Geriatrics Flashcards
BEERS criteria applies to who?
65+ except on hospice
avoid ___ non valvular afib or VTE
warfarin
anithhrombics to avoid
aspirin, warfarin (high)
rivaroxaban (moderate)
diabetes avoid:
sulfonylureas
short acting insulin (only)
DOAC to avoid
rivaroxaban
DOAC to caution
dabigatran
ADP receptor antag to caution
ticagrelor
prasurgel
(Bleeding risk over 75)
SGLT-2s cautions
increased risk urinary infectuions and euglycemic DKA
older adults make up __ of US population but use ___ of the meds
13%, 33%
older adults have a greater risk of dying from____
chronic conditions rather than acute
LTC communication form
physician action report, between providers and pharmacy
LTC pharmacy pros
flexible schedule
independent work
multiple disciplines
clear role of pharmacist
LTC pharmacy cons
travel time significant
written communication
limited patient interaction
consultant pharmacy services LTC
review meds every month or three months
healthy aging
maintaining functional ability to enable wellbeing in older age (capabilities to engage in something one values)
goals for care
indepenence
avoid institutionalization
good quality of life
functional ability
medications with risk of falls
sedatives/hypnotics
antipsychotics
antidepressants
opioids
loop diuretics
alpha blockers
aging is not a barrier to adherence (t/f)
TRUE, there are so many barriers to adherence
what happens to body water with age
decrease
what happens to lean body mass with age
decrease
what happens to body fat
increase
what happens to barroreceptor response
decrease
what happens to heart rate with age
not as much variability
what happens to hepatic and renal blood flow
decrease
what happens to neurotransmitter volume
decreased, more sensitive to CNS adverse effects
what happens to bioavailability of drugs
stays the same
what happens to water soluble drugs (give example of drug)
decreased Vd so increased concentration (atenolol)
what happens to lipid soluble drugs (give drug)
increased Vd and increased half life (rifampin)
what happens to hepatically and renally cleared drugs?
decreased clearance and increased half life (atenolol and propanolol)
can we predict the rate of change in pharmacokinetics?
no, unique to each person
what is the Beers criteria
potentially inapropriate med use in pts 65+, made by American Geriatric Society, updated every 3 years
recognize new symptoms as
potential adverse reactions
when to do pallative care?
after diagnosis of terminal illness, disease is not responsive to curative treatment or there is no treatment
pallative care med considerations
only want to optimize QOL
stop meds not improving QOL
focus on symptoms only
Hospice care life expectancy
6 months or less
what are Advanced Care Directives
instructions about future medical care and treatment, don’t take away your right to make current decisions
what do advanced care directives include? (three things)
health care representative
psychiatric advance directive
power of attorney
what is a healthcare representative
makes decisons for you if you are unable
what is a psychiatric advance directive
sets preferences like mental illness when you cant
what is power of attorney
grants power to others for financial
POST
physicain orders for scope of treatment
- agreement between patient and physician, MUST BE SIGNED AND DATED TO BE VALID
what does a POST include?
resusitation pref
medical interventions (dialysis)
antibiotics
artifical nutrition
geriatrics prefer what terms
older adult over elderly
what receptors support detrusor relaxation/filling
beta 3
age related changes to bladder and urethra
decrese bladder capacity/elasticity
increase spontaneous detrusor contractions
decrease sphincter compliance
what is overflow
urethral blockage
bladder cant empty properly
what is stress incontinence
relaxed pelvic floor, increased abdomnial pressure
medciation causes of frequency
diuretics
alpha antagonists
medication causes of urgency
acetylcholinesterase
medication causes of overflow
alpha antagonists
antihistamines
overflow treatment
alpha antagonists
urge treatmemt classes
anticholinergic/antimuscarinic
beta 3
combination
urge meds
oxybutinin
tolterodine
mirabegron
-enacin
how long does it take to see effects of urge meds (anticholinergic/antimuscarinic)
2-4 weeks
anticholinergic/antimuscarinic side effects
dry mouth, constipation, fatigue, confusion
stress meds
topical estrogen, duloxetine 40mg BID, alpha agonists
overflow meds
tamsulosin 0.4mg
doxazosin 1-4mg
neurogenic tx
scheduled voiding
meds dont rlly want
