Geriatrics

Question 1

Where pharmacists interact with older adults

Answer 1

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

Question 2

Goals of pharmacy in LTC

Answer 2

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

Question 3

Common geriatric “syndromes”

Answer 3

Sensory impairment
Constipation
Depressing / insomnia
Falls –> immobility
Dementia

Question 4

Goals of tx for older adults (4M framework)

Answer 4

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

Question 5

ADLs

Answer 5

Dressing
Bathing
Feeding
Toileting

Question 6

IADLs

Answer 6

Managing finances
Shopping for groceries
Using telephone
Housekeeping / laundry

Question 7

Medications and risk of falls

Answer 7

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

Question 8

Medication problems in older adults

Answer 8

Polypharmacy
Non-adherence
Altered pharmacokinetics

Question 9

Physiological changes with aging

Answer 9

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

Question 10

Pharmacokinetic changes with aging

Answer 10

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

Question 11

Beers criteria

Answer 11

Criteria for potentially inappropriate medication use in older adults

Question 12

How are recommendation about Beers criteria decided?

Answer 12

Based on how medications impact the safety of older adults

Question 13

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

Answer 13

American Geriatrics Society

Question 14

What types of evidence is evaluated for Beers criteria?

Answer 14

Clinical trials and research studies published since the last revision

Question 15

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

Answer 15

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

Question 16

Considerations in choosing medications

Answer 16

Life expectancy
Goals of care
Treatment targets
Time required to benefit

Question 17

Palliative care

Answer 17

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

Question 18

Hospice care

Answer 18

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

Question 19

Role of pharmacists in end of life care

Answer 19

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

Question 20

Advanced care directives (ACD)

Answer 20

Instructions about future medical care

Question 21

Health care representative

Answer 21

Someone who makes decisions if you’re unable

Question 22

Psychiatric advance directive

Answer 22

Treatment preferences if in an unstable state

Question 23

Power of attorney

Answer 23

Financial or health care grants power to others you choose

Question 24

Physician orders for scope of treatment (POST)

Answer 24

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

Question 25

Urinary incontinence

Answer 25

Involuntary leakage Ex. OAB, stress, overflow

Question 26

Goal of UI treatmen

Answer 26

Improve QOL Regain sense of independence Improve self-esteem

Question 27

Bladder function pathway

Answer 27

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

Question 28

OAB

Answer 28

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

Question 29

Stress urinary incontinence

Answer 29

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

Question 30

Overflow incontinence

Answer 30

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

Question 31

Neurogenic (atonic) bladder

Answer 31

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

Question 32

Non pcol UI treatment

Answer 32

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

Question 33

UI management: urge

Answer 33

Anticholinergics: Oxybutynin, tolterodine, solifenacin, darifenacin, trospium, fesoterodine AE: dry mouth, constipation B3 agonists: Mirabegron, vibegron AE: UTI, incr BP

Question 34

UI management: stress

Answer 34

Non-pcol: Kegel Pcol: Duloxetine Topical estrogen Alpha agonists (pseudoephedrine) --> rare

Question 35

UI management: overflow

Answer 35

Non-pcol: Address obstruction, catheter Pcol: Alpha adrenergic blockers (if BPH) Doxazosin, Tamsulosin

Question 36

UI management: neurogenic

Answer 36

Pcol management not routinely effective Non-pcol: Scheduled voiding Catheter Botox Augmentation cystoplasty

Question 37

Catheters

Answer 37

Intermittent straight Indwelling (foley) --> chronic Condom Suprapubic