Geriatrics Flashcards
Donepezil
Acetylcholinesterase inhibitor
metabolized in part by CYP2D6 and CYP3A4.
Labeled for mild to moderate and moderate to severe AD
Rivastigmine
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
Galantamine
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
Memantine
N-methyl-d-aspartate receptor antagonist that blocks glutamate transmission
Labeled for moderate to severe AD
may be used in combination with CIs
Donepezil/memantine
Use after stabilized on donepezil and memantine separately
Renal dosing
Urge or overactive bladder treatment
Auntimuscarinic agents
Beta-3 Agonist
Onabotulinumtoxin A
Oxybutynin
Antimuscarinic agent
clinical efficacy is modest
Strong anticholinergic effects (on Beers Criteria)
Long acting formulations preferred due to modest decreased side effect profile
Tolterodine
Antimuscarinic agent
clinical efficacy is modest
Strong anticholinergic effects (on Beers Criteria)
Long acting formulations preferred due to modest decreased side effect profile
Fesoterodine
Antimuscarinic agent
clinical efficacy is modest
Strong anticholinergic effects (on Beers Criteria)
Long acting formulations preferred due to modest decreased side effect profile
Trospium
Antimuscarinic agent
clinical efficacy is modest
Strong anticholinergic effects (on Beers Criteria)
Long acting formulations preferred due to modest decreased side effect profile
Solifenacin
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
Darifenacin
Antimuscarinic agent
clinical efficacy is modest
Strong anticholinergic effects (on Beers Criteria)
Long acting formulations preferred due to modest decreased side effect profile
Mirabegron
Minimal anticholinergic effects
Cost is commonly a barrier for patients
Can be used in combination with antimuscarinic agents if monotherapy fails
Avoid in hypertension
OnabotulinumtoxinA
Prevents stimulation of detrusor muscle
Must be able to perform self-catheterization
Stress Incontinence Treatment
alpha-adrenergic agonist limited evidence
Topical estrogens
SNRI (duloxetine) **may reduce severity but AE limits its usefulness
Topical estrogens for stress incontinence
Use if other symptoms of estrogen deficiency
Vaginal estrogens may improve severity of stress incontinence
Overflow Incontinence Treatment
alpha-adrenergic antagonist
5-alpha-reductase inhibitors
Cholinomimetics
Phosphodiesterase type 5 inhibitors
Alfuzoisn
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
Tamsulosin
alpha-adrenergic antagonist
uroselective antagonists of α1 -adrenergic receptors
less likely to cause hypotension
Silodsoin
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
Doxazosin
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
Terazosin
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
Prazosin
alpha-adrenergic antagonist
metabolized through the CYP3A4 pathway and have drug interactions with strong CYP3A4 inhibitors and inducers
Intraoperative floppy iris syndrome
Finasteride
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
Dutasteride
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
Bathanechol
Cholinometics
Tadalifil
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
Allopurinol (Zyloprim)
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
Febuxostat (Uloric)
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
Lesinurad
(Zurampic)
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
Lesinurad/ allopurinol (Duzallo)
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
Probenecid
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
Pegloticase (Krystexxa)
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
