Geriatrics Part 3

Question 1

what is a concern when treating parkinsons

Answer 1

confusion, dyskinesias (abnormal movements + parkinsons induced rigidity), anticholinergic, orthostatic hypotension

FALL RISK

Question 2

true or false

dementia is not a normal part of aging

Answer 2

true

Question 3

true or false

all dementia is alzheimers

Answer 3

false

not all dementia is alzheimers

Question 4

what is the treatment for dementia

Answer 4

monoclonal antibodies

extremely expensive treatment and not very effective. side effects are edema and hemorrhaging

Question 5

true or false

antipsychotics can be used in a dementia patient to treat behavioral symptoms

Answer 5

FALSE - black box warning. can cause stroke and death and cv issues

Question 6

_____ is one of the most feared conditions among older adults

Answer 6

stroke

Question 7

to prevent stroke,

_____ are used in patients with cerebrovascular disease

_____ are used in afib patients

Answer 7

antiplatelets for CV disease

anticoagulants for afib (DOACs preferred over warfarin!)

Question 8

____ is often undiagnosed in elderly patients

Answer 8

depression

Question 9

what sleep meds should be avoided in the elderly and why?

Answer 9

benzodiazepines and zolpidem (fall risk)

OTC sleep aids (anticholinergic)

consider using MELATONIN

Question 10

in general, which diabetes meds should be avoided in all elderly patients?

Answer 10

long acting sulfonylureas due to risk of hypoglycemia (glyburide, glimepiride, glipizide (best))

Question 11

why should sliding scale insulin be avoided in the elderly

Answer 11

risk of hypoglycemia

Question 12

for which diabetes med should renal function be monitored

Answer 12

metformin

Question 13

which diabetes meds should be avoided in patients with congestive heart failure

Answer 13

glitazones

Question 14

which diabetes meds appear safe for use in elderly?

Answer 14

gliptins (januvia)
GLP1-agonists (ozempic)

Question 15

for which 2 diabetes meds is the timing of the dose very important

Answer 15

acarbose and miglitol

thus should be avoided in elderly - adherence

Question 16

which diabetes meds should be used with caution in the elderly and why?

Answer 16

flozins (jardiance, farxiga)

UTIs, incontinence, dehydration, ketoacidosis

Question 17

explain how there are loose goals for elderly diabetes patients

Answer 17

HgA1C doesnt NEED to be less than 7. avoid symptoms due to hyperglycemia

monitor for hypoglycemia

Question 18

___thyroidism is very common in older adults

Answer 18

hypo

Question 19

explain what treatment is/isn’t recommended for menopause/osteoporosis

Answer 19

hormone replacement therapy should not be used in greater than 60, and should only be used short term in those younger. cardiovascular and cancer risk

calcium and vitamin D is recommended for osteoporosis - often under-treated - risk of fractures

Question 20

what is the treatment for elderly males with low testosterone

Answer 20

no clear cut guidelines

be cautious of BPH and if there’s a history of prostate cancer

Question 21

explain oncology considerations in older adults

Answer 21

mainly focused on PAIN MANAGEMENT and palliative (end of life) care

Question 22

true or false

prolonged use of PPIs for GERD is not recommended

Answer 22

true - risk of GI cancers

Question 23

what is the 1st line treatment for elderly patients with constipation?

what should be avoided?
what should be monitored?

Answer 23

1st line treatment is fiber/fluids/exercise

avoid long term use of stimulants (dehydration), mineral oil

MONITOR to see if constipation is drug induced

Question 24

give 2 examples of drugs that can induce constipation

Answer 24

iron
calcium channel blockers

Question 25

what drugs are/aren’t recomended for urinary incontinence in the elderlt

Answer 25

not recomended - anticholinergis like oxybutynin

newer drugs like myrbetriq and gemtesa are better

also, nonpharmacologic measures

Question 26

what drugs are/aren’t recomended for benign prostatic hyperplasia

Answer 26

not - nonselective alpha blockers (fall risk) terazosin and doxasozin

recomended - flomax

Question 27

there is underrepresentiation of the elderly in clinical trials, particularly what age?

Answer 27

over 75

Question 28

true or false

there is a shortage of trained professionals in geriatrics

Answer 28

true

Question 29

what is medication reconciliation and why is it important

Answer 29

game of telephone- compiling all meds together form multiple sources and ensuring appropriateness

avoids duplication and interactions