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ACCP-Therapeutics > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Donepezil

A

Acetylcholinesterase inhibitor

metabolized in part by CYP2D6 and CYP3A4.

Labeled for mild to moderate and moderate to severe AD

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2
Q

Rivastigmine

A

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

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3
Q

Galantamine

A

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

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4
Q

Memantine

A

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

Labeled for moderate to severe AD

may be used in combination with CIs

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5
Q

Donepezil/memantine

A

Use after stabilized on donepezil and memantine separately

Renal dosing

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6
Q

Urge or overactive bladder treatment

A

Auntimuscarinic agents

Beta-3 Agonist

Onabotulinumtoxin A

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7
Q

Oxybutynin

A

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

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8
Q

Tolterodine

A

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

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9
Q

Fesoterodine

A

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

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10
Q

Trospium

A

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

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11
Q

Solifenacin

A

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

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12
Q

Darifenacin

A

Antimuscarinic agent

clinical efficacy is modest

Strong anticholinergic effects (on Beers Criteria)

Long acting formulations preferred due to modest decreased side effect profile

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13
Q

Mirabegron

A

Minimal anticholinergic effects

Cost is commonly a barrier for patients

Can be used in combination with antimuscarinic agents if monotherapy fails

Avoid in hypertension

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14
Q

OnabotulinumtoxinA

A

Prevents stimulation of detrusor muscle

Must be able to perform self-catheterization

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15
Q

Stress Incontinence Treatment

A

alpha-adrenergic agonist limited evidence

Topical estrogens

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

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16
Q

Topical estrogens for stress incontinence

A

Use if other symptoms of estrogen deficiency

Vaginal estrogens may improve severity of stress incontinence

17
Q

Overflow Incontinence Treatment

A

alpha-adrenergic antagonist

5-alpha-reductase inhibitors

Cholinomimetics

Phosphodiesterase type 5 inhibitors

18
Q

Alfuzoisn

A

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

19
Q

Tamsulosin

A

alpha-adrenergic antagonist

uroselective antagonists of α1 -adrenergic receptors

less likely to cause hypotension

20
Q

Silodsoin

A

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

21
Q

Doxazosin

A

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

22
Q

Terazosin

A

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

23
Q

Prazosin

A

alpha-adrenergic antagonist

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

Intraoperative floppy iris syndrome

24
Q

Finasteride

A

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

25
Q

Dutasteride

A

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

26
Q

Bathanechol

A

Cholinometics

27
Q

Tadalifil

A

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

28
Q

Allopurinol (Zyloprim)

A

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

29
Q

Febuxostat (Uloric)

A

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

30
Q

Lesinurad
(Zurampic)

A

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

31
Q

Lesinurad/ allopurinol (Duzallo)

A

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

32
Q

Probenecid

A

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

33
Q

Pegloticase (Krystexxa)

A

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

34
Q
A

ACCP-Therapeutics (4 decks)

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