Geriatrics

Question 1

Polypharmacy is the concurrent use of ___ or more drugs, regular consumption of ___ meds, use of ___-risk meds.

Answer 1

2, multiple, high

Question 2

Factors that can contribute to polypharmacy include: ___ conditions, ___-medication, lack of ___, multiple ___.

Answer 2

chronic, self, knowledge, providers

Question 3

Elderly have less ___ ___ effect for metabolism, so meds like CCB can have hypotensive effect.

Answer 3

first pass

Question 4

Lean mass and total body water ___ in elderly.

Answer 4

decrease

Question 5

Water-soluble compounds like ___ and ___ can have an increased effect on elderly and may cause toxicity.

Answer 5

Digoxin, Lithium

Question 6

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.

Answer 6

increases, diazepam, alprazolam, prolonged

Question 7

High protein-bound have ___ binding. Meds like ___ and ___ should be cut in half for elderly.

Answer 7

decreased, warfarin, phenytoin

Question 8

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.

Answer 8

decrease, 2-3, falls

Question 9

General rule of thumb:

Answer 9

Start low and go slow. Use lowest dose for shortest amt of time.

Question 10

GFR ___ w/aging. Important to calculate ___ ___. Dosage of drugs eliminated by kidneys will need to be ___.

Answer 10

declines, creatinine clearance, decreased

Question 11

Normal GFR is ___-___.

Answer 11

90-100

Question 12

What the drug does to the body and is the observed clinical response is known as ___ changes.

Answer 12

pharmacodynamic

Question 13

Alcohol can cause increased ___. Opioids can cause ___ changes. Anticholinergics can cause ___. Antipsychotics and metoclopramide can cause ___ symptoms.

Answer 13

drowsiness, behavioral, delirium, extrapyramidal

Question 14

BB’s can cause a ___ HR response and cause ___ ___.

Answer 14

diminished, orthostatic hypotension

Question 15

___ should be avoided in elderly d/t increasing risk for GI effects and inhibiting renal blood flow, increasing sodium retention, and causing HTN.

Answer 15

NSAIDS

Question 16

Important to use anxioloytic/hypnotic agents w/___ half-life and avoid agents w/___ half-life like ___.

Answer 16

shorter, long, valium/diazepam

Question 17

OTC ___ can cause sedation, delirium, dizziness, confusion, unsteady gait, hangover effect, and blurred vision.

Answer 17

Benadryl

Question 18

Anxiolytics can cause ___ ___ in elderly and have opposite effect, making them agitated.

Answer 18

paradoxical excitement

Question 19

Anticholinergic ___ refers to an accumulation of medications that have ___ properties.

Answer 19

burden, anticholinergic

Question 20

Anticholinergic s/e include:

Answer 20

dry mouth, constipation, tachy, urinary retention, glaucoma problems, sedation, confusion, delirium, dizziness

Question 21

___ are the best choice for antidepressants in the elderly. Avoid ___.

Answer 21

SSRI’s, TCA’s

Question 22

___ is the most appropriate BB for elderly b/c it is least liphophilic.

Answer 22

Atenolol

Question 23

Normal serum dig level is ___-___.

Answer 23

0.5-2.0

Question 24

Digitalis is used for control of ___, not ___ alone.

Answer 24

A-fib, CHF

Question 25

H2 blockers have ___ effects. Safest for elderly are ___ and ___ b/c they have weak ___ properties. Do not use ___ d/t CNS effects.

Answer 25

anticholinergic, ranitidine (Zantac), famotidine (Pepcid), anticholinergic, cimetidine (Tagamet)

Question 26

Antipsychotics are used in the tx of ___ to control hallucinations and psychosis. ___ is the DOC, but has increased risk for ___ symptoms and ___ events.

Answer 26

dementia, Risperidone (Risperdal), extrapyramidal, CV

Question 27

Factors contributing to adverse drug events (ADE’s) include:

Answer 27

multiple comorbidities, memory issues, multiple meds

Question 28

Drug to disease interaction:
Parkinson's disease
Constipation
Diabetes
Seizures

Answer 28

• 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

Question 29

Drug to drug interactions:
warfarin and ___
PPI and ___
warfarin and ___

Answer 29

any antibx
clopidogrel (Plavix)
Digoxin

Question 30

Meds that have higher risk for falls include:

Answer 30

benzo’s, hypnotics, anxiolytics, antiHTN, diuretics, SSRI’s/TCA’s

Question 31

The ___ list provides a list of meds that are potentially inappropriate for older adults.

Answer 31

Beers

Question 32

D/C drugs when possible if ___ is unclear or s/e could be d/t ___.

Answer 32

benefit, med

Question 33

ADE’s in elderly occur more ___, are present at ___ doses, are more ___, and have a ___ impact.

Answer 33

frequently, lower, pronounced, greater

Question 34

Use ___ dly dose regimens, limit the use of ___ meds, d/c a drug if it is ___, provide legible ___ instruction, instruct ___.

Answer 34

single, PRN, ineffective, written, caregivers

Question 35

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.

Answer 35

one, ACE inhibitor

Question 36

At least ___, ask elderly pts to bring in meds from ___.

Answer 36

yearly, home

Question 37

Use one ___. Avoid seeing multiple ___. Do not use meds from ___.

Answer 37

pharmacy, providers, others

Question 38

Attempted to prescribe a drug that will tx more than ___ existing problem. Example is ___ to tx both HTN, CHF, and renal protection for diabetics.

Answer 38

one, ACE inhibitor