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Pharm II Exam 4 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What conditions can present atypically w/ confusion in older adults?

A

Acute MI
CHF
URI
UTI

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2
Q

Older adults w/ a GI bleed can present atypically w/ ___

A

AMS

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3
Q

Describe medication use among older adults

A

OTC med use = 46%

Herbal & dietary = 38-49%

Sharing meds = 13-20%

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4
Q

Define polypharmacy

A

Either the concomitant use of multiple drugs OR the administration of more meds than are indicated

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5
Q

What % of prescription drugs is consumed today vs in the future?

A

Today = 33%

By 2040, will be 50%

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6
Q

Which population is at greatest risk for taking multiple meds?

A

Nursing home living elders

7-9 different meds/day

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7
Q

In nursing homes, how much is spent on ADEs for every $1.00 spent on med?

A

$1.33

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8
Q

What are predictors of ADEs?

A

≥ 6 concurrent chronic conditions

≥ 9 meds

≥ 12 doses of drugs/day

Prior ADE

Low body weight / BMI

≥ 85 yo

CrCl < 50

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9
Q

What are the most common meds involved in ADEs?

A

CV

Diuretics

NSAIDs

Hypoglycemics

Anticoagulants

Meds w/ narrow margin of safety

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10
Q

What % of all prescribed meds are estimated to be inappropriately selected or dosed?

A

25%

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11
Q

What % of all meds for older people is considered unnecessary?

A

30%

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12
Q

What criteria is used for potentially inappropriate medication in older adults?

A

Beers

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13
Q

According to the beers criteria, what drugs are commonly used inappropriately?

A 
Antihistamines
Anticholinergics
GI/antispasmotics
Antipsychotics
Benzos 
TCAs 
Sedatives/hypnotics
Anticoagulants/antiplatelets
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14
Q

What does the beers criteria say about first-gen antihistamines?

A

clearance reduced w/ advance age

risk of tolerance, confusion, dry mouth, & constipation

Therefore they should be avoided in older adults

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15
Q

How does body composition change in older adults?

A 
↓ Total body water
↓ Lean body mass
↑ Body fat
↔ or ↓ Serum albumin
↑ α1-Acid glycoprotein
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16
Q

What changes in the CV system are seen in older adults?

A

↓ CO

↑ SVR w/ loss of arterial elasticity & dysfunction of systems maintaining vascular tone

17
Q

What change in the endocrine system is seen in older adults?

A

Altered insulin signaling

18
Q

What changes in the GI system are seen in older adults?

A

↓ Motility of the large intestine

↓ Vitamin absorption by active transport

↓ Splanchnic blood flow

↓ Bowel surface area

19
Q

What changes in hepatic system are seen in older adults?

A

↓ Hepatic size

↓ Hepatic blood flow

↓ Phase I (oxidation, reduction, hydrolysis) metabolism

20
Q

What change in the pulmonary system is seen in older adults?

A

↓ Respiratory muscle strength

21
Q

What oral change is seen in older adults?

A

Altered dentition

22
Q

What renal changes are seen in older adults?

A 
↓ GFR
↓ Renal blood flow
↓ Filtration fraction
↓ Tubular secretory function
↓ Renal mass
23
Q

What skin change is seen in older adults?

A

Thinning of stratum corneum

24
Q

What is the action of phase I pathways?

A

Convert drugs to metabolites w/ pharmacologic effects than parent compound

*CYP3A4 is involved in 50% of drugs on the market

25
Q

What is the action of phase II pathways

A

Conjugate drugs to inactive metabolites that do not accumulate

*Less affected w/ age

26
Q

Does SCr reflect CrCl in older adults?

A

HELL NAH

27
Q

What is the “screening tool to alert doctors to the right treatment criteria” focused on?

A

identifying undertreatment of prescribing omissions in elderly

28
Q

Describe the prescribing cascade

A

Drug 1 (metoclopramide) –> ADE (parkinsonism) –> misinterpretation as a new condition –> Drug 2 (CCB & antiparkinsonism) –> ADE (peripheral edema) –> misinterpretation as a new condition –> Drug 3 (diuretics)

29
Q

What are common food interactions?

A 
Dairy
Coffee/tea
Grapefruit 
Alcohol 
Charcoal-broiled 
Green leafy veggies
Licorice 
Ginseng

Pharm II Exam 4 (14 decks)

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