Geriatrics Flashcards
Can diuretics exacerbate urinary incontinence?
Yes,
Increased urine production: Diuretics work by increasing urine output, which can lead to more frequent urination. If a person already has urinary incontinence, the increased volume and frequency of urination can put additional stress on the bladder and worsen the symptoms of incontinence.
Urgency and overactive bladder: Some diuretics, such as loop diuretics, can cause an increase in bladder contractions and make the bladder more sensitive to filling. This can result in an overactive bladder, causing a sense of urgency and difficulty controlling urine flow.
Electrolyte imbalances: Diuretics can alter the balance of electrolytes in the body, including potassium and sodium. Electrolyte imbalances, particularly low levels of potassium (hypokalemia), can affect the muscles involved in urinary control and potentially lead to urinary incontinence.
Bladder irritation: Diuretics may cause irritation of the bladder lining, resulting in inflammation and increased urinary urgency. This irritation can contribute to urinary incontinence or worsen existing symptoms.
Medication interactions: Diuretics are often prescribed along with other medications for various health conditions. Some of these medications, such as alpha-blockers or calcium channel blockers, may themselves have urinary side effects that can contribute to urinary incontinence when combined with diuretics.
What is tolterodine used to treat?
urge incontinence.
In older adults, the atrial kick can contribute up to ____ of ventricular preload in older patients.
30-40%
What are the possible reasons for low INR desite being on warfarin?
- medication compliance, 2. new medication that interacts with warfarin, 3. diet change, eating too many foods like green leafy vegetables that can lower INR. 4. Prescribed too low of a warfarin dose
For warfarin dosing in older adults:
Initiation dose should be ____ per day or less.
Maintenance doses are usually achieved with ____ per day.
Should you avoid using more than one warfarin strength?
5, 3-5mg, yes
Contraindications to warfarin therapy?
- pregnancy, 2. hypersensitivity 3. warfarin skin necrosis 4. medication compliance, or inability to follow up for INR monitoring, 5. Bleeding disorders (coagulation defects severe thrombocytopenia 6. malignant hypertension.
Peak response of warfarin ? Starts to have effect when?
3-4 days, 24 hours
Warfarin is highly _____ to albumin, and _______, and remains in the ____ form.
bound, plasma proteins, inactive
Warfarin is metabolized by the _________ into minimally active and inactive metaboiltes
CYP450, primary is CYP 2C9
Warfarin’s metabolites are primarily excreted by _______
the kidneys
_______ body mass in older patients will result in the increase of effect of warfarin
Lean
______ in serum albumin will result in the increase of the effect of warfarin
decrease
_______ in the blood flow to kidneys and liver will result in the increase effect of warfarin.
Decrease
_______ in the hepatic mass and hepatic enzyme activity will result in the increased effect of warfarin.
Decrease
What are the steps you could have taken to help ensure successful communication and patient adherence?
- Clear written instructions, 2. Giving time to ask questions and perform a teach back. 3. Consider choosing a simpler regimen 4. Simplifying her overall medication regimen and reducing burden. 5. Considering home mcare or other supports because of her MCI
