Geriatrics

Question 1

BEERS criteria applies to who?

Answer 1

65+ except on hospice

Question 2

avoid ___ non valvular afib or VTE

Answer 2

warfarin

Question 3

anithhrombics to avoid

Answer 3

aspirin, warfarin (high)
rivaroxaban (moderate)

Question 4

diabetes avoid:

Answer 4

sulfonylureas
short acting insulin (only)

Question 5

DOAC to avoid

Answer 5

rivaroxaban

Question 6

DOAC to caution

Answer 6

dabigatran

Question 7

ADP receptor antag to caution

Answer 7

ticagrelor
prasurgel
(Bleeding risk over 75)

Question 8

SGLT-2s cautions

Answer 8

increased risk urinary infectuions and euglycemic DKA

Question 9

older adults make up __ of US population but use ___ of the meds

Answer 9

13%, 33%

Question 10

older adults have a greater risk of dying from____

Answer 10

chronic conditions rather than acute

Question 11

LTC communication form

Answer 11

physician action report, between providers and pharmacy

Question 12

LTC pharmacy pros

Answer 12

flexible schedule
independent work
multiple disciplines
clear role of pharmacist

Question 13

LTC pharmacy cons

Answer 13

travel time significant
written communication
limited patient interaction

Question 14

consultant pharmacy services LTC

Answer 14

review meds every month or three months

Question 15

healthy aging

Answer 15

maintaining functional ability to enable wellbeing in older age (capabilities to engage in something one values)

Question 16

goals for care

Answer 16

indepenence
avoid institutionalization
good quality of life
functional ability

Question 17

medications with risk of falls

Answer 17

sedatives/hypnotics
antipsychotics
antidepressants
opioids
loop diuretics
alpha blockers

Question 18

aging is not a barrier to adherence (t/f)

Answer 18

TRUE, there are so many barriers to adherence

Question 19

what happens to body water with age

Answer 19

decrease

Question 20

what happens to lean body mass with age

Answer 20

decrease

Question 21

what happens to body fat

Answer 21

increase

Question 22

what happens to barroreceptor response

Answer 22

decrease

Question 23

what happens to heart rate with age

Answer 23

not as much variability

Question 24

what happens to hepatic and renal blood flow

Answer 24

decrease

Question 25

what happens to neurotransmitter volume

Answer 25

decreased, more sensitive to CNS adverse effects

Question 26

what happens to bioavailability of drugs

Answer 26

stays the same

Question 27

what happens to water soluble drugs (give example of drug)

Answer 27

decreased Vd so increased concentration (atenolol)

Question 28

what happens to lipid soluble drugs (give drug)

Answer 28

increased Vd and increased half life (rifampin)

Question 29

what happens to hepatically and renally cleared drugs?

Answer 29

decreased clearance and increased half life (atenolol and propanolol)

Question 30

can we predict the rate of change in pharmacokinetics?

Answer 30

no, unique to each person

Question 31

what is the Beers criteria

Answer 31

potentially inapropriate med use in pts 65+, made by American Geriatric Society, updated every 3 years

Question 32

recognize new symptoms as

Answer 32

potential adverse reactions

Question 33

when to do pallative care?

Answer 33

after diagnosis of terminal illness, disease is not responsive to curative treatment or there is no treatment

Question 34

pallative care med considerations

Answer 34

only want to optimize QOL stop meds not improving QOL focus on symptoms only

Question 35

Hospice care life expectancy

Answer 35

6 months or less

Question 36

what are Advanced Care Directives

Answer 36

instructions about future medical care and treatment, don't take away your right to make current decisions

Question 37

what do advanced care directives include? (three things)

Answer 37

health care representative psychiatric advance directive power of attorney

Question 38

what is a healthcare representative

Answer 38

makes decisons for you if you are unable

Question 39

what is a psychiatric advance directive

Answer 39

sets preferences like mental illness when you cant

Question 40

what is power of attorney

Answer 40

grants power to others for financial

Question 41

POST

Answer 41

physicain orders for scope of treatment - agreement between patient and physician, MUST BE SIGNED AND DATED TO BE VALID

Question 42

what does a POST include?

Answer 42

resusitation pref medical interventions (dialysis) antibiotics artifical nutrition

Question 43

geriatrics prefer what terms

Answer 43

older adult over elderly

Question 44

what receptors support detrusor relaxation/filling

Answer 44

beta 3

Question 45

age related changes to bladder and urethra

Answer 45

decrese bladder capacity/elasticity increase spontaneous detrusor contractions decrease sphincter compliance

Question 46

what is overflow

Answer 46

urethral blockage bladder cant empty properly

Question 47

what is stress incontinence

Answer 47

relaxed pelvic floor, increased abdomnial pressure

Question 48

medciation causes of frequency

Answer 48

diuretics alpha antagonists

Question 49

medication causes of urgency

Answer 49

acetylcholinesterase

Question 50

medication causes of overflow

Answer 50

alpha antagonists antihistamines

Question 51

overflow treatment

Answer 51

alpha antagonists

Question 52

urge treatmemt classes

Answer 52

anticholinergic/antimuscarinic beta 3 combination

Question 53

urge meds

Answer 53

oxybutinin tolterodine mirabegron -enacin

Question 54

how long does it take to see effects of urge meds (anticholinergic/antimuscarinic)

Answer 54

2-4 weeks

Question 55

anticholinergic/antimuscarinic side effects

Answer 55

dry mouth, constipation, fatigue, confusion

Question 56

stress meds

Answer 56

topical estrogen, duloxetine 40mg BID, alpha agonists

Question 57

overflow meds

Answer 57

tamsulosin 0.4mg doxazosin 1-4mg

Question 58

neurogenic tx

Answer 58

scheduled voiding meds dont rlly want