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Therapeutics > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

fat is what in elderly

A

increased

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2
Q

bone, water, and muscle are what in elderly

A

decreased

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3
Q

what generally occurs with the CV system and the CNS in the elderly

A

functional decline

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4
Q

kidney nephron degeneration and decreased renal BF leads to

A

decline in renal function

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5
Q

is the respiratory system normal in elderly?

A

normal at rest, compromised under stress

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6
Q

multifactorial health conditions that occur when accumulated effects of impairment in multiple systems render an older person vulnerable to situational challenges

A

geriatric syndromes

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7
Q

excess vulnerability to stressors which reduce ability to maintain or regain homeostasis after a destabilizing event

A

frailty

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8
Q

hallmark indicators of frailty

A

weight loss, self reported exhaustion, low energy expenditure, slow gait, weak grip strength

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9
Q

common geriatric syndromes (9)

A

dementia, delirium, urinary incontinence, falls, dizziness, syncope, malnutrition, pressure ulcers, sleep problems

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10
Q

gastric ph in elderly is

A

higher (less acidic)

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11
Q

how is oral bioavailability affected

A

reduced 1st pass- may inc bioavailability of high ER drugs

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12
Q

drying of skin affects absorption of transdermal products how?

A

less absorption of hydrophilic drugs

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13
Q

what syndrome in elderly affects absorption of patches such as fentanyl

A

cachexia

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14
Q

inc fat and dec water affects drug distribution by

A

inc dist of lipophilic
dec dist/higher conc of hydrophilic

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15
Q

decreased lean body mass affects distribution and causes

A

increased drug conc in blood

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16
Q

which phase 1 metab processes are decreased

A

hydroxylation, demethylation

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17
Q

how is the liver changed to affect metab

A

decrease mass and volume

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18
Q

is phase 2 metab affected?

A

reduced glucuronidation in very old

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19
Q

which classes may not metabolize well in elderly (5)

A

benzos, nsaids, ccbs, antidepress, some antiepileptics

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20
Q

which drugs elimination are affected by renal function decline (6))

A

ace, hydrophilic BB, -cyclovir, aminoglycosides, vanco, some psych meds, etc

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21
Q

4 tools used to identify PIMs

A

BEers, start/stopp, med appropriateness index, anticholinergic risk scale

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22
Q

anticholinergic meds that may not be safe (5)

A

oxybutynin, amitriptyline, paroxetine, atropine, tolterodine, etc

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23
Q

effects of anticholinergics

A

limitations in physical/cog function, increased dementia risk

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24
Q

4 main classes “not safe” for elderly

A

anticholinergic, benzos, antidepressants, nsaids

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25
Q

3 major risks of nsaids

A

GI bleed, CV risks, renal considerations

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26
Q

which drugs/classes are FRIDs (6)?

A

loops, benzos, antidepressants, antipsychotics, sed/hypnotic, opioids, etc

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27
Q

which receptors in the LUT are responsible for storage of urine

A

B3 adrenergic

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28
Q

which receptors in the LUT are responsible for voiding

A

M3 receptors

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29
Q

which meds/classes can cause incontinence (11)

A

a agonist/antagonist, alcohol, anticholinergic, cholinesterase inhibitors, CCBs, diuretics, narcotics, antidepressants, antipsychotics, sed/hyp

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30
Q

agent used for nocturia with 2 or more night time wakings

A

desmopressin

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31
Q

warnings for desmopressin?

A

fluid retention, hyponatremia, nasal conditions

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32
Q

contraindications for desmopressin

A

hyponatremia, polydipsia, nocturnal enuresis, loops, steroids, low renal function, SIADH, illness causing imbalance, HF, uncontrolled HTN

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33
Q

what is 1st line for oab?
2nd line?

A

1st behavioral (maybe pharm)
2nd- anti-M or B3 agonist

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34
Q

how do M receptor antagonists work for OAB?

A

relax smooth muscle

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35
Q

AEs of antimuscarinics for OAB

A

confusion, delirium, dementia, urinary retention, dry mouth, etc (anticholinergic)

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36
Q

6 antimuscarinics for OAB

A

oxybutynin, tolterodine, trospium, darifenacin, solifenacin, fesoterodine

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37
Q

which 3 OAB antimuscarinics have low BBB crossing

A

tolterodine, trospium, fesoterodine

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38
Q

which 2 antimuscarinics for OAB are M3 specific

A

darifenacin, solifenacin

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39
Q

benefit of ER and M3 specific antimuscarinics for OAB

A

less AEs

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40
Q

IM injection used for OAB with poor response/intolerance to antimuscarinics

A

botox

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41
Q

how do b3 agonists work for oab

A

relax detrusor

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42
Q

2 b3 agonists used for oab

A

mirabegron er, vibegron

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43
Q

AE of mirabegron?
leads to what caution

A

htn- avoid in uncontrolled HTN

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44
Q

4 agents used for stress incontinence

A

sudafed, midodrine, estrogen replacement, duloxetine (off label)

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45
Q

agent used for overflow incontinence

A

bethanechol

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46
Q

which drugs to avoid in BPH

A

TCAs, benadryl, disopyramide, sudefed, ephedrine, anticholinergics

47
Q

2 patho mechs of BPH

A

a1 receptors inc smooth muscle tone
5a-reductase enzymes increase cellularity

48
Q

1st line for bph?
2nd line?
no response w/ prost >30 cc?

A

1st- a block (pde5 if ed)
2nd- pde5
3rd prost >30cc- add 5ARI

49
Q

a1 nonselective antagonists for bph (3)

A

terazosin, doxazosin, prazosin

50
Q

a1a selective blockers for BPH (3)

A

silodosin, alfuzosin, tamsuolosin

51
Q

type II 5-a1 reductase inhibitor for bph

A

finasteride

52
Q

type I and II 5 a1 reductase inhibitor

A

dutasteride

53
Q

how long for 5ARI to work?
which is more potent

A

3-6 months
dutasteride more potent

54
Q

2 combo products approved for bph

A

dutast/tamsulosin (jalyn)
finast/tadalafil (entadfi)

55
Q

drug classes that may cause ED (13)

A

diuretics, antiHTN, CV drugs, antidepress, tranquilizers, H2Ras, hormones, cytotoxic agents, immunomod, anticholinergic, recreational drugs, opioids, nsaids

56
Q

which 2 htn meds may worsen erectile function

A

thiazides and BB (not nebivolol)

57
Q

major DDI with pde-5

58
Q

contraindication for pde5s

A

do not use with nitrate therapy

59
Q

4 pde5 inhibitors

A

sildenafil, vardenafil, tadalafil, avanafil

60
Q

which pde5 had quickest onset

61
Q

which pde5 works longest

62
Q

which 2 pde5 have lower cmax/tmax when taken with food

A

sildenafil, vardenafil

63
Q

general wait time for nitrates after taking a pde5

A

~24 hours (48 for tadalafil)

64
Q

which drugs/classes are used for delusions/hallucinations in dementia (5)

A

aripiprazole, olanzapine, quetiapine, risperidone, brexpiprazole

any aps, but above are preferred

65
Q

meds used for hallucinations/delusions in dementia with parkinsons or lewy body

A

quetiapine, olanzapine, pimavanserin

66
Q

drugs used for depressive episodes in dementia

A

SSRIs, SNRIs

67
Q

do not use which meds for dementia depression (3)

A

paroxetine, desipramine, nortiptyline

68
Q

which med used for depression in dementia WITH INSOMNIA AND WEIGHTLOSS?

WHEN SEDATION DESIRED?

A

insomnia/weight loss- mirtazipine
sedation- trazodone

69
Q

3 drugs used for apathy in dementia

A

methylphenidate, dextroamphetamine, modafinil

70
Q

4 agents used for manic behavior in dementia?
which is preferred? why?

A

divalproex, lamotrigine, lithium, carbamazepine

divalproex preferred- sprinkle caps, tolerable

71
Q

which meds used for agitation in dementia d/t PSYCHOSIS

A

aripiprazole, olanzapine, quetiapine, risperidone, brexpiprazole

72
Q

which meds used for agitation in dementia d/t DEPRESSION

73
Q

which meds used for agitation in dementia d/t ANXIETY/MILD IRRITABILITY

A

buspirone, trazodone

74
Q

which meds used for agitation in dementia UNRESPONSIVE TO 1ST LINE

A

divalproex, olanzapine, carbamazepine

75
Q

which meds used for agitation in dementia with SEXUAL AGGRESSION

A

2nd gen APS, divalproex
estrogens 2nd line

76
Q

agents used ACUTE for sundowning in dementia? CHRONIC?

A

acute- trazodone, APS
chronic- above or melatonin

77
Q

agents used ACUTE for insomnia in dementia? CHRONIC?

A

acute- trazodone, melatonin, benzos, mirtazapine
chronic- trazodone, melatonin

78
Q

4 steps of nociceptive pain

A

stimulation – transmission – perception – modulation

79
Q

what is used 1st for mild pain

A

apap +/- nsaid

80
Q

what is used for moderate pain

A

combo opioid + apap/nsaid +/- adjuvant

81
Q

what is used for severe chronic pain

A

opioid analgesics +/- adjuvant

82
Q

pros of APAP for pain? cons?

A

pros- mild/mod pain, elderly safe, adjunct
cons- hepatic, patient perception

83
Q

total daily apap use

A

4 grams per day

84
Q

cons of nsaids/cox2 for pain

A

ceiling effect, GI/renal/CV risks

85
Q

ddi with NSAIDs

86
Q

contraindications to nsaids

A

pud, ckd, hf

87
Q

topical nsaid useful for localized persistent nonneuro pain

A

diclofenac

88
Q

adjuncts for neuro pain

A

SNRI, pregabalin, gabapentin, TCAs
topical- lidocaine, capsaicin

89
Q

AEs of opioids

A

resp depression, miosis, constipation, lethargy, sedation, etc

90
Q

agents to manage NV due to opiates

A

zofran, meclizine, hydroxyzine, scopolamine, prochlorperazine, metoclopramide, etc

91
Q

main agents to manage constipation due to opiates

A

docusate + senna/bisacodyl

op antag- naloxegol, methylnaltrexone, nalmefene

92
Q

signs of opioid OD

A

sev resp depression, apnea, decreased consciousness, unarousable, pinpoint pupils

93
Q

preferred opioids in elderly

A

morphine, hydrocodone, oxycodone, hydromorphone, fentanyl

94
Q

active total care of patient whose disease is not responsive to curative treatment, may be in conjunction with curative care

A

palliative care

95
Q

palliative care delivered in last 6 mos of life

96
Q

main toolkit for palliative care (7)

A

intensol, morphine, lorazepam, haloperidol, atropine, dexamethasone, ondansetron

97
Q

palliative treatment
gut wall associated NV

A
  1. h2ra, ppi
  2. metoclopramide
  3. zofran
98
Q

palliative treatment
area postrema associated NV

A
  1. haloperidol, metoclopramide
  2. 1 + dexamethasone, pamidronate
  3. zofran + dexamethasone
99
Q

palliative treatment
movement/vertigo associated NV

A
  1. benadryl, dimenhydrinate
  2. meclizine, cyclizine
  3. glycopyrrolate, scopolamine
100
Q

palliative treatment
dyspnea

A
  1. based on cause
  2. ipratro/albu +/- dexamethasone
  3. morphine +/- dexamethasone
  4. morphine + chlorpromazine/diazepam/midazolam
101
Q

palliative treatment
cough

A
  1. treat cause
  2. nebulized saline and/or guaifenesin
  3. morphine, hydrocodone, DXM
  4. dexamethasone or glycopyrrolate/atropine; NAC
  5. neb lidocaine, gabapentin
102
Q

palliative treatment
PREVENT constipation

A
  1. opioid induced- senna/bisa +/- docusate +/- metoclopramide
    Age/disease- finer fluid docusate
  2. sorbitol, lactulose, peg
  3. mom, mag citrate, bisacodyl supp
103
Q

palliative treatment
ACUTE constipation

A
  1. stim lax
  2. double dose
  3. osmotic lax
  4. MOM
  5. bisacodyl supp
  6. naloxegol, methylnaltrexone
  7. nuclear enema
104
Q

palliative treatment
BOWEL OBSTRUCTION

A
  1. metoclopramide +/- dexamethasone
  2. glycopyrrolate +/- morphine +/- haloperidol
  3. octreotide +/- above
  4. PEG tube or stent
105
Q

palliative treatment
asthenia

A
  1. energy conserve measures
  2. methylphenidate, dexamethasone
106
Q

palliative treatment
depression

A
  1. SSRI +/- methylphen
  2. amitriptyline/nortriptyline +/- methylphen

(both if >4 weeks live^^)

  1. methylphen, ketamine
107
Q

palliative treatment
anorexia/cachexia

A
  1. treat cause
  2. metoclopramide
  3. <3mos dexamethasone; >3 mos mirtazipine, megestrol
  4. dronabinol
108
Q

palliative treatment
insomnia

A
  1. treat causes
  2. initiate sleep- trazodone, melatonin, zolpidem, temazepam; stay sleep- haloperidol; depression- mirtazipine, amitriptyline
  3. inc doses/combos, substitute midazolam or lorazepam
109
Q

palliative treatment
xerostomia

A
  1. ice chips, gum, lemon drops
  2. saliva substitute
  3. pilocarpine
110
Q

palliative treatment
terminal secretions

A
  1. atropine drops NO SOONER THAN END STAGE
  2. scopolamine, glycopyrrolate
111
Q

palliative treatment
empiric sedation selection

A

opioids, benzos, neuroleptics, barbiturates, anesthetics, combos

112
Q

Palliative treatment
Anxiety

A
  1. Nonpharm
  2. Short term lorazepam, alprazolam, amaitriptyline (w/ depress)
  3. Long term buspiron, ssri, mirtazipine (w/ depress, insomnia, anorexia)
113
Q

Palliative treatment
Delirium

A
  1. Haloperidol
  2. Haloperidol + lorazepam
  3. Haloperidol + midazolam or chlorpromazine

Therapeutics (31 decks)

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