Geriatrics

Question 1

Donepezil

Answer 1

Acetylcholinesterase inhibitor

metabolized in part by CYP2D6 and CYP3A4.

Labeled for mild to moderate and moderate to severe AD

Question 2

Rivastigmine

Answer 2

Acetyl- and butyryl-cholinesterase inhibitor

Nausea, vomiting, and diarrhea seem more intense than with other CIs.

Labeled for mild to moderate and moderate to severe AD & mild to moderate dementia with Parkinson disease

Question 3

Galantamine

Answer 3

Selective competitive, reversible acetylcholinesterase inhibitor and nicotine receptor modulator

Metabolized in part by CYP2D6 and CYP3A4

Labeled for mild to moderate AD dementia

Preferable to take with food

Renal dosing

Question 4

Memantine

Answer 4

N-methyl-d-aspartate receptor antagonist that blocks glutamate transmission

Labeled for moderate to severe AD

may be used in combination with CIs

Question 5

Donepezil/memantine

Answer 5

Use after stabilized on donepezil and memantine separately

Renal dosing

Question 6

Urge or overactive bladder treatment

Answer 6

Auntimuscarinic agents

Beta-3 Agonist

Onabotulinumtoxin A

Question 7

Oxybutynin

Answer 7

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

Question 8

Tolterodine

Answer 8

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

Question 9

Fesoterodine

Answer 9

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

Question 10

Trospium

Answer 10

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

Question 11

Solifenacin

Answer 11

Selective Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Does not worsen cognition in Demetia

Long acting formulations preferred due to modest decreased side effect profile

Question 12

Darifenacin

Answer 12

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

Question 13

Mirabegron

Answer 13

Minimal anticholinergic effects

Cost is commonly a barrier for patients

Can be used in combination with antimuscarinic agents if monotherapy fails

Avoid in hypertension

Question 14

OnabotulinumtoxinA

Answer 14

Prevents stimulation of detrusor muscle

Must be able to perform self-catheterization

Question 15

Stress Incontinence Treatment

Answer 15

alpha-adrenergic agonist limited evidence

Topical estrogens

SNRI (duloxetine) **may reduce severity but AE limits its usefulness

Question 16

Topical estrogens for stress incontinence

Answer 16

Use if other symptoms of estrogen deficiency

Vaginal estrogens may improve severity of stress incontinence

Question 17

Overflow Incontinence Treatment

Answer 17

alpha-adrenergic antagonist

5-alpha-reductase inhibitors

Cholinomimetics

Phosphodiesterase type 5 inhibitors

Question 18

Alfuzoisn

Answer 18

alpha-adrenergic antagonist

selective antagonists of postsynaptic α1-adrenergic receptors

Can cause hypotension

metabolized through the CYP3A4 pathway and have drug interactions with strong CYP3A4 inhibitors and inducers

Intraoperative floppy iris syndrome

Question 19

Tamsulosin

Answer 19

alpha-adrenergic antagonist

uroselective antagonists of α1 -adrenergic receptors

less likely to cause hypotension

Question 20

Silodsoin

Answer 20

alpha-adrenergic antagonist

uroselective antagonists of α1 -adrenergic receptors

less likely to cause hypotension

metabolized through the CYP3A4 pathway and have drug interactions with strong CYP3A4 inhibitors and inducers

Intraoperative floppy iris syndrome

Question 21

Doxazosin

Answer 21

alpha-adrenergic antagonist

Nonspecific α-adrenergic blockers so it lowers blood pressure significantly

metabolized through the CYP3A4 pathway and have drug interactions with strong CYP3A4 inhibitors and inducers

Intraoperative floppy iris syndrome

Question 22

Terazosin

Answer 22

alpha-adrenergic antagonist

Nonspecific α-adrenergic blockers so it lowers blood pressure significantly

metabolized through the CYP3A4 pathway and have drug interactions with strong CYP3A4 inhibitors and inducers

Intraoperative floppy iris syndrome

Question 23

Prazosin

Answer 23

alpha-adrenergic antagonist

metabolized through the CYP3A4 pathway and have drug interactions with strong CYP3A4 inhibitors and inducers

Intraoperative floppy iris syndrome

Question 24

Finasteride

Answer 24

5-α-reductase inhibitors

prevent the conversion of testosterone to dihydrotestosterone, modify the disease course, and may reduce the risk of urinary retention and surgical interventions

competitively inhibits type II 5-α-reductase and lowers prostatic dihydrotestosterone by 80%–90%.

no difference than dutasteride

Question 25

Dutasteride

Answer 25

5-α-reductase inhibitors prevent the conversion of testosterone to dihydrotestosterone, modify the disease course, and may reduce the risk of urinary retention and surgical interventions nonselective inhibitor of both type I and II 5-α-reductase Prostatic dihydrotestosterone production is quickly suppressed with this age no difference than finasteride

Question 26

Bathanechol

Answer 26

Cholinometics

Question 27

Tadalifil

Answer 27

Phosphodiesterase type 5 inhibitors Mechanism is thought to be caused by phosphodiesterase-induced smooth muscle relaxation in the bladder, urethra, and prostate. Studied as monotherapy; the FDA does not recommend use in combination with α-blockers because the combination has not been adequately studied for BPH, and there is a risk of lowering the blood pressure

Question 28

Allopurinol (Zyloprim)

Answer 28

XOI for gout Low starting dose reduces early gout flares risk of hypersensitivity syndrome Consider keeping dose lower in CKD and not increasing to maximum dose of 300mg

Question 29

Febuxostat (Uloric)

Answer 29

XOI for gout Low starting dose reduces early gout flares risk of hypersensitivity syndrome More expensive than allopurinol Increased risk of death compared with allopurinol CrCl < 30 Use caution

Question 30

Lesinurad (Zurampic)

Answer 30

Selective urate reabsorption inhibitor for gout Not for use as monotherapy Not for use if asymptomatic hyperuricemia Potential increase in cardiovascular events Do not use if CrCl < 45

Question 31

Lesinurad/ allopurinol (Duzallo)

Answer 31

Combination urate reabsorption inhibitor and XOI for gout Indicated when serum uric acid concentrations not achieved with allopurinol alone Continue the same allopurinol dose when initiating Do not use if CrCl < 45

Question 32

Probenecid

Answer 32

inhibits the tubular reabsorption of urate, thus increasing the urinary excretion of uric acid and decreasing serum urate levels First line in Uricosuric not recommended for first-line or alternative first-line treatment if CrCl < 50 or history of urolithiasis Do baseline and periodic urine uric acid; elevated urine uric acid concentration (uric acid overproduction) is contraindication When initiating, increase fluid intake and consider urine alkalinization

Question 33

Pegloticase (Krystexxa)

Answer 33

catalyzes uric acid to the water-soluble purine metabolite allantoin. Use only if severe gout disease burden and refractory to or intolerant of other ULT options All other antihyperuricemic agents must be discontinued before initiation Premedicate with antihistamines and corticosteroids