Geriatric Psychiatry (Exam 2 Cut Off)

Question 1

Core Principles

Answer 1

1. Psychiatric conditions may present differently in the elderly
2. May be drug induced or secondary to another medical condition
3. Consider PK/PD, and comorbidities when developing a therapeutic plan

Question 2

Depression

Answer 2

• Somatic complaints are more frequent in elderly depressed patients
• Diminished cognitive function, sleep disruptions, poor social interactions, inattention
• Depressed mood is signature symptoms and less prominent than the other symptoms

Question 3

Antidepressants

Answer 3

• Problems with over and under treatment
• SSRIs are usually drug of choices since TCAs are associated with AE
• Hyponatremia is a risk
• Citalopram: Don’t exceed 20 mg/day (Beers)

Question 4

Depression Exacerbators

Answer 4

• Long term Benzo use
• Methyldopa (Aldomet)
• Methyldopa-HCTZ (Aldoril)

Question 5

GAD

Answer 5

• Generalized Anxiety Disorder
• Drug accumulation decreases capacity for oxidation and alters Vd can occur from common medications
• Drugs of choice: SSRI (consider comorbidities)
• Avoid duloxetine in the hepatic insufficient

Question 6

Panic Disorders

Answer 6

• Fewer and less intense symptoms (avoidant behavior)

- Drug of choice: SSRI

Question 7

Insomnia

Answer 7

• Most common general complaint
• Chronic insomnia occurs in about 20% of elderly
• Decongestants, theophylline, methylphenidate, amphetamines, and MAOIs can exacerbate

Question 8

Alternative Insomnia Treatments

Answer 8

• Melatonin: 3-6 mg QHS
• Trazodone: 25 mg QHS
• Mirtazapine: 7.5 mg QHS (insomnia, depression, and appetite use)

Question 9

NSAIDs

Answer 9

• Non-COX selective have concerns for GI bleeding, renal failure, HTN, and heart failure
• Alt: APAP, topicals, capsaicin
• Can consider opiates in moderate to severe pain
• Start low and increase slowly with these medications

Question 10

Drug Abuse/Misuse

Answer 10

• Extremely vulnerable population
• Accidental or unintended misuse is common from difficulty reading labels, hard of hearing for directions, or using old/unused medications

Question 11

Medication Adherence

Answer 11

• Failure to take medications
• D/C too early
• Excessive consumption of medication
• Use of not prescribed medication

Question 12

Strategies to Improve Adherence

Answer 12

• Limit number of different medications and their frequencies
• Simplify instructions
• Tailor regimens to patient schedules
• Use compliance aides and phone reminders
• Give information on financial assistance programs
• Use help of friends and family members