Geriatrics Info Flashcards

Question

Pharmacokinetics: Absorption info

Answer 1

Potential for DELAY in absorption, but no significant change in EXTENT of absorption for most drugs

Answer 2

Increased Gastric pH: decreased absorption of acid-dependent drugs (calcium carbonate) Drug-Induced changes: pH (PPI, Antacids) Gastric motility/emptying (opioids/anticholinergics)

Answer 3

decrease total body water and lean body mass | increase body fat

Answer 4

Decreased Vd Increase plasma conc greater swing within the dosing interval examples: ethanol, lithium, aminoglycosides

Answer 5

Increased Vd Half-life increase Duration of therapeutic and toxic effects increase Examples: diazepam, phenothiazine, phenytoin, benzos

Answer 6

affect extracellular water

Answer 7

decrease albumin increase % of unbound or free drug Age-related decrease is modest but important in chronically ill or malnurished

Answer 8

Highly protein bound drugs Example: Warfarin, phenytoin, benzos

Answer 9

1st pass metabolism decreased due to decreased hepatic blood flow and mass decrease dose of drugs with high hepatic extraction and consider efficacy of prodrugs

Answer 10

decrease clearance and increase half life should decrease dose and adjust based on patient Drugs metabolized by Phase II preferred

Answer 11

higher bioavailability

Answer 12

lower bioavailability

Answer 13

CrCL may not be accurate | Check product labeling to determine use of CrCL or eGFR

Answer 14

decreased clearance and increased 1/2 life for drugs with renal elimination and active metabolites

Answer 15

Decreased renal clearance, accounts for majority of necessary dose adjustments

Answer 16

Estimated using Cockroft-Gault Used for Drug dosing most drugs Overestimate due to frail, reduced muscle mass patients

Answer 17

estimated using MDRD Stages CKD Drug dosing of new drugs Underestimates heathy patients

Answer 18

Centrally-acting drugs ``` Benzo Opioids Alcohol Neuroleptics Anticholinergics H1-antihistamine 1st gen ```

Answer 19

Decreased response

Answer 20

Increased risk of bleeding

Answer 21

increased risk of orthostatic hypertension

Answer 22

Decreased effectiveness

Answer 23

Activities of Daily Living ``` Bathing Transfers Eating Dressing Toileting Ambulation ```

Answer 24

Instrumental ADLs Shopping Cooking/Cleaning Using phone or transportation Managing money and medications

Answer 25

Treating side effects of the previously prescribed drug "Research shows that any symptoms in an elderly person should be considered an adverse effect until proven otherwise"

Answer 26

STOPP: Potentially inappropriate/duplication of therapy Drugs you want to stop due to poly pharmacy START: Omission of therapy Drugs that you want to consider to start prescribing/using

Answer 27

1st Gen antihistamines Potential harm (highly anticholingeric and reduced clearance in older patients) Exceptions: Benadryl used for allergic reactions Extra: Tolerance develops when used as a hypnotic

Answer 28

Conditions: Avoid use > 8 weeks Potential Harm: C.Dif infection, bone loss/fractures Exceptions: Chronic NSAID or corticosteroid use Erosive esophagitis Failure of drug discontinuation or H2 blocker trial

Answer 29

conditions: used 1st line for HF or rate control fib want doses <125mcg/day Potential Harm: higher doses have no added benefit, just toxicity other agents have evidence of mortality and hospitalization benefits in HFrEF

Answer 30

Conditions: when used for treatment of hypertension Potential Harm: Orthostatic hypotension = high risk

Answer 31

Rationale: Increased sensitivity and decreased metabolism Potential Harm: Cognitive impairment, delirium, falls/fractures Exceptions: Seizes disorders, REM sleep behavior disorder, ethanol withdrawal and severe anxiety

Answer 32

Potential Harm: Highly Anticholinergic Sedating Orthostatic Hypertension

Answer 33

Med: All NSAIDs Harm: Fluid retention may exacerbate HF

Answer 34

Med: All NSAIDs Harm: May cause acute kidney injury or worsen renal function Med: H2 Blockers Harm: May need to reduce dose if CrCl < 50ml/min

Answer 35

Med: H2 Blockers Harm: May cause or increase confusion

Answer 36

Med: Anticholinergics Harm: Adverse CNS effects

Answer 37

Bunch of questions about the medication Ranging from safety, to correct dosage/instructions/to cost compared to other options

Answer 38

Dosing: Start Slow, Go Slow, But go Monitoring: Meds that are no longer needed Consider medications individually and within the big picture

Answer 39

more common females often family member not just physical

Answer 40

Intentional use of physical force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, distress, or death

Answer 41

Forced and/or unwanted sexual interaction (touching and non-touching acts) of any kind with an older adult

Answer 42

Verbal or nonverbal behavior that results in the infliction of anguish, mental pain, fear, or distress

Answer 43

Illegal, unauthorized, or improper use of an older individual’s resources, for the benefit of someone other than the older individual

Answer 44

Failure to protect an elder from harm or to meet needs for essential necessities of life which results in a serious risk to health and/or safety

Answer 45

Failure to meet needs due to ignorance or infirmity

Answer 46

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