Geriatrics Flashcards
Polypharmacy is the concurrent use of ___ or more drugs, regular consumption of ___ meds, use of ___-risk meds.
2, multiple, high
Factors that can contribute to polypharmacy include: ___ conditions, ___-medication, lack of ___, multiple ___.
chronic, self, knowledge, providers
Elderly have less ___ ___ effect for metabolism, so meds like CCB can have hypotensive effect.
first pass
Lean mass and total body water ___ in elderly.
decrease
Water-soluble compounds like ___ and ___ can have an increased effect on elderly and may cause toxicity.
Digoxin, Lithium
Fat content ___ in elderly, so there is an increased volume of distribution of lipid-soluble meds like ___ and ___ - their activity is ___, which may cause increased sedation in elderly.
increases, diazepam, alprazolam, prolonged
High protein-bound have ___ binding. Meds like ___ and ___ should be cut in half for elderly.
decreased, warfarin, phenytoin
Liver mass and blood flow ___, along w/Cytochrome P450. This means that half-life of meds like diazepam and alprazolam increases ___-___ fold. There is also in increased risk of ___ during first few wks of tx.
decrease, 2-3, falls
General rule of thumb:
Start low and go slow. Use lowest dose for shortest amt of time.
GFR ___ w/aging. Important to calculate ___ ___. Dosage of drugs eliminated by kidneys will need to be ___.
declines, creatinine clearance, decreased
Normal GFR is ___-___.
90-100
What the drug does to the body and is the observed clinical response is known as ___ changes.
pharmacodynamic
Alcohol can cause increased ___. Opioids can cause ___ changes. Anticholinergics can cause ___. Antipsychotics and metoclopramide can cause ___ symptoms.
drowsiness, behavioral, delirium, extrapyramidal
BB’s can cause a ___ HR response and cause ___ ___.
diminished, orthostatic hypotension
___ should be avoided in elderly d/t increasing risk for GI effects and inhibiting renal blood flow, increasing sodium retention, and causing HTN.
NSAIDS
Important to use anxioloytic/hypnotic agents w/___ half-life and avoid agents w/___ half-life like ___.
shorter, long, valium/diazepam
OTC ___ can cause sedation, delirium, dizziness, confusion, unsteady gait, hangover effect, and blurred vision.
Benadryl
Anxiolytics can cause ___ ___ in elderly and have opposite effect, making them agitated.
paradoxical excitement
Anticholinergic ___ refers to an accumulation of medications that have ___ properties.
burden, anticholinergic
Anticholinergic s/e include:
dry mouth, constipation, tachy, urinary retention, glaucoma problems, sedation, confusion, delirium, dizziness
___ are the best choice for antidepressants in the elderly. Avoid ___.
SSRI’s, TCA’s
___ is the most appropriate BB for elderly b/c it is least liphophilic.
Atenolol
Normal serum dig level is ___-___.
0.5-2.0
Digitalis is used for control of ___, not ___ alone.
A-fib, CHF
H2 blockers have ___ effects. Safest for elderly are ___ and ___ b/c they have weak ___ properties. Do not use ___ d/t CNS effects.
anticholinergic, ranitidine (Zantac), famotidine (Pepcid), anticholinergic, cimetidine (Tagamet)
Antipsychotics are used in the tx of ___ to control hallucinations and psychosis. ___ is the DOC, but has increased risk for ___ symptoms and ___ events.
dementia, Risperidone (Risperdal), extrapyramidal, CV
Factors contributing to adverse drug events (ADE’s) include:
multiple comorbidities, memory issues, multiple meds
Drug to disease interaction: Parkinson's disease Constipation Diabetes Seizures
- carbidopa/levodopa increases risk of hallucinations and confusion
- increased risk w/CCB’s, anticholinergics
- blunted hypoglycemic symp w/BB’s
- lowered seizure threshold w/quinolones, antidepressants, and tramadol
Drug to drug interactions:
warfarin and ___
PPI and ___
warfarin and ___
any antibx
clopidogrel (Plavix)
Digoxin
Meds that have higher risk for falls include:
benzo’s, hypnotics, anxiolytics, antiHTN, diuretics, SSRI’s/TCA’s
The ___ list provides a list of meds that are potentially inappropriate for older adults.
Beers
D/C drugs when possible if ___ is unclear or s/e could be d/t ___.
benefit, med
ADE’s in elderly occur more ___, are present at ___ doses, are more ___, and have a ___ impact.
frequently, lower, pronounced, greater
Use ___ dly dose regimens, limit the use of ___ meds, d/c a drug if it is ___, provide legible ___ instruction, instruct ___.
single, PRN, ineffective, written, caregivers
Attempt to prescribe a drug that will treat more than ___ existing problem. Examples: ___ to tx both HTN, heart failure, and for renal protection in diabetes.
one, ACE inhibitor
At least ___, ask elderly pts to bring in meds from ___.
yearly, home
Use one ___. Avoid seeing multiple ___. Do not use meds from ___.
pharmacy, providers, others
Attempted to prescribe a drug that will tx more than ___ existing problem. Example is ___ to tx both HTN, CHF, and renal protection for diabetics.
one, ACE inhibitor
