Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Medications with Geriatric Rx Concerns

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Eldery = ______ yo

A

65+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

______% of the pop is eldery
_____% of all meds are Rx to the eldery
_____% of Eldery take at least 1 Rx, 1 OTC, AND 1 dietary supp
____% of Elderly take at least 5Rx and at least 1 OTC

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most commonly Rx drug classes to Eldery

A

Analgesics
Diuretics
Cardiovascular Rx
Sedative Hypnotics

Pain, Pee, Heart, Sedatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In general, what are the 2 main pharmacokinetic and Dynamic changes in the elderly?

A
  • Decreased clearance
  • Increased sensitivity to meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does absorption of must drugs change in geriatrics?

A

unchanged in most drugs
Absorption is slowed down but it will occur. No change in bioavailability

decr absorption of drugs requiring active transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

As pt becomes geriatric, how might you change their dose of albumin-bound drug?

A

decr as they get older bc you have less plasma albumin as you get older. Therefore, need less for it to work. Higher doses will incr risk of SE and overdose/toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is Drug Distribution different in geriatrics?

A

More free (unbound) drug -> incr SE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is drug metabolism different in geriatrics?

A

Their liver is slower and doesn’t do first pass metabolism as well -> increases risk for SE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most significant change in elderly affecting pharmacokinetics? What organ?

A

decr kidney function and excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Renal Function
Cockcroft-Gault (C-G) Equation

Will be on test

A

Serum creatinine (Scr) and BUN can be unreliable markers
Creatinine clearance (Clcr) adjusts for patient specific differences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cockcroft Gault Equation Q

79 yo Male
6’2” 255 lbs
SCr 1.3

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why is serum creatinine a great indicator of kidney function?

A

its only secreted by the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Geriatrics have altered receptor sensitivity. Does this result in increased or decreased diuretic response to loop diuretics?

A

decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cholinergic effects (SLUDGE)
vs
Anticholinergic effects (ABCDS)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

8 drug classes that have strong anticholinergic properties

A
  • Urinary Incontinence
  • Antihistamines
  • Antiemetics
  • Skeletal Muscle relaxants
  • Anti-spasmodic
  • Antiparkinsonians
  • Antipsychotics
  • Antidepressants

only need to know drug classes for test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When should you not Rx anticholinergics?

A
  • Uncontrolled narrow angle glaucoma, urinary retention, gastric retention, decr gastric motility
  • if taking acetylcholinesterase inhibitor for Alzheimer’s/dementia
  • May worsen confusion -> altered mental status
  • Caution if pts does tasks requiring mental alterness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Alzheimer’s Disease Pathophysiology

Alzheimer’s Dz leads to _____ tangles, ____ plaques, and decreased production of ______

A

Tau tangles
Amyloid plaques
Decr Acetylcholine (ACh)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Alzheimer’s Dz Non-Pharm trmnt

A

Physical activity
Vascular health
Thinking
Healthy diet

NO CURE or TRMNT to STOP DISEASE PROGRESSION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

2 drug classes for geriatric Alzheimer’s/Dementia

A
  • Acetylcholinesterase (AChE) Inhibitors
  • N-methyl D-aspartate (NMDA) Inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Acetylcholinesterase (AChE) Inhibitors:
Meds?
MOA?
SE?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Drug class?

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)

A

Acetylcholine Esterase (AChE) Inhibitors

23
Q

AChE Inhibitors: Drug Interactions

Which drug route formulations show decreased GI SE?

oral capsules? ODT? injections? instant release? ER/XR? patches?

A
  • Patches
  • Orally disintegrating tablets (ODT)
  • Extended release (ER, XR)
24
Q

AChE Inhibitors: Drug interactions

give Donepezil (Aricept) at night to decrease _____ or in the morning to decrease _____

A

night -> decr nausea
morning -> decr insomnia

25
geriatric pt is taking Donepezil (Aricept) and reports new onset nausea. What 2 things can they do?
take with **food** at **night**
26
Pt is taking Donepezil (Aricept) for Geriatric Alzheimer's/Dementia. Her son asks you if it will improve her symptoms and help her return to her old self. what do you say?
It may not help her improve clinically, but it may slow progression. ## Footnote slows inevitble downhill progression
27
# AChE-I Drug interactions AChE-I + BB/CCB/Digoxin =
**BRADYCARDIA** RISK in drugs that already decr HR
28
Combining an AChE-I + any of the following Rx may cause _____ ## Footnote ▪ Anti-psychotics ▪ Anti-hypertensives ▪ Alpha-blockers ▪ Hypnotics ▪ Opioids ▪ Alcohol ▪ Muscle relaxants
Dizziness ## Footnote those drugs already cause dizzy
29
N-methyl D-aspartate (NMDA) Inhibitors: Drugs? MOA? SE?
Memantine (Namenda) MOA: There is too much Glutamate in Alzheimer's Dz. Decreasing Glutamate will decrease the avail Ca+ -> prevent nerve damage SE: Sleepy, Hallucinations, Constipation, Confusion, H/A, Dizzy
30
# Drug class and indication Memantine (Namenda or Namenda XR)
NMDA Inhibitor Moderate/Severe Alzheimers Disease
31
2 big Drugs classes to avoid or use with care in dementia patients
Anticholinergics (AcH receptor blockers) Sedatives
32
Which Alzheimer's Dz Med treats all 3 stages?
Donepezil (AChE-I)
33
Which Alzheimer's Dz med ONLY treats mild/Mod stage?
Rivastigmine & Galantamine
34
Urinary Incontinence Non-Pharm Trmnt
_Behavioral therapies: 1st line_ * Bladder training * Delayed or scheduled voiding * Pelvic floor muscle exercises (Kegel): may be effective for OAB * Urge control techniques * Fluid management * Dietary changes (avoiding caffeine, alcohol and artificial sweeteners) * Weight loss _Surgical intervention_ * Reserved for rare non-neurogenic patient who has failed all other options
35
Urinary Incontinence Drug Targets
M3 B3 A1
36
Which receptor(s) are on the detrusor smooth muscle? | A1? M3? B3?
M3 B3 ## Footnote A1 are on bladder outlet (bladder neck)
37
Anticholinergic: M2 and M3 Antagonists should only be used for what types of Urinary problems?
Urge incontinence OAB (overactive bladder) ## Footnote Using these anticholinergic agents for other types of incontinence such as obstructive incontinence can be dangerous, as it could lead to damaging urinary retention. These meds inhibit parasympathetic detrusor muscle contractions so you pee less often. If there is a bladder obstruction, these meds would just let your bladder overfill too much! Your bladder should be contracting harder to overcome the urethral obstruction to avoid this
38
Pt with urge incontinence is taking a M2/M3 antagonist. They complain of dry mouth, blurry vision, and constipation. How can you change the formulation to decrease anticholinergic effects throughout the rest of the body?
Minimize this by using **ER formulations, patches, or newer, more M3-selective agents**
39
Pt is on a M2/M3 antagonist for OAB. They report dry mouth. What drug can you switch them to?
Beta 3 agonist Mirabegron (Myrbetriq)
40
# Urinary Incontinence If taking M2 or M3 antagonists (Anticholinergics) fail, try ____
Beta 3 Agonist -> Mirabegron (Myrbetriq) ## Footnote less dry mouth HTN risk
41
How do Beta 3 Agonists interact with metoprolol?
B3 agonists are Moderate CYP450 2D6 inhibitors and may increase levels of metoprolol. ## Footnote might want to lower metorpolol dose
42
How might you want to change a digoxin dose when starting a Beta 3 Agonist?
decrease digoxin ## Footnote Beta 3 agonists increase digoxin levels
43
# Geriatric Considerations Anticoagulants
- might not be worth it if gonna **die soon anyways** * risk of major bleed * Warfarin req **INR monitoring, has many drug interactions** * consider co-managing pts with **anticoagulation therapy unit (ATU)** ## Footnote Most common indication: reduce risk of stroke in chronic non-valvular atrial fibrillation
44
Blood Brain Barrier
The BBB is a  is a diffusion barrier, which impedes influx of most compounds from blood to brain or CNS; it allows some materials to cross, but prevents others from crossing ## Footnote * Protects the brain from "foreign substances" in the blood that may injure the CNS. * Protects the brain from hormones and neurotransmitters in the rest of the body. * Maintains a constant environment for the CNS.
45
# Geriatric Considerations 1st gen Antihistmaines (Benadryl, Unisom, etc)
- avoid in older adults - Crosses blood brain barrier * **SHOULD NOT** use as a sleep aid * risk of **falls, confusion**
46
# Geriatric Considerations 2nd Gen Antihistamines
* doesnt readily cross blood brain barrier (safer) * generally safe in seniors * some anticholinergic effects: drowsiness, dry mouth * short term trmnt preferred
47
# Geriatric Considerations NSAIDs
_chronic use may lead to_ * GI bleed or PUD in high-risk grps (PPIs dont decr this risk) * Kidney damage * HTN * HF ## Footnote High risk: Age >75 years old, taking PO or IV corticosteroids, anticoagulants, or antiplatelet agents Alternatives -> short term acetaminophen or topical analgesics If alt fail -> use low dose NSAID chronically + gastroprotective agent
48
# Geriatric Considerations Opiods
* NOT 1st line for **CHRONIC** pain * may be safer for pain than large chronic doses of tylenol or NSAIDs _Major Toxicities_ - **Resp depression** - Constipation **(stimulant laxative (senna)) to treat and prevent)**
49
# Geriatric Considerations Antipsychotics
* Elderly Dementia + Psychosis + Antipsychotics -> incr risk of **DEATH** * may still be okay for eldery with **Schizophrenia or bipolar disorder** * Also appropriate for acute agitation as an alternative to benzodiazepines
50
# Geriatric Considerations First Generation Antipsychotics “typicals”
* **Extrapyramidal SE (EPS)** * Anticholinergic effects: sedation, confusion, urinary retention * QTc prolongation (*highest risk) ## Footnote **EPS Examples Dystonia, akathisia, parkinsonism, bradykinesia, tremor Tardive dyskinesia**
51
# Geriatric Considerations Second Generation Antipsychotics “atypicals”
Lower risk of EPS compared to typicals
52
# Geriatric Considerations Anxiolytics
* AVOID ALL BENZOS (alprazolam, midazolam, diazepam, lorazepam, temazepam) * RISKS: of **cognitive impairment, delirium, falls, fractures and motor vehicle crashes**
53
# Geriatric Considerations Antihypertensives
Start low and go slow _1ST LINE MONOTHERAPY_ THIAZIDES ACE-I/ARBs Long acting CCBs
54
Beer's List
general list of drugs to avoid in geriatrics NOT A BIBLE ## Footnote Can use Beer's list as a clinical rational if insurance is being a bitch

Pharmacology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions