Geriatrics: Age-Related Changes Flashcards

Question

Body Composition of older adults

Answer 1

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

Answer 2

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

Answer 3

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.

Answer 4

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

Answer 5

Highly protein-bound drugs | Examples: warfarin, phenytoin, benzodiazepines

Answer 6

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

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

Alpha-Blockers Examples ▪ Doxazosin ▪ Prazosin ▪ Terazosin Conditions ▪ When used for the treatment of hypertension Potential harm ▪ Orthostatic hypotension (high risk)

Answer 11

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

Answer 12

``` Estimates GFR Stages CKD (chronic kidney disease) Drug dosing (new drugs) ``` Metformin neeed eGFR rate Rivaroxaban and Zoledronic acid Reclast (actual BW)

Answer 13

``` 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

Answer 14

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

Answer 15

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

Answer 16

``` Bathing Ambulation Toileting Transfers Eating Dressing ```

Answer 17

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

Answer 18

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

Answer 19

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** ```

Answer 20

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

Answer 21

Tricyclic antidepressants Examples ▪ Amitriptyline ▪ Nortriptyline ▪ Protriptyline Potential harm ▪ Highly anticholinergic ▪ Sedating ▪ Orthostatic hypotension

Answer 22

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

Answer 23

``` 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.

Answer 24

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)

Answer 25

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

Answer 26

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

Answer 27

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

Answer 28

``` 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 ```

Answer 29

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

Answer 30

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

Answer 31

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

Answer 32

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

Answer 33

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.

Answer 34

Potentially inappropriate/ duplication of therapy means we have to consider stopping this polypharmacy in older adults.

Answer 35

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

Answer 36

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;

Geriatrics: Age-Related Changes Flashcards

(60 cards)