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Geriatrics Flashcards

1
Q

What socioeconomic and physiologic factors make geriatric patients epsecially susceptible to adverse drug events?

A

frailty more common.
multiple diseases, nutritional problems, reduced financial resources, decreased dosing compliance, polypharmacy.
Average TN geriatric takes 43+ meds

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2
Q

What is the purpose of the Beers criteria?

A

panel to determine suitability of drugs for use in elderly

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3
Q

What qualifies as geriatric?

A

society says >65years

authority says > 75years

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4
Q

What is used to measure frailty?

A 
weight loss
exhaustion
weak grip
slow walk
low physical activity
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5
Q

What are common causes of ADEs in old people?

A

unnecessary drug use, inappropriate drug choice, long term use W/O review, inappropriate dosing regimen, inappropriate dosing regiments, therapeutic duplication

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6
Q

When should you suspect ADE drug effect in older patients?

A

if they become cognitively impaired, fall, or have N/V with weight loss

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7
Q

What is Cockcroft-Gault equation?

A

form estimating GFR based on age and serum creatinine.
GFR = (114-.8xage)/serum creatinine
x0.85 for women

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8
Q

Why doesn’t serum creatinine relfect decline in renal function in elderly?

A

because they also lose muscle mass and dont produce as much so levels stay same with loss of clearance and loss of production

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9
Q

Which drugs have highest CNS access?

A

diazepam, nicotine, ethanol, phenytoin, heroin, phenobarbital

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10
Q

What happens to gastric acidity with age? Gastric emptying and splanchnic blood flow?

A

all decrease. Low acidity changes absorption.

Slow emptying and low splanchnic blood flow affect 1st pass metabolism

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11
Q

What happens to body fat levels and lean body mass in elderly?

A

fat increases, lean mass decreases changing the distribution pattern of drugs

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12
Q

What happens to serum albumin in elderly?

A

decreases so less protein binding

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13
Q

What happens to monoamine oxidase in elderly?

A

it increases

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14
Q

What happens to acethylcoholine, dopamine and serotonin in elderly?

A

they all decrease

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15
Q

What is a common new symptom when starting narcotics in elderly?

A

constipation

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16
Q

What is a common new symptom when starting aminoglycosides in elderly?

A

renal failure, hearing loss

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17
Q

What is a common new symptom when starting anticholinergics in elderly?

A

dry mouth, constipation, urine retention, delirium

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18
Q

What is a common new symptom when starting antiarrhytmics in elderly?

A

diarrhea (quinidine); urine retention (disopyramide)

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19
Q

What is a common new symptom when starting diuretics in elderly?

A

dehydration, hyponatremia, hypokalemia, incontinence

20
Q

What is a common new symptom when starting antipsychotics in elderly?

A

delirium, sedation, hypotension, extrapyramidal disorders

21
Q

What is a common new symptom when starting sedatives/hypnotics in elderly?

A

excessive sedation, delirium, gait trouble

22
Q

What drug will interfere with oral hypoglycemics, aspirins, and chloral hydrates?

A

warfarin. Will cause protein binding displacement

23
Q

What OTC used by elderly commonly will interfere with absorption of digoxin, isoniazid, and antipsychotics?

A

antacids

24
Q

What OTC used by elderly can alter the metabolism of propranolol or phenytoin?

A

cimetidine

25
Q

What common product causes increased bioavailabiliyt of DM, midazolam or imatinib?

A

grapefruit juice

26
Q

What must be avoided in elderly with glaucoma?

A

antimuscarinics

27
Q

What can cause acute decompensation if given to elderly with CHF?

A

BBs or verapamil

28
Q

What drug can cause heart block if given to elderly with conduction disorders?

A

TCAs

29
Q

What OTC can cause increased BP in elderly with HTN?

A

NSAIDs

30
Q

What drug can cause intermittent claudication in elderly with peripheral vascular disease?

A

BBs

31
Q

What drug can cause bronchoconstriction in elderly with COPD?

A

BBs

32
Q

What drugs can trigger acute renal failure in elderly with chronic renal impairment?

A

NSAIDs, contrast, aminoglycosides

33
Q

What drugs can worsen hyperglycemia in diabetics?

A

diuretics and prednisone

34
Q

What drug class will cause urinary retention in BPH patients?

A

antimuscarinics

35
Q

Can BBs sorsen depression?

A

yes. so can antiHTN, alcohol, BNZ, and steroids

36
Q

When is digoxin contraindicated?

A

hypokalemia. it will cause cardiac arrhtym

37
Q

In addition to antihistamines, what drug classes can also have anticholinergic activity?

A

antiparkinson agents - benzotropine, trihexyphenidyl
skeletal relaxants - carisoprodol, cyclobenzaprine
urinary incontinence agents - darifenacin, trospium
Antidepressants - amitriptyline, doxepin
antipsychotics - chlorpromazine, clozapine,

38
Q

What medication has high risk of prolong QT in elderly with dysrhythmias?

A

TCAs

39
Q

What drug has high risk of worsening hyponatremia?

A

SSRIs

40
Q

What drugs have high risk of syncope and falling in patients who already have orthostatic hypotension?

A

diuretics, a-blockers, vasodilators

41
Q

What drugs have high risk for worsening heart failure?

A

drugs with inotropic effects (disopyramide drugs with high Na content like bisphosphate, citrate or salicylate

42
Q

What are the preferred BNZs for elderly because they are less likely to cause falls?

A

alprazolam, temazepam and lorazepam because they are short acting

43
Q

What antidepressant should be avoided in elderly bcuase of its strong anticholinergic and sedative properties? What should be given instead?

A

amitriptyline makes you trip.

Give SSRI like citalopram or escitalopram instead

44
Q

What is disopyramide?

A

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.

45
Q

ADE of disopyramide

A

strong anticholinergic effects so galucoma, excacerbation of BPH. Should be avoided in elderly. May induce heart failure becuase potent inotropic effects.

46
Q

What three drugs have been deemed too risky by the Beers criteria for elderly?

A

warfarin, digoxin and insulin

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