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CDM 1 > Geriatrics: Age-Related Changes > Flashcards

Geriatrics: Age-Related Changes Flashcards

1
Q

Aging

A

is a pattern of life changes that occurs as one grows older

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2
Q

Cardio vascular changes in old patients are

A

Hypertrophy cause by increase build ups
Ischemic area cause by debris
Fibrosis is building of fiber that decrease elasticity

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3
Q

Cardiovascular Aging effects on heart rate can

A

Decreased maximum HR and resting heart rate is same ( but the ability of heart rate decrease to reach maximum threshold )

Decreased sensitivity to beta stimulation which can decrease sensitivity to beta-blockers

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4
Q

Cardiovascular Aging effects on Vasculature

A

Blunted baroreceptor reflex means the ability of heart rate decrease to compensate the volume when it is more

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5
Q

Cardiovascular Aging also cause

A

1) Orthostatic hypotension which cause low blood flow during movement
2) HFpEF (Heart failure with preserved ejection fraction)
3) Bradycardia and Exercise intolerance

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6
Q

Respiratory Aging cause an Increase in ____ and decreased in _______

A

an increase in Energy of breathing (means more energy needed to breathe) (especially in smokers)
Increase Airway resistance
Increase Dead space

 and decrease in 
Respiratory muscle strength
Chest wall compliance
Total alveolar surface
Vital capacity
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7
Q

Gastrointestinal Aging of stomach

A

Decreased gastric acid secretion ( it will be hard for pt to digest food and protect the stomach)

Decreased taste sensation

Dysphagia/aspiration (trouble swallowing)

GERD

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8
Q

Gastrointestinal Aging of small intestine leads to

A 
Decreased absorption of calcium, folic acid, vitamin B12
Nutrient depletion 
Diverticulosis
Constipation
Incontinence (fecal/urine)
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9
Q

Gastrointestinal Aging of colon

A

Slow transit time

Increased water reabsorption

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10
Q

Renal Aging leads to

A

Decreased
Glomerular filtration rate –> has direct effect on drugs that excreted through urine
Aldosterone
Antidiuretic hormone (ADH)

Due to all these factor organ reserve increase and cause injury

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11
Q

Genitourinary Aging of Bladder/Urethra

A

Increased
Residual urine volume
Activity of detrusor muscle means even after emptying their is something in bladder

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12
Q

Pathophysiology of Genitourinary Aging of Bladder/Urethra cause

A 
Urinary frequency (overactive bladder)
Urinary retention/obstruction
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13
Q

Genitourinary Aging of women

A 
Decreased estrogen
Ovaries, uterus, vagina atrophy
Decreased lubrication (due to decrease estrogen
Urinary tract infections
Dyspareunia ( pain during sex)
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14
Q

Genitourinary Aging of men leads to

A

BPH (Bening prostatic hyperplasia)
Erectile Dysfunction

Note: Older adults are sexually active!!

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15
Q

Skin and Aging leads to

A

Loss of interdigitations between epidermis and dermis leading to ease of tearing or breakdown

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16
Q

Sensory Aging: Vision effects on lens lead to

A

Increased Opacity ( lack of transparency)
Increased sensitivity to glare
Decreased elasticity

Because pupil shrink

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17
Q

Sensory Aging: Vision Pathophysiology cause

A

Light and dark adaptation
Accommodation/presbyopia ( focusing of near to far an eye )
Contrast sensitivity (what color we use to contrast)
Depth perception (edge of stairs)

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18
Q

Sensory Aging: Hearing Pathophysiology

A 
Hearing loss
High pitched sound
Background noise
Vertigo
Cerumen impaction
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19
Q

Ototoxic drugs are

A

Aminoglycosides
High dose salicylates
Diuretics specifically FUROSEMIDE

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20
Q

Skeletal Aging causes are

A

Decrease in bone mass and density

Pathophysiology is:

Osteoporosis
Arthritis
Gait changes
Loss of balance
Falls
Fractures
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21
Q

Pharmacokinetics of Geriatrics: Absorption

A

Potential for the delay in absorption, but no significant change in the extent of absorption for most drugs (means it will take longer but the whole drug will absorbe)

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22
Q

Increased gastric pH (means high ph)

A

Decreased absorption of acid-dependent drugs (calcium carbonate)
Early dissolution of enteric coating –> High pH so it dissolves early as it is suitable in an acidic environment

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23
Q

Pharmacokinetics: Absorption also leads to drug-induced changes MEANS drugs that change our gastric pH are

A

pH: PPI, antacids

Gastric motility/emptying: opioids and anticholinergics drugs change the extent of absorption

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24
Q

Absorption: Take-Home Message

A

Most drugs are well-absorbed in the presence of age-related changes only
Age-related changes, as well as concurrent diseases, result in increased variability in drug absorption
Effects of aging on absorption from other sites of administration is poorly understood

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25
Q

Body Composition of older adults

A

have decreased total body water
Decrease lean body mass
Increase body fat

26
Q

Aging Pharmacokinetics and Distribution of hydrophilic drug

A

Decrease in Volume of distribution means
less water in the body and lower volume of distribution (not going all over the body)There’s going to be a higher concentration within the plasma, so you have higher plasma concentrations of hydrophilic drugs in older patients which will have a Greater swing within the dosing interval means if they drink more alcohol they will have more effects.

that’s why older people will have more effects of alcohol

extracellular water
Examples: ethanol, lithium, aminoglycosides

27
Q

Aging Pharmacokinetics and Distribution of lipophilic drugs

A

Increase in Volume of distribution due to increase in body fat
Increase in Half-life
Increase Duration of therapeutic and toxic effects
Examples: diazepam, phenothiazine, phenytoin
Diuretics can have more effect especially if they consume alcohol (which will increase the effect of alcohol)

Benzodiazepines are not good for older patients.

28
Q

Aging Pharmacokinetics and Distribution of Protein-binding

A

Decrease in Albumin means increased % of unbound or free drug
The age-related decrease is modest but important in chronically ill or malnourished

29
Q

Aging Pharmacokinetics and Distribution of Clinically significant interactions are

A

Highly protein-bound drugs

Examples: warfarin, phenytoin, benzodiazepines

30
Q

Distribution: Take-Home Message

A

Distribution may be altered due to age-related physiologic changes and concurrent diseases
Lipid-soluble drugs may show an increased volume of distribution while water-soluble drugs may show a decreased volume of distribution
Age-related changes in protein binding do not generally result in clinically significant changes in drug therapy

31
Q

Pharmacodynamics and Pharmacologic Effects are

A 
Centrally-acting drugs demonstrate increased sensitivity and side effects
Benzodiazepines
Opioids
Alcohol
Neuroleptics
Anticholinergics
H1-antihistamines (1st generation)
32
Q

Aging Pharmacokinetics Excretion and Reduction in glomerular filtration leads to

A

Cockroft-Gault (CrCl) may not be accurate
Check product labeling to determine the use of CrCl or eGFR
Decrease clearance and increase t½ for drugs with renal elimination and active metabolites

33
Q

AGS Beers Criteria: Cardiovascular for Digoxin

A

Digoxin

Conditions
▪ When used first-line for rate control for afib
▪ When used first-line for heart failure
▪ Doses >125mcg/day

Potential harm
▪ Higher doses have no added benefit;
toxicity
▪ Other agents have evidence of mortality and hospitalization benefits in HFrEF

34
Q

AGS Beers Criteria: Cardiovascular Alpha Blockers

A

Alpha-Blockers

Examples
▪ Doxazosin
▪ Prazosin
▪ Terazosin

Conditions
▪ When used for the treatment of hypertension

Potential harm
▪ Orthostatic hypotension (high risk)

35
Q

Excretion: Take-Home Message

A

Decreased renal clearance of drugs is the most significant age-related change in PK, accounting for the majority of necessary dose adjustments
Serum creatinine may be a poor predictor of renal function, especially in frail older adults

36
Q

Renal Aging and MDRD will

A 
Estimates GFR
Stages CKD (chronic kidney disease)
Drug dosing (new drugs)

Metformin neeed eGFR rate
Rivaroxaban and Zoledronic acid Reclast (actual BW)

37
Q

AGS Beers Criteria: Sedating Antihistamines

A 
Examples
▪Brompheniramine
▪Chlorpheniramine
▪Dimenhydrinate
▪Diphenhydramine
▪Doxylamine

Potential harm
▪Highly anticholinergic
▪Clearance reduced in older patients

Exceptions
▪Diphenhydramine may be used
for acute allergic reactions

Notes
▪ Tolerance develops when used as a hypnotic

38
Q

Renal Aging of CrCl vs GFR with Cockroft-gault are

A

Estimates the CrCl
Estimate Drug dosing (most drugs)
Overestimates the Frail and Reduced muscle mass

39
Q

Pharmacodynamics and other Pharmacologic Effects are

A

Beta-blockers: decrease response
Warfarin: increase risk of bleeding
Cardiac drugs: increased risk of orthostatic hypotension
Diuretics: decrease the effectiveness

40
Q

Functional loss of aging: Activities of Daily Living (ADLs)

A 
Bathing
Ambulation
Toileting
Transfers
Eating
Dressing
41
Q

Functional loss of aging: Instrumental ADLs

A

Shopping
Cooking/ Cleaning
Using Telephone or transportation
Managing Money and Medications

42
Q

AGS Beers Criteria: Proton Pump Inhibitor

A

Examples
▪Omeprazole
▪ Esomeprazole
▪ Lansoprazole

Conditions
▪ Avoid use >8 weeks

Potential harm
▪C difficile infection
▪Bone loss and fractures

Exceptions
▪Chronic NSAID or corticosteroid use
▪ Erosive esophagitis
▪ Failure of drug discontinuation or H2 blocker trial

43
Q

Metabolism

A

First pass metabolism (decreased) which means drugs that are undergoing the first pass have higher bioavailability

Prodrugs have lower bioavailability

Decrease drug clearance due to changes in kidney

Increase t½

Hepatic enzymes (CYP450) appear unchanged
**Caution with CYP450 inhibitors/inducers**
44
Q

AGS Beers Criteria: Central Nervous System CNS for Benzodiazepines

A

Benzodiazepines

Rationale
▪ Increased sensitivity and decreased metabolism

Potential harm
▪ Cognitive impairment
▪ Delirium
▪ Falls/fractures

Exceptions
▪ Seizure disorders, REM sleep behavior disorder, ethanol withdrawal, severe anxiety

45
Q

AGS Beers Criteria: Central Nervous System CNS for Tricyclic Antidepressants

A

Tricyclic antidepressants

Examples
▪ Amitriptyline
▪ Nortriptyline
▪ Protriptyline

Potential harm
▪ Highly anticholinergic
▪ Sedating
▪ Orthostatic hypotension

46
Q

AGS Beers Criteria: Disease-specific

A

Condition Medication Potential Harm

Heart failure NSAIDs (all) Fluid retention may exacerbate heart failure
Chronic kidney disease NSAIDs (all) May cause acute kidney injury or worsen renal function
Delirium H2-receptor blockers May cause or increase confusion
Chronic kidney disease H2-receptor blockers May need to reduce dose if CrCl<50 ml/min
Dementia Anticholinergics Adverse CNS effects

47
Q

Medication Appropriateness Index (MAI)

A 
This is  ( implicit criteria tool)
Indication 
Are directions practical or correct
Efficacy with minimal toxicity 
Ease of administration
are there drug-drug interaction 
Medications that are no longer needed

The things that are different are
Cost So it’s not going to be effective again if the patient can’t take it, they have administration issues or if they can’t afford it.

48
Q

Physical Elder Abuse

A

Intentional use of physical force that results in acute or chronic
illness, bodily injury, physical pain, functional impairment, distress,
or death
-Hitting, beating, slapping
-Shoving, pushing
-Choking, suffocation
-Unlawful confinement (lock them in the room)
-Restraints (limit their physical movement)

49
Q

Sexual Elder Abuse

A

Sexual Abuse
Forced and/or unwanted sexual interaction (touching and non-
touching acts) of any kind with an older adult
-Contact between the penis and the vulva or the penis and the anus
involving penetration, however slight
-Contact between the mouth and the penis, vulva, or anus
-Penetration of the anal or genital opening of another person by a hand,
finger, or another object
-Touching, either directly or through the clothing, of the genitalia, anus,
groin, breast, inner thigh, or buttocks

50
Q

Psychological or Emotional Abuse (Elder)

A

Verbal or nonverbal behavior that results in the infliction of
anguish, mental pain, fear, or distress
-Humiliation ( why did u wet your pants or cannot hold pee)
-Threats of abandonment ( if u not gonna do this I will not come to you)
-Isolation
-Intimidation (frightening)
-Control

51
Q

Financial Elder Abuse

A

Illegal, unauthorized, or improper use of an older individual’s
resources, for the benefit of someone other than the older
individual
-Misuse or theft of money or possessions
-Use of coercion/deception to surrender money/property
-Withholding pension
-Misusing power of attorney
-Forging signatures

52
Q

Neglect Elder Abuse: Intentional

A 
Failure to protect an elder from harm or to meet needs for essential necessities of life results in a serious risk 
to health and/or safety 
Withholding 
-Food or water
-Medical treatment
-Medications (or over-medicating)
Failure to provide 
-Personal hygiene
-Clothing
-Shelter
-Protection from unsafe 
activities/environments
53
Q

unintentional neglect

A

Failure to meet needs due to ignorance or infirmity

  • Caregiver who is ill
  • Caregiver who lacks knowledge or skills
  • Caregiver who is unaware of community resources
  • Unwilling caregiver
54
Q

Self Neglect

A

Older adult fails or refuses to address their own basic physical,
emotional, or social needs in a way that threatens his/her own
health and safety

  • Poor nutrition
  • Inadequate housekeeping
  • Over/under-medicating
  • Not meeting healthcare needs
55
Q

Identifying Abuse and Neglect

A 
Identify physical cues
-Repeated or unexplained 
injuries
-Repeated falls
-Medication levels
-Malnutrition 
-Poor hygiene
-Lack or delay in obtaining 
durable medical equipment 
(DME)
56
Q

What to do in case of elder abuse

A

Document all data
Learn how to recognize signs
Adult Protective Services
Check in often

57
Q

MRP: Prescribing cascade

A

Cascade is a doctor prescribes one medication and that medication effect other parts then the doctor prescribes the side effect of the first drug and the cascade keeps going.

58
Q

STOP Criteria

A

Potentially inappropriate/ duplication of therapy

means we have to consider stopping this polypharmacy in older adults.

59
Q

Start Criteria

A

Omission of therapy

Medication we need to consider based on a certain disease state,

60
Q

Inappropriate prescribing : AGS beer criteria

A

potentially inappropriate medications in older adults;
potentially inappropriate medications to avoid in older adults with certain conditions;
medications to be used with considerable caution in older adults;

CDM 1 (15 decks)

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