define an adverse drug reaction.

A

An undesired SE or toxicity casued by the administration of drugs

***Onset may be sudden or take days

In older patients: this may present as confusion!

39
Q

Adverse drug reactions may be undetected in older adults b/c they can mimic the characterisitics of problems, diseases, or symptoms.

True/False

A

True

40
Q

Name some common adverse drug reactions in the Elderly.

A
  • Cognitive status- **Confusion is the most common
  • Accidents and Falls(especially with anticholinergic effects)
  • Renal toxicity
  • Hepatic toxicity
41
Q

What is the Beers Criteria?

A

A guidline for healthcare professionals to help improve the safety of prescribing medications for older adults.

It emphasizes deprescribing meds that are unnecessary to reduce problems of high risk-benefit ration, polypharmacy, drug interactions, and adverse drug reactions

42
Q

Which are of pharmacokinetics is the least affected by normal aging?

Absorption

Distribution

Metabolism

Excretion

A

Absorption

43
Q

What are some age-realted chagnes to the GI tract that may affect absorption?

A
  • Decrease in # of absorptive cells
  • Decrease gastric acidity( inc. gastric pH)
  • Decrease GI blood flow and motility
44
Q

What are some age-realted chagnes to the GI tract that may affect distribution?

A
  • Inc in fat %

–fat soluble drugs will be asborbed faster and maintain longer

–in water soluble drugs they will not be absorbed quickly

  • Dec in TBW
  • Dec[plama protein]-may be more sensitive to drugs; need to drop dose
  • Dec lean muscle mass
  • Dec blood flow to organs
45
Q

What are some age-realted chagnes to the GI tract that may affect metabolism?

A
  • Dec. in liver mass & blood flow + concomitant diseases, nutritional status, genetics = potential for dec. in hepatic function
46
Q

What are the results of a decreased metabolism?

A
  • Inc concentrations of
    1. benzos
    2. tricyclic antidepressants
    3. B-blockers
    4. narcotic analgesics
  • Inc for potential for adverse events
  • Lower doses may be therapeutic
47
Q

Liver function tests do not entirely represent the extent of changes in the drug metabolism?

true/false

A

True

48
Q

What are some age-realted chagnes to the GI tract that may affect elimination?

A
  • Dec renal funtion( dec GFR)
  • Drug interactions
  • Presence of multiple diseases
49
Q

Recall that serum creatinine is NOT a reliable measurement of renal function

A

Use clearance

140 - age in yrs x weight in kg

72 x serum creatinine (% mg/100mL)

for women, multiply result by 0.85

50
Q

WATCH for Drugs requiring low dosing due to decreased renal function!!

A

Ex.

  • Allopurinol
  • Digoxin
  • Many cephalosporins
  • Ciprofloxacin
  • Histamine receptor antagonists (e.g., cimetidine, ranitidine, famotidine)
  • Venlafaxine
  • Morphine
51
Q

Morphine: Prolonged pain relief at lower doses

Benzodiazepines: Inc. sedation & postural instability (extended effect r/t long ½ life)

Warfarin: Inc sensitivity to anticoagulant effect

A
52
Q

What are some drugs where the toxicity for drugs with age-related decrease effects?

A

Beta-blockers and tolbutamide

53
Q

What are some potential barriers of non-adherence?

A

Physiological factors

Behavioral/attitudes

Tx-related factors

Prescriber/pt interactions

54
Q

What are some assessments of adherence?

A
  • Observation of home environment
  • Ask client to gather all medications (Brown Bag Review)
  • –Open ended questions regarding each medication (time consuming)
    • -what drugs are they taking? how are they taking?
  • Direct questions:

•“do you ever forget to take your medicines?” “how many times in the last week have you missed a dose?”
•“when you feel better do you stop taking your medicines”
•“sometimes if you feel worse do you stop taking your medicines?”
•

  • Pharmacy refill patterns

GDA (5 decks)

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