Geriatrics Flashcards
Older adult age
-over 60
Pharm services in LTC
-review and identify drug therapy probs
-ensure accurate monitoring
-educate patients
Meds w fall risk
-sedatives/hypnotics
-antipsychotics/neuroleptics
-antidepressants
-opiods
-loop diuretics
-a-blockers
Med probs in older adults
-polypharmacy
-nonadherance
-altered PK
Physiologic changes w aging
-dec body water and mass
-inc fat
-dec barorecepter response!!!
-dec HR variability!!!!
-dec hepatic and renal flow
-dec neurotransmitter volume (sensitive to CNS effects)
PK of water soluble drugs in aging
-dec distribution
-inc concentration
-Atenolol
PK of lipid soluble drugs in aging
-inc Vd
-inc half life
-Rifampin
PK of hepatic/renally-cleared drugs in aging
-dec clearance
-inc half-life
-propranolol hepatic
-atenolol propranolol
Beers criteria
-65+
-evaluate risk of meds for old ppl
Required reading
-Beer
Meds considered by Beers
-anticholinergics (cognitive)
-sedatives/CNS effects
-diabetic agents (sulfonylureas)
-meds that might make chronic illness worse
How are decisions about recommendations decided
Who involved in decision making
what types of lit evaluated
how does committee decribe quality of eveidence
Sedative alternative
-non pharma
-other anxiety tx
Sulfonylurea alternative
-shorter-acting agents
-relaxed treatment targets
Palliative Care
-after dx of terminal illness
-optimize QOL
-look at symptoms only not life prolonging
Hospice Care
-provided at home or facility
-6 months or less to live
-focus on comfort
-
Advanced Care Directives (ACD)
-intructions about future tx
-might differ state to state
-health care rep
-psychiatric advance directive
-power of attorney
Health care representative
-name somone to make decisions on pt behalf
psychiatric advance directive
-sets preferences during periods of mental incapacity
Power of Attorney
-financial or health care grants power to others you choose
Physician Orders for Scope of Treatment (POST)
-legal doc between pt and physician
-signed and dated
-A: resuscitation pref
-B: med interventions
-C: antibiotics
-D: artificial nutrition
