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D&T 4, Exam 3 (Liver) > Goebel - Drugs in the Elderly > Flashcards

Goebel - Drugs in the Elderly Flashcards

1
Q

REMEMBER: Start low and go slow!

A
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2
Q

What juice do Statin drugs interact with?

A

grapefruit

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3
Q

What type of medications require this compliance?

_________: must be taken on empty stomach 30 minutes before eating and other meds or 2 hrs after a meal

________: empty stomach 1 hour before eating and other meds, can’t lie down

A

Thyroid

Bisphosphonates

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4
Q

Remember: Symptoms could be due to side effects even years after the drug was started. (i.e. Statins, ACE Inhibitors)

A
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5
Q

Functional Changes in the Elderly:

  • GFR declines 35-50%
  • Body fat _________/lean body mass _________ – increase effects of fat soluble meds
  • Serum albumin ___________ – warfarin dosing problems (free fraction increases)
  • Hepatic blood flow decreases
  • Less stomach acid – hard to absorb iron, calcium
A

body fat increases/lean body mass decreases

decreases

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6
Q

Common Medication Probs

Wrong dose! Important to calculate GFR and adjust doses for renally excreted drugs (i.e. Gabapentin)

NSAIDS can cause GI bleeding w/o warning so give _________ with it, can cause renal insufficiency

__________: cause memory loss/confusion

__________: cause confusion and falls
(Diazepam can have prolonged half-life due to fat soluble)

A

PPI

Anticholinergics

Benzodiazepines

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7
Q

What is the name of the list of potentially inappropriate meds for the elderly?

A

Beers List

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8
Q

What is first line drug for UTIs if GFR >30?

Why not Fluoroquinolones?

A

Nitrofurantoin

Bc can cause neuro symptoms

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9
Q

Don’t use sleeping pills!

Can use ____________ (antidepressant) for sleep in dementia.

A

trazodone

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10
Q

Avoid _________ use greater than 8 weeks d/t C. Diff and fracture risk, use H2 blockers instead, like _________ (name drug).

A

PPI

ranitidine

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11
Q

If GFR is lower, reduce dose for what 3 drugs?

1.

2.

3.

AVOID NSAIDS, if possible!

A
  1. Gabapentin/Pregabalin
  2. H2 Blockers - ranitidine, famotidine
  3. Endoxaban/Rivaroxaban
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12
Q

65 yo woman has dementia and her daughter asks for a sleeping pill. Which one is the best?

A

Trazodone

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13
Q

85 yo woman complains of falling. She takes alprazolam 0.25mg twice daily, gabapentin 300 tid, lisinopril 5 mg daily and furosemide 40mg daily.

Physical exam BP 145/80 P 80. Non-focal neuro exam. Heart normal, lungs normal.

Labs: cbc normal, BUN 30, creatinine 1.5 (eGFR 35), glucose 100.

Which of the following the next best management?

  1. stop furosemide and substitute chlorthalidone
  2. stop gabapentin and start pregabalin
  3. decrease gabapentin interval and furosemide dose
  4. decrease alprazolam dose and lisinopril dose
A
  1. decrease gabapentin interval and furosemide dose
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14
Q

68 year old man complains of arthritis pain in his knees. He has no history of kidney problems or peptic ulcer. He drinks alcohol, 2-3 drinks in the evenings.

Which of the following would be appropriate mgmt?

  1. IB profen 800 mg tid with physical therapy
  2. Tramadol 50 mg tid with acetaminophen 4 grams daily
  3. Naproxen 500 mg bid with omeprazole 20 mg daily
  4. Meloxicam 15 mg daily with joint injections of hyaluronic acid
A

All non-steroidals

Naproxen 500 mg bid with omeprazole 20 mg daily.

(NOT B bc acetaminophen max dose is 3 grams a day)

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15
Q

A 72 yo man has iron deficiency anemia. How do you counsel him to take the iron?

  1. Take it 4x/day
  2. Take it with Vit C
  3. Take if for a month
  4. Take it with omeprazole
A

Take it with Vit C in order to be absorbed

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16
Q
  • An 83 year old woman has a UTI. Her last UTI was two years ago and she had pansensitive E.Coli. She has no drug allergies. PMH is significant for HTN and stage 3 chronic kidney disease.
  • Medications include losartan 50mg daily and atorvastatin 10mg daily.
  • Physical exam including vital signs is normal.

Best management?

  1. Trimethaprim Sulfamethoxisole
  2. Ciprofloxacin
  3. Nitrofurantoin ER (extended release)
  4. Monurol 1 dose
A
  1. Nitrofurantoin ER (extended release)
17
Q

A 65 year old man is starting cholesterol medication. He regularly drinks grapefruit juice and is not wiling to give it up.

Which medication choice would be best for him?

  1. Rosuvastatin
  2. Lovastatin
  3. Simvastatin
  4. Atorvastatin
A
  1. Rosuvastatin

D&T 4, Exam 3 (Liver) (19 decks)

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