Geriatrics Part 3 Flashcards
what is a concern when treating parkinsons
confusion, dyskinesias (abnormal movements + parkinsons induced rigidity), anticholinergic, orthostatic hypotension
FALL RISK
true or false
dementia is not a normal part of aging
true
true or false
all dementia is alzheimers
false
not all dementia is alzheimers
what is the treatment for dementia
monoclonal antibodies
extremely expensive treatment and not very effective. side effects are edema and hemorrhaging
true or false
antipsychotics can be used in a dementia patient to treat behavioral symptoms
FALSE - black box warning. can cause stroke and death and cv issues
_____ is one of the most feared conditions among older adults
stroke
to prevent stroke,
_____ are used in patients with cerebrovascular disease
_____ are used in afib patients
antiplatelets for CV disease
anticoagulants for afib (DOACs preferred over warfarin!)
____ is often undiagnosed in elderly patients
depression
what sleep meds should be avoided in the elderly and why?
benzodiazepines and zolpidem (fall risk)
OTC sleep aids (anticholinergic)
consider using MELATONIN
in general, which diabetes meds should be avoided in all elderly patients?
long acting sulfonylureas due to risk of hypoglycemia (glyburide, glimepiride, glipizide (best))
why should sliding scale insulin be avoided in the elderly
risk of hypoglycemia
for which diabetes med should renal function be monitored
metformin
which diabetes meds should be avoided in patients with congestive heart failure
glitazones
which diabetes meds appear safe for use in elderly?
gliptins (januvia)
GLP1-agonists (ozempic)
for which 2 diabetes meds is the timing of the dose very important
acarbose and miglitol
thus should be avoided in elderly - adherence
which diabetes meds should be used with caution in the elderly and why?
flozins (jardiance, farxiga)
UTIs, incontinence, dehydration, ketoacidosis
explain how there are loose goals for elderly diabetes patients
HgA1C doesnt NEED to be less than 7. avoid symptoms due to hyperglycemia
monitor for hypoglycemia
___thyroidism is very common in older adults
hypo
explain what treatment is/isn’t recommended for menopause/osteoporosis
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
what is the treatment for elderly males with low testosterone
no clear cut guidelines
be cautious of BPH and if there’s a history of prostate cancer
explain oncology considerations in older adults
mainly focused on PAIN MANAGEMENT and palliative (end of life) care
true or false
prolonged use of PPIs for GERD is not recommended
true - risk of GI cancers
what is the 1st line treatment for elderly patients with constipation?
what should be avoided?
what should be monitored?
1st line treatment is fiber/fluids/exercise
avoid long term use of stimulants (dehydration), mineral oil
MONITOR to see if constipation is drug induced
give 2 examples of drugs that can induce constipation
iron
calcium channel blockers
what drugs are/aren’t recomended for urinary incontinence in the elderlt
not recomended - anticholinergis like oxybutynin
newer drugs like myrbetriq and gemtesa are better
also, nonpharmacologic measures
what drugs are/aren’t recomended for benign prostatic hyperplasia
not - nonselective alpha blockers (fall risk) terazosin and doxasozin
recomended - flomax
there is underrepresentiation of the elderly in clinical trials, particularly what age?
over 75
true or false
there is a shortage of trained professionals in geriatrics
true
what is medication reconciliation and why is it important
game of telephone- compiling all meds together form multiple sources and ensuring appropriateness
avoids duplication and interactions
