Geriatrics Flashcards
1
Q
fat is what in elderly
A
increased
2
Q
bone, water, and muscle are what in elderly
A
decreased
3
Q
what generally occurs with the CV system and the CNS in the elderly
A
functional decline
4
Q
kidney nephron degeneration and decreased renal BF leads to
A
decline in renal function
5
Q
is the respiratory system normal in elderly?
A
normal at rest, compromised under stress
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
7
Q
excess vulnerability to stressors which reduce ability to maintain or regain homeostasis after a destabilizing event
A
frailty
8
Q
hallmark indicators of frailty
A
weight loss, self reported exhaustion, low energy expenditure, slow gait, weak grip strength
9
Q
common geriatric syndromes (9)
A
dementia, delirium, urinary incontinence, falls, dizziness, syncope, malnutrition, pressure ulcers, sleep problems
10
Q
gastric ph in elderly is
A
higher (less acidic)
11
Q
how is oral bioavailability affected
A
reduced 1st pass- may inc bioavailability of high ER drugs
12
Q
drying of skin affects absorption of transdermal products how?
A
less absorption of hydrophilic drugs
13
Q
what syndrome in elderly affects absorption of patches such as fentanyl
A
cachexia
14
Q
inc fat and dec water affects drug distribution by
A
inc dist of lipophilic
dec dist/higher conc of hydrophilic
15
Q
decreased lean body mass affects distribution and causes
A
increased drug conc in blood
16
Q
which phase 1 metab processes are decreased
A
hydroxylation, demethylation
17
Q
how is the liver changed to affect metab
A
decrease mass and volume
18
Q
is phase 2 metab affected?
A
reduced glucuronidation in very old
19
Q
which classes may not metabolize well in elderly (5)
A
benzos, nsaids, ccbs, antidepress, some antiepileptics
20
Q
which drugs elimination are affected by renal function decline (6))
A
ace, hydrophilic BB, -cyclovir, aminoglycosides, vanco, some psych meds, etc
21
Q
4 tools used to identify PIMs
A
BEers, start/stopp, med appropriateness index, anticholinergic risk scale
22
Q
anticholinergic meds that may not be safe (5)
A
oxybutynin, amitriptyline, paroxetine, atropine, tolterodine, etc
23
Q
effects of anticholinergics
A
limitations in physical/cog function, increased dementia risk
24
Q
4 main classes “not safe” for elderly
A
anticholinergic, benzos, antidepressants, nsaids
25
3 major risks of nsaids
GI bleed, CV risks, renal considerations
26
which drugs/classes are FRIDs (6)?
loops, benzos, antidepressants, antipsychotics, sed/hypnotic, opioids, etc
27
which receptors in the LUT are responsible for storage of urine
B3 adrenergic
28
which receptors in the LUT are responsible for voiding
M3 receptors
29
which meds/classes can cause incontinence (11)
a agonist/antagonist, alcohol, anticholinergic, cholinesterase inhibitors, CCBs, diuretics, narcotics, antidepressants, antipsychotics, sed/hyp
30
agent used for nocturia with 2 or more night time wakings
desmopressin
31
warnings for desmopressin?
fluid retention, hyponatremia, nasal conditions
32
contraindications for desmopressin
hyponatremia, polydipsia, nocturnal enuresis, loops, steroids, low renal function, SIADH, illness causing imbalance, HF, uncontrolled HTN
33
what is 1st line for oab?
2nd line?
1st behavioral (maybe pharm)
2nd- anti-M or B3 agonist
34
how do M receptor antagonists work for OAB?
relax smooth muscle
35
AEs of antimuscarinics for OAB
confusion, delirium, dementia, urinary retention, dry mouth, etc (anticholinergic)
36
6 antimuscarinics for OAB
oxybutynin, tolterodine, trospium, darifenacin, solifenacin, fesoterodine
37
which 3 OAB antimuscarinics have low BBB crossing
tolterodine, trospium, fesoterodine
38
which 2 antimuscarinics for OAB are M3 specific
darifenacin, solifenacin
39
benefit of ER and M3 specific antimuscarinics for OAB
less AEs
40
IM injection used for OAB with poor response/intolerance to antimuscarinics
botox
41
how do b3 agonists work for oab
relax detrusor
42
2 b3 agonists used for oab
mirabegron er, vibegron
43
AE of mirabegron?
leads to what caution
htn- avoid in uncontrolled HTN
44
4 agents used for stress incontinence
sudafed, midodrine, estrogen replacement, duloxetine (off label)
45
agent used for overflow incontinence
bethanechol
46
which drugs to avoid in BPH
TCAs, benadryl, disopyramide, sudefed, ephedrine, anticholinergics
47
2 patho mechs of BPH
a1 receptors inc smooth muscle tone
5a-reductase enzymes increase cellularity
48
1st line for bph?
2nd line?
no response w/ prost >30 cc?
1st- a block (pde5 if ed)
2nd- pde5
3rd prost >30cc- add 5ARI
49
a1 nonselective antagonists for bph (3)
terazosin, doxazosin, prazosin
50
a1a selective blockers for BPH (3)
silodosin, alfuzosin, tamsuolosin
51
type II 5-a1 reductase inhibitor for bph
finasteride
52
type I and II 5 a1 reductase inhibitor
dutasteride
53
how long for 5ARI to work?
which is more potent
3-6 months
dutasteride more potent
54
2 combo products approved for bph
dutast/tamsulosin (jalyn)
finast/tadalafil (entadfi)
55
drug classes that may cause ED (13)
diuretics, antiHTN, CV drugs, antidepress, tranquilizers, H2Ras, hormones, cytotoxic agents, immunomod, anticholinergic, recreational drugs, opioids, nsaids
56
which 2 htn meds may worsen erectile function
thiazides and BB (not nebivolol)
57
major DDI with pde-5
cyp3a4
58
contraindication for pde5s
do not use with nitrate therapy
59
4 pde5 inhibitors
sildenafil, vardenafil, tadalafil, avanafil
60
which pde5 had quickest onset
avanafil
61
which pde5 works longest
tadalafil
62
which 2 pde5 have lower cmax/tmax when taken with food
sildenafil, vardenafil
63
general wait time for nitrates after taking a pde5
~24 hours (48 for tadalafil)
64
which drugs/classes are used for delusions/hallucinations in dementia (5)
aripiprazole, olanzapine, quetiapine, risperidone, brexpiprazole
any aps, but above are preferred
65
meds used for hallucinations/delusions in dementia with parkinsons or lewy body
quetiapine, olanzapine, pimavanserin
66
drugs used for depressive episodes in dementia
SSRIs, SNRIs
67
do not use which meds for dementia depression (3)
paroxetine, desipramine, nortiptyline
68
which med used for depression in dementia WITH INSOMNIA AND WEIGHTLOSS?
WHEN SEDATION DESIRED?
insomnia/weight loss- mirtazipine
sedation- trazodone
69
3 drugs used for apathy in dementia
methylphenidate, dextroamphetamine, modafinil
70
4 agents used for manic behavior in dementia?
which is preferred? why?
divalproex, lamotrigine, lithium, carbamazepine
divalproex preferred- sprinkle caps, tolerable
71
which meds used for agitation in dementia d/t PSYCHOSIS
aripiprazole, olanzapine, quetiapine, risperidone, brexpiprazole
72
which meds used for agitation in dementia d/t DEPRESSION
SSRI
73
which meds used for agitation in dementia d/t ANXIETY/MILD IRRITABILITY
buspirone, trazodone
74
which meds used for agitation in dementia UNRESPONSIVE TO 1ST LINE
divalproex, olanzapine, carbamazepine
75
which meds used for agitation in dementia with SEXUAL AGGRESSION
2nd gen APS, divalproex
estrogens 2nd line
76
agents used ACUTE for sundowning in dementia? CHRONIC?
acute- trazodone, APS
chronic- above or melatonin
77
agents used ACUTE for insomnia in dementia? CHRONIC?
acute- trazodone, melatonin, benzos, mirtazapine
chronic- trazodone, melatonin
78
4 steps of nociceptive pain
stimulation -- transmission -- perception -- modulation
79
what is used 1st for mild pain
apap +/- nsaid
80
what is used for moderate pain
combo opioid + apap/nsaid +/- adjuvant
81
what is used for severe chronic pain
opioid analgesics +/- adjuvant
82
pros of APAP for pain? cons?
pros- mild/mod pain, elderly safe, adjunct
cons- hepatic, patient perception
83
total daily apap use
4 grams per day
84
cons of nsaids/cox2 for pain
ceiling effect, GI/renal/CV risks
85
ddi with NSAIDs
aspirin
86
contraindications to nsaids
pud, ckd, hf
87
topical nsaid useful for localized persistent nonneuro pain
diclofenac
88
adjuncts for neuro pain
SNRI, pregabalin, gabapentin, TCAs
topical- lidocaine, capsaicin
89
AEs of opioids
resp depression, miosis, constipation, lethargy, sedation, etc
90
agents to manage NV due to opiates
zofran, meclizine, hydroxyzine, scopolamine, prochlorperazine, metoclopramide, etc
91
main agents to manage constipation due to opiates
docusate + senna/bisacodyl
op antag- naloxegol, methylnaltrexone, nalmefene
92
signs of opioid OD
sev resp depression, apnea, decreased consciousness, unarousable, pinpoint pupils
93
preferred opioids in elderly
morphine, hydrocodone, oxycodone, hydromorphone, fentanyl
94
active total care of patient whose disease is not responsive to curative treatment, may be in conjunction with curative care
palliative care
95
palliative care delivered in last 6 mos of life
hospice
96
main toolkit for palliative care (7)
intensol, morphine, lorazepam, haloperidol, atropine, dexamethasone, ondansetron
97
palliative treatment
gut wall associated NV
1. h2ra, ppi
2. metoclopramide
3. zofran
98
palliative treatment
area postrema associated NV
1. haloperidol, metoclopramide
2. 1 + dexamethasone, pamidronate
3. zofran + dexamethasone
99
palliative treatment
movement/vertigo associated NV
1. benadryl, dimenhydrinate
2. meclizine, cyclizine
3. glycopyrrolate, scopolamine
100
palliative treatment
dyspnea
1. based on cause
2. ipratro/albu +/- dexamethasone
3. morphine +/- dexamethasone
4. morphine + chlorpromazine/diazepam/midazolam
101
palliative treatment
cough
1. treat cause
2. nebulized saline and/or guaifenesin
3. morphine, hydrocodone, DXM
4. dexamethasone or glycopyrrolate/atropine; NAC
5. neb lidocaine, gabapentin
102
palliative treatment
PREVENT constipation
1. opioid induced- senna/bisa +/- docusate +/- metoclopramide
Age/disease- finer fluid docusate
2. sorbitol, lactulose, peg
3. mom, mag citrate, bisacodyl supp
103
palliative treatment
ACUTE constipation
1. stim lax
2. double dose
3. osmotic lax
4. MOM
5. bisacodyl supp
6. naloxegol, methylnaltrexone
7. nuclear enema
104
palliative treatment
BOWEL OBSTRUCTION
1. metoclopramide +/- dexamethasone
2. glycopyrrolate +/- morphine +/- haloperidol
3. octreotide +/- above
4. PEG tube or stent
105
palliative treatment
asthenia
1. energy conserve measures
2. methylphenidate, dexamethasone
106
palliative treatment
depression
1. SSRI +/- methylphen
2. amitriptyline/nortriptyline +/- methylphen
(both if >4 weeks live^^)
3. methylphen, ketamine
107
palliative treatment
anorexia/cachexia
1. treat cause
2. metoclopramide
3. <3mos dexamethasone; >3 mos mirtazipine, megestrol
4. dronabinol
108
palliative treatment
insomnia
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
palliative treatment
xerostomia
1. ice chips, gum, lemon drops
2. saliva substitute
3. pilocarpine
110
palliative treatment
terminal secretions
1. atropine drops NO SOONER THAN END STAGE
2. scopolamine, glycopyrrolate
111
palliative treatment
empiric sedation selection
opioids, benzos, neuroleptics, barbiturates, anesthetics, combos
112
Palliative treatment
Anxiety
1. Nonpharm
2. Short term lorazepam, alprazolam, amaitriptyline (w/ depress)
3. Long term buspiron, ssri, mirtazipine (w/ depress, insomnia, anorexia)
113
Palliative treatment
Delirium
1. Haloperidol
2. Haloperidol + lorazepam
3. Haloperidol + midazolam or chlorpromazine
