Geriatrics Flashcards
What socioeconomic and physiologic factors make geriatric patients epsecially susceptible to adverse drug events?
frailty more common.
multiple diseases, nutritional problems, reduced financial resources, decreased dosing compliance, polypharmacy.
Average TN geriatric takes 43+ meds
What is the purpose of the Beers criteria?
panel to determine suitability of drugs for use in elderly
What qualifies as geriatric?
society says >65years
authority says > 75years
What is used to measure frailty?
weight loss exhaustion weak grip slow walk low physical activity
What are common causes of ADEs in old people?
unnecessary drug use, inappropriate drug choice, long term use W/O review, inappropriate dosing regimen, inappropriate dosing regiments, therapeutic duplication
When should you suspect ADE drug effect in older patients?
if they become cognitively impaired, fall, or have N/V with weight loss
What is Cockcroft-Gault equation?
form estimating GFR based on age and serum creatinine.
GFR = (114-.8xage)/serum creatinine
x0.85 for women
Why doesn’t serum creatinine relfect decline in renal function in elderly?
because they also lose muscle mass and dont produce as much so levels stay same with loss of clearance and loss of production
Which drugs have highest CNS access?
diazepam, nicotine, ethanol, phenytoin, heroin, phenobarbital
What happens to gastric acidity with age? Gastric emptying and splanchnic blood flow?
all decrease. Low acidity changes absorption.
Slow emptying and low splanchnic blood flow affect 1st pass metabolism
What happens to body fat levels and lean body mass in elderly?
fat increases, lean mass decreases changing the distribution pattern of drugs
What happens to serum albumin in elderly?
decreases so less protein binding
What happens to monoamine oxidase in elderly?
it increases
What happens to acethylcoholine, dopamine and serotonin in elderly?
they all decrease
What is a common new symptom when starting narcotics in elderly?
constipation
What is a common new symptom when starting aminoglycosides in elderly?
renal failure, hearing loss
What is a common new symptom when starting anticholinergics in elderly?
dry mouth, constipation, urine retention, delirium
What is a common new symptom when starting antiarrhytmics in elderly?
diarrhea (quinidine); urine retention (disopyramide)
What is a common new symptom when starting diuretics in elderly?
dehydration, hyponatremia, hypokalemia, incontinence
What is a common new symptom when starting antipsychotics in elderly?
delirium, sedation, hypotension, extrapyramidal disorders
What is a common new symptom when starting sedatives/hypnotics in elderly?
excessive sedation, delirium, gait trouble
What drug will interfere with oral hypoglycemics, aspirins, and chloral hydrates?
warfarin. Will cause protein binding displacement
What OTC used by elderly commonly will interfere with absorption of digoxin, isoniazid, and antipsychotics?
antacids
What OTC used by elderly can alter the metabolism of propranolol or phenytoin?
cimetidine
What common product causes increased bioavailabiliyt of DM, midazolam or imatinib?
grapefruit juice
What must be avoided in elderly with glaucoma?
antimuscarinics
What can cause acute decompensation if given to elderly with CHF?
BBs or verapamil
What drug can cause heart block if given to elderly with conduction disorders?
TCAs
What OTC can cause increased BP in elderly with HTN?
NSAIDs
What drug can cause intermittent claudication in elderly with peripheral vascular disease?
BBs
What drug can cause bronchoconstriction in elderly with COPD?
BBs
What drugs can trigger acute renal failure in elderly with chronic renal impairment?
NSAIDs, contrast, aminoglycosides
What drugs can worsen hyperglycemia in diabetics?
diuretics and prednisone
What drug class will cause urinary retention in BPH patients?
antimuscarinics
Can BBs sorsen depression?
yes. so can antiHTN, alcohol, BNZ, and steroids
When is digoxin contraindicated?
hypokalemia. it will cause cardiac arrhtym
In addition to antihistamines, what drug classes can also have anticholinergic activity?
antiparkinson agents - benzotropine, trihexyphenidyl
skeletal relaxants - carisoprodol, cyclobenzaprine
urinary incontinence agents - darifenacin, trospium
Antidepressants - amitriptyline, doxepin
antipsychotics - chlorpromazine, clozapine,
What medication has high risk of prolong QT in elderly with dysrhythmias?
TCAs
What drug has high risk of worsening hyponatremia?
SSRIs
What drugs have high risk of syncope and falling in patients who already have orthostatic hypotension?
diuretics, a-blockers, vasodilators
What drugs have high risk for worsening heart failure?
drugs with inotropic effects (disopyramide drugs with high Na content like bisphosphate, citrate or salicylate
What are the preferred BNZs for elderly because they are less likely to cause falls?
alprazolam, temazepam and lorazepam because they are short acting
What antidepressant should be avoided in elderly bcuase of its strong anticholinergic and sedative properties? What should be given instead?
amitriptyline makes you trip.
Give SSRI like citalopram or escitalopram instead
What is disopyramide?
antiarrhythmic used to control v-fib. Works by inhibitng influx of Na through fast channels of mycaridal cells.
significant anticholinergic properties that severely depress SA node so no net change in HR.
ADE of disopyramide
strong anticholinergic effects so galucoma, excacerbation of BPH. Should be avoided in elderly. May induce heart failure becuase potent inotropic effects.
What three drugs have been deemed too risky by the Beers criteria for elderly?
warfarin, digoxin and insulin
