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PHRM844 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Where pharmacists interact with older adults

A

Inpatient units (wards)
Retail setting
Ambulatory care setting
Long term care (LTC)

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2
Q

Goals of pharmacy in LTC

A

Identify unnecessary medications
Identify adverse rxns
Ensure appropriate monitoring of tx
Dose reduction of psychiatric medications

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3
Q

Common geriatric “syndromes”

A

Sensory impairment
Constipation
Depressing / insomnia
Falls –> immobility
Dementia

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4
Q

Goals of tx for older adults (4M framework)

A

Maintain independence
Address “what matters most”
Optimize risk/benefits of medications
Preserve cognition
Maintain functional mobility

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5
Q

ADLs

A

Dressing
Bathing
Feeding
Toileting

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6
Q

IADLs

A

Managing finances
Shopping for groceries
Using telephone
Housekeeping / laundry

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7
Q

Medications and risk of falls

A

Sedatives
Antipsychotics
Antidepressants
Opioids (esp long term)
Loop diuretics
Alpha-blockers

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8
Q

Medication problems in older adults

A

Polypharmacy
Non-adherence
Altered pharmacokinetics

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9
Q

Physiological changes with aging

A

Decr TBW
Decr lean body mass –> Incr body fat
Decr baroreceptor response/activity
Reduced HR variability
Decr hepatic and renal blood flow
Decr neurotransmitter volume

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10
Q

Pharmacokinetic changes with aging

A

Decr Vd and incr conc of water-soluble drugs
Incr Vd and incr half-life of lipid-soluble drugs
Decr clearance and incr half-life of hepatically and renally cleared drugs

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11
Q

Beers criteria

A

Criteria for potentially inappropriate medication use in older adults

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12
Q

How are recommendation about Beers criteria decided?

A

Based on how medications impact the safety of older adults

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13
Q

Who is involved in the decision-making process of Beers criteria?

A

American Geriatrics Society

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14
Q

What types of evidence is evaluated for Beers criteria?

A

Clinical trials and research studies published since the last revision

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15
Q

How does the committee describe quality of evidence and strength of recommendation of Beers criteria?

A
  1. Potentially inappropriate medications
  2. Potentially inappropriate medications if certain conditions
  3. Use with caution
  4. Potentially inappropriate drug-drug interactions
  5. Doses should be adjusted by renal function
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16
Q

Considerations in choosing medications

A

Life expectancy
Goals of care
Treatment targets
Time required to benefit

17
Q

Palliative care

A

Disease is not responsive to curative treatment or treatment doesn’t exist

18
Q

Hospice care

A

Life expectancy ≤ 6 months
Provided at home, in LTC, or independent facility

19
Q

Role of pharmacists in end of life care

A

Align medications with goals
Control bothersome symptoms
Educate family and providers
Adjust doses as needed
Support financial concerns

20
Q

Advanced care directives (ACD)

A

Instructions about future medical care

21
Q

Health care representative

A

Someone who makes decisions if you’re unable

22
Q

Psychiatric advance directive

A

Treatment preferences if in an unstable state

23
Q

Power of attorney

A

Financial or health care grants power to others you choose

24
Q

Physician orders for scope of treatment (POST)

A

Agreement between patient and physician
Must be signed and dated to be valid (but can be updated at any time)

25
Q

Urinary incontinence

A

Involuntary leakage
Ex. OAB, stress, overflow

26
Q

Goal of UI treatmen

A

Improve QOL
Regain sense of independence
Improve self-esteem

27
Q

Bladder function pathway

A

Stretch receptors notify brain bladder is full
B3 receptors support detrusor relax/fill
Neurologic stimulation initiates contraction
Ach receptors in dome
Alpha-adrenergic receptors in base and proximal urethra
Sphincter relaxes
Urine released

28
Q

OAB

A

Urgency: uncontrollability
Frequency: excessive feeling of urination
Can be caused by medications

29
Q

Stress urinary incontinence

A

Outlet incompetence with abdominal pressure
Risk factors: multiple child births, estrogen deficiency

30
Q

Overflow incontinence

A

Outlet obstruction or altered detrusor constriction
Commonly from BPH or prostatic blockage of urethra

31
Q

Neurogenic (atonic) bladder

A

Disruption in innervation of the bladder
Increases risk of UTI and kidney stones

32
Q

Non pcol UI treatment

A

Scheduled voiding
Pelvic floor muscle strengthening daily
Avoiding irritants (coffee, alc, caffeine)
Avoid water before bed
Absorbent products
Catheters

33
Q

UI management: urge

A

Anticholinergics:
Oxybutynin, tolterodine, solifenacin, darifenacin, trospium, fesoterodine
AE: dry mouth, constipation

B3 agonists:
Mirabegron, vibegron
AE: UTI, incr BP

34
Q

UI management: stress

A

Non-pcol: Kegel

Pcol:
Duloxetine
Topical estrogen
Alpha agonists (pseudoephedrine) –> rare

35
Q

UI management: overflow

A

Non-pcol: Address obstruction, catheter

Pcol:
Alpha adrenergic blockers (if BPH)
Doxazosin, Tamsulosin

36
Q

UI management: neurogenic

A

Pcol management not routinely effective

Non-pcol:
Scheduled voiding
Catheter
Botox
Augmentation cystoplasty

37
Q

Catheters

A

Intermittent straight
Indwelling (foley) –> chronic
Condom
Suprapubic

PHRM844 (16 decks)

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