Geriatrics Flashcards
What conditions can present atypically w/ confusion in older adults?
Acute MI
CHF
URI
UTI
Older adults w/ a GI bleed can present atypically w/ ___
AMS
Describe medication use among older adults
OTC med use = 46%
Herbal & dietary = 38-49%
Sharing meds = 13-20%
Define polypharmacy
Either the concomitant use of multiple drugs OR the administration of more meds than are indicated
What % of prescription drugs is consumed today vs in the future?
Today = 33%
By 2040, will be 50%
Which population is at greatest risk for taking multiple meds?
Nursing home living elders
7-9 different meds/day
In nursing homes, how much is spent on ADEs for every $1.00 spent on med?
$1.33
What are predictors of ADEs?
≥ 6 concurrent chronic conditions
≥ 9 meds
≥ 12 doses of drugs/day
Prior ADE
Low body weight / BMI
≥ 85 yo
CrCl < 50
What are the most common meds involved in ADEs?
CV
Diuretics
NSAIDs
Hypoglycemics
Anticoagulants
Meds w/ narrow margin of safety
What % of all prescribed meds are estimated to be inappropriately selected or dosed?
25%
What % of all meds for older people is considered unnecessary?
30%
What criteria is used for potentially inappropriate medication in older adults?
Beers
According to the beers criteria, what drugs are commonly used inappropriately?
Antihistamines Anticholinergics GI/antispasmotics Antipsychotics Benzos TCAs Sedatives/hypnotics Anticoagulants/antiplatelets
What does the beers criteria say about first-gen antihistamines?
clearance reduced w/ advance age
risk of tolerance, confusion, dry mouth, & constipation
Therefore they should be avoided in older adults
How does body composition change in older adults?
↓ Total body water ↓ Lean body mass ↑ Body fat ↔ or ↓ Serum albumin ↑ α1-Acid glycoprotein
What changes in the CV system are seen in older adults?
↓ CO
↑ SVR w/ loss of arterial elasticity & dysfunction of systems maintaining vascular tone
What change in the endocrine system is seen in older adults?
Altered insulin signaling
What changes in the GI system are seen in older adults?
↓ Motility of the large intestine
↓ Vitamin absorption by active transport
↓ Splanchnic blood flow
↓ Bowel surface area
What changes in hepatic system are seen in older adults?
↓ Hepatic size
↓ Hepatic blood flow
↓ Phase I (oxidation, reduction, hydrolysis) metabolism
What change in the pulmonary system is seen in older adults?
↓ Respiratory muscle strength
What oral change is seen in older adults?
Altered dentition
What renal changes are seen in older adults?
↓ GFR ↓ Renal blood flow ↓ Filtration fraction ↓ Tubular secretory function ↓ Renal mass
What skin change is seen in older adults?
Thinning of stratum corneum
What is the action of phase I pathways?
Convert drugs to metabolites w/ pharmacologic effects than parent compound
*CYP3A4 is involved in 50% of drugs on the market
What is the action of phase II pathways
Conjugate drugs to inactive metabolites that do not accumulate
*Less affected w/ age
Does SCr reflect CrCl in older adults?
HELL NAH
What is the “screening tool to alert doctors to the right treatment criteria” focused on?
identifying undertreatment of prescribing omissions in elderly
Describe the prescribing cascade
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)
What are common food interactions?
Dairy Coffee/tea Grapefruit Alcohol Charcoal-broiled Green leafy veggies Licorice Ginseng
