Geriatrics Flashcards
1
Q
At what age is it considered to be a senior?
A
> 65
2
Q
What is difference between life expectancy and health span?
A
Life expectancy= max age a person may live
Health span= number of years spent free from limitations and morbidity
3
Q
What are ADLs?
A
activities of daily living= dress, bathe, walk, eat
4
Q
What are IADLs?
A
instrumental activities of daily living= shop, housekeep, meds, finnacials
5
Q
What is the clinical frailty scale and what numbers mean what?
A
1= Super fit
9= terminally ill
6
Q
What is functional reserve
A
capabilities beyond what is needed for everyday life
7
Q
How does absorption change in seniors?
A
less acid, slower emptying, delayed transit, lower blood flow which all equals LESS rate absorption
8
Q
True or false: Seniors have less overall absorption of the drug?
A
FALSE- only rate is affected
less acid may affect some tho
9
Q
Which drugs are affected by less acid secretion?
A
Iron, calcium carb, ketoconazole
10
Q
How can we improve iron absorb in elderly?
A
EMPTY stomach
11
Q
How does topical absorption change?
A
Drier and less lipids= less absorption of lipid agents
12
Q
How does distribution change?
A
more fat and less muscle and water
less albumin
13
Q
If a lipophilic drug is administered to a senior what happens generally?
A
longer half life
14
Q
If a hydrophilic drug is administered to a senior what happens generally?
A
lower half life but greater of an effect
15
Q
What drugs are highly protein bound that elderly patients may be on?
A
Warfarin and phenytoin
16
Q
How does metabolism change?
A
liver smaller and less blood flow= less metabolism and less first pass
17
Q
Which phase of metabolism is affected in geriatric patients?
A
phase 1= CYP= longer half lives
18
Q
How does elimination change?
A
bad kidneys
19
Q
Why is SCr not the best measure of kidney function in old people?
A
less muscle= may be falsely low
20
Q
Why does Cockcroft formula suck?
A
if overweight or underweight
21
Q
What PD changes happen in CV system?
A
receptor insensitivity= beta blockers work less, vessels damaged, Qt risk
22
Q
What changes in CNS system?
A
BBB not as good, anticholinergic increase, EPS
23
Q
What are old people at risk of in regards to electrolytes?
A
dehydration, hyponatremia, SIADH, hyperkalemia
24
Q
What is considered a high number of meds?
A
> 5= risk
10 BAD
25
What is a common pathway of poly pharmacy?
s/e from one= add another agent to fix and so on= rising health care cost
26
DO BEERS LIST
PWEASE
27
Cons of Beers list?
if not on doesn't mean it is okay, may need to use
28
What are some other tools for helping with poly pharmacy?
STOPP FRAIL
STOPP/START
medication appropriateness index
29
Difference between explicit and implicit prescribing tools?
explicit= list
implicit= a process to identify issues with meds
30
Issue with medication appropriateness index?
doesn't help with finding untreated conditions
31
Resource for deprescribing?
Canadian Deprescribing network
32
Tips for deprescirbing?
do one at a time= know what is causing what
get rid of prescribing cascade
what for DI when stopping med
withdrawal
33
What is a adverse drug withdrawal reaction of antidepressants?
insomnia, agitation, sweat, depression
34
What is a adverse drug withdrawal reaction of Benzo?
rebound insomnia
35
What is a adverse drug withdrawal reaction of beta blockers?
raised HR and BP, angina
36
What meds have no withdrawal reaction?
bisphosphonates
aspirin
anticoagulant
statin
vitamins and minerals
37
What is considered orthostatic hypotension?
drop of greater than >20/10 from sitting to standing
38
What is a geriatric syndrome? EX?
common health condition in older that doesn't fit into a disease category
EX= falls, frailty, delirium, cog impaire
39
Best predictor of future falls?
previous falls
40
What usually happens with a fall?
broken bones/sprain= could lose independence forever
41
What is a mental effect of falls?
fear= avoid and lose quality of life
42
Where do people fall the most?
home
43
What biological stuff contribute to falls?
loss of muscle, vision, hypotension, heart, dizzy, pain
44
What are environment factors of falls?
home clutter
community hazard
45
What drugs can contribute to cognitive changes?
benzo, TCA, anticholinergic
46
What drugs contribute to movement disorders?
antipsychotic, metoclopramide
47
What AD's are on Beers?
all TCA
paroxetine
48
What OTC are on beers?
dimenhydrinate, diphenhydramine
49
What AP are on beers?
clozapine, 1st gen, quetiapine, olanzapine
50
What muscle relaxants are on Beers?
baclofenm cyclobenzaprine, methocarbamol
51
Does opioids increase falls?
mixed results BUT if greater than 85, and higher doses yes
52
Who should have a multifactorial fall risk assessment?
fallen 2+ in past year, after acute fall, gait or balance issues
53
Does vitamin D help?
mixed but why not
54
What is frailty?
syndrome that increase vulnerability to loss of independence or death= less functional reserve
55
Best predictor of frailty?
gait speed of <0.8m/s
56
What meds contribute to frailty?
gi upset= weight loss
fatigue= less activity
if on >5 meds
57
How can we improve frailty?
optimize meds and health, exercise
58
At what number of meds is associated with more falls?
>4
59
At what number of meds is it seen that malnourishment is common?
>10
60
Issues with AP?
cog impair, fall, urine incontinence, depression
61
Issues with AD/ epileptics?
delirium, cog, falls, weight loss, urine, depression
62
Issues with Benzos?
delirium, cog, falls
63
What is delirium?
acute (hours-days) confusional stat
64
Why is delirium bad?
increases mortality, hospitalization stay,
65
What predisposes delirium?
age, Comorbidity, drugs, surgery, infection, pain
66
What are the worst drugs that cause delirium?
TCA, 1st gen antihistamines, first gen AP, muscle relaxants, benzos, opioid, z drugs
67
What may also elicit delirium?
phenytoin, CMZ, gabapentin, topiramate
68
What hyperactive delirium?
agitated, restless
69
What is hypoactive delirium?
drowsy, unarousable
70
Major cause of delirium?
infection!!!
71
Difference between delirium and dementia?
Delirium= acute, fluctuates, attention is impaired, hallucinate
dementia=chronic, progressive, no loss of attention and rare to get hallucinations
72
How can we prevent delirium?
orientation= clocks, calendars, sleep cycle
mobilize= move
meds
hydration/nutrition
73
What is the number one treatment for delirium?
TREAT UNDERLYING CAUSE
74
When should medications be added for delirium?
significant distress, lefty issue, impedes care
75
What meds to avoid in delirium?
NO BENZO
76
What drugs are usually added for delirium?
haloperidol= DOC if short term
olanzapine= NO due to anticholinergic
quetiapine= if Parkinson's due to less DA blocking
risperidone
77
If want to avoid EPS which AP?
Quetiapine
78
If we want to avoid sedation?
Haloperidol, risperidone
79
Why is there a black box warning for AP in delirium?
increases mortality BUT not in short term use
80
What is dementia?
progressive cognitive decline
81
What is mild cognitive impairment? Does it interfere with independent function?
modest decline in cognitive function
NO
82
True or false mild cognitive impairment progresses to dementia?
False- not always
83
What other factors can contribute to cognitive decline?
drugs
emotional state
electrolytes
eyes/ears declining
nutrition
tumour
infection
anemia
84
How does use of anticholinergic use relate to dementia?
cumulative risk increases risk of subsequent dementia
85
What is the hallmarks of alzeihmers?
slow and progressive
build up of B amyloid
86
Risk factors of Alzheimers?
age, genetics
trauma to head
smoke, no exercise, obese, HTN, diabetes
87
What is vascular dementia?
interrupted flow to brain ie) stroke
88
How is vascular dementia different from other forms?
can be abrupt
more personality changes and aggression
89
What is frontotemporal dementia?
damage initially to frontal and temporal lobes
speech is heavily impacted
90
How is frontotemporal dementia different from the other forms?
STRONG genetic
earlier onset
and no increase risk with age
91
What is Parkinson's dementia?
dementia after diagnosis of Parkinson
impairment in attention, planning and complex tasks
92
What treatment is good for Parkinson's dementia?
quetiapine
93
What i8s Lew body dementia?
alpha synuclein protein
cognitive impariemtn/ visual hallucinations BEFORE or with motor issues seen in parkinsons
94
How can we diagnose dementia?
imaging- may help
rule out
detailed history
95
Behaviour symptoms of dementia?
agitation
wandering
repetitive
hoarding
96
Psychological symptoms of dementia?
apathy
paranoia
hallucination
97
Triggers of BP symptoms of dementia?
anticholinergic
benzo
opioids
cannabis
anticonvulsants
clarithromycin
FQ
diclo/indomethacine
98
What are the cholinesterase inhibitors? How do they work?
donepezil, galantamine
rivastigmine
prevent breakdown of acetylcholine- improve cognition
99
Benefit of cholinesterase inhibitors?
may slow progression by a couple months
NOT used long term as their effect becomes useless in later stages
100
S/e of cholinesterase inhibitors?
NVD, insomnia, urinary
101
Which cholinesterase drug causes QTc prolonging?
RHabdo?
QTC= donepezil, galantamine
Rhabdo= donepezil
102
Who can't use cholinesterase inhibitors?
severe COPD and asthma, bradycardia
103
How do you get coverage of dementia meds by EDS?
reassessment every 6 months and can't take any other anticholinergic meds
104
How does memantine work?
NMDA antagonist=block glutamate
105
When do we use memantine? Does combo help?
if others fail
NO evidence of benefit in combo
106
True or False: memantine has some effect on acetylcholine?
FALSE
107
Whats the benefit of memantine?
minimal
108
S/e of memantine?
more tolerated
dizzy, constipation, insomnia, HTN, headache
109
At what MMSE score is severe dementia?
<10`
110
When do we generally say that meds for dementia need to be stopped?
loss of ability to perform ADL
111
What dementia agents should be taken with food?
donepezil, galantamine
112
What agent for dementia takes the longest to work?
memantine
113
Non pharm for dementia?
lower CV risk
cognitive strategies
exercise
diet
social
114
How do mabs work for dementia?
clear beta amyloid
115
What is lecanemab for? How is it given?
alzheimers or mild cognitive impairment
IV q2 weeks
116
What is the proportion of effect of lecanemab?
improve by 27%
117
Safety profile of lecanemab
infusion
brain bleed/swelling
118
How long till ARIA-H or ARIA-E resolve?
spontaneously over 2-3 months
119
What is donanedab for?
same as lecanemab
120
How is donanemab dosed? Is it helpful?
monthly IV
slowed by 22%
121
s/e of donanemab
same as lecanemab
122
What antidepressants to avoid in dementia?
TCA, paroxetine, fluoxetine
123
If sleep is an issue in dementia patient what do we use?
mirtazepine or trazadone
124
Why is there a black box warning for antipsychotics?
increased mortality, try to stop every 3 months
125
Which antipsychotic has no anticholinergic?
risperidone
126
Which AP has worse EPS/ TDK?
quetiapine
127
Will we use stimulants to help with apathy?
maybe but external activity and others are better
