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PR4152 GERI > IC1 (Intro. + BEERS) > Flashcards

IC1 (Intro. + BEERS) Flashcards

1
Q

What does the Medication Appropriateness Index cover?

A
  1. Indication?
  2. Effective?
  3. Correct dosage?
  4. Correct directions?
  5. Practical directions?
  6. Sig. DDI
  7. Sig. DDI
  8. Unnecessary duplication?
  9. Duration acceptable?
  10. Least expensive for its utility?

IE DDD DDI 2T $

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2
Q

What are the 5 possible classes of DRPs?

A
  1. Indication-related
  2. Dose-related
  3. Interactions
  4. ADR
  5. Failure to receive drugs
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3
Q

What are the 4 sections of the pharmaceutical care framework?

A
  1. What matters most to the patient
  2. Implicit criteria
  3. Explicit criteria (pt specific)
  4. Successful delivery of appropriate drugs
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4
Q

What does a prescribing cascade refer to?

A

using a drug to treat the SIDE EFFECTS of another drug with the belief that they arise from a new medical problem

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5
Q

What are common prescribing cascade examples?
MRA (spirinolactone) and _______

A

Fludrocortisone / midodrine for OH

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6
Q

What are common prescribing cascade examples?
Midodrine and _______

A

Alpha blocker (eg. prazosin)
(alpha agonist + alpha antagonist)

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7
Q

What are common prescribing cascade examples?
Anticholinergic and _______

A

Acetylcholinesterase inhibitor (eg. donepezil)
(ACh side effects)

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8
Q

What are common prescribing cascade examples?
NSAIDs and _______

A

Antihypertensives
(NSAIDs can increase BP)

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9
Q

What are common prescribing cascade examples?
SNS-active drugs (sympathomimetics like pseudoephedrine) and _______

A

Antihypertensives
(sympathomimetics can increase BP from sympathetic effect)

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10
Q

What are the 4M’s in age friendly health systems?

A

what MATTERS
MEDICATION
MENTATION
MOBILITY

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11
Q

What is the CFS rated from?

A

1 (robust) to 9 (frail)

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12
Q

What CFS scores indicate pre-frailty?

A

CFS 3-4

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13
Q

Briefly describe CFS 3

A

Medical problems well controlled but not regularly active

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14
Q

Briefly describe CFS 4

A

Not dependent on others for daily help but symptoms limit activities

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15
Q

Briefly describe CFS 5

A

Mild frailty: more evident slowing, requires help with higher order instrumental ADL (transport, housework, meal preparation)

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16
Q

What does explicit criteria refer to?

A

Spotlighting problem drugs (eg. Beers list, STOPPFALL)

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17
Q

What does implicit criteria refer to?

A

MAI (indication, CI, DDI, ADR)
Any untreated indications

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18
Q

What are the antihistamine drugs that may be inappropriate in the elderly?

A

1st gen antihistamines
(chlorpheniramine, hydroxyzine, dimenhydrinate, diphenhydramine, promethazine, triprolidine)

Highly anticholinergic (dry mouth, constipation, urinary retention, confusion)

19
Q

What are the anti-infectives drugs that may be inappropriate in the elderly?

A

Nitrofurantoin

Potential for pulmonary toxicity, hepatotoxicity, peripheral neuropathy

20
Q

What are the CV drugs that may be inappropriate in the elderly? (6)

A
  1. Aspirin (high bleeding risk)
  2. Warfarin (high bleeding risk)
  3. Rivaroxaban (bleeding risk higher than apixaban)
  4. Alpha blockers (non-selective: prazosin, terazosin) (high risk of OH)
  5. Nifedipine IR (risk of OH and precipitating MI)
  6. AF medication (amiodarone, dronedarone, digoxin) (high risk of toxicity)
21
Q

What are the CNS drugs that may be inappropriate in the elderly? (5)

A
  1. Antidepressants with high chol. activity (amitriptyline, nortriptyline, paroxetine) (highly anticholinergic, sedating, OH)
  2. Antipsychotics (haloperidol, aripiprazole, olanzapine, quetiapine, risperidone) (high risk of stroke and cognitive decline)
  3. Barbituates (phenobarbital) (high risk of physical dependence, OD)
  4. BZD (lorazepam, alprazolam, diazepam) (risk of abuse, concomitant use w opioids can cause respiratory depression)
  5. Z-hypnotics (risk of abuse, falls and fractures)
22
Q

What are the endocrine drugs that may be inappropriate in the elderly? (4)

A
  1. testosterone (cardiac issue and prostate cancer risk)
  2. estrogens (carcinogenic potential in women above 60)
  3. rapid acting insulin (lispro, aspart, glulisine) (risk of hypoglycemia without baseline coverage eg. NPH, detemir, glargine)
  4. sulfonylureas (glipizide, glimenperide, gliclazide) (high risk of hypoglycemia, SA agents better like glipizide)
23
Q

What are the GI drugs that may be inappropriate in the elderly? (3)

A
  1. PPIs (risk of cdiff, pneumonia, bone loss, dont give for more than 8 wks)
  2. Metoclopramide (can cause EPSE, dont use for more than 12 wks)
  3. Antispasmodics (atropine, scopolamine) (highly anticholinergic)
24
Q

What are the genitourinary drugs that may be inappropriate in the elderly? (1)

A

Desmopressin (high risk of hyponatremia)

25
Q

What are the pain management drugs that may be inappropriate in the elderly? (2)

A
  1. PO non-cox2-selective NSAIDs (aspirin, diclofenac, naproxen, ibuprofen) (risk of GI bleed in pts on steroids, anticoags and antiplatelets, can increase BP and cause AKI)
  2. Skeletal muscle relaxants (orphenadrine) (highly anticholinergic)
26
Q

What medications should be avoided in elderly with HF? (3)

A
  1. non-DHP CCBs (diltiazem, verapamil)
  2. NSAIDs
  3. Pioglitazone

all 3 can promote fluid retention and worsen HF, avoid

27
Q

What medications should be avoided in elderly with syncope (fainting spells)? (4)

A
  1. Some antipsychotics (olanzapine) (increased OH risk)
  2. AChEi (donepezil, galantamine, rivastigmine) (can cause bradycardia and fainting)
  3. non-selective alpha blockers (prazosin, terazosin) (increased OH risk)
  4. TCAs (amitriptyline) (increased sedation)
28
Q

What medications should be avoided in elderly with delirium, dementia and history of falls? (6)

A
  1. Anticholinergics
  2. Antipsychotics
  3. BZD
  4. Z-hypnotics
  5. Opioids
  6. Corticosteroids and H2RA

will WORSEN!!!
1-5 for all 3 conditions
6 only for delirium

29
Q

What medications should be avoided in elderly with parkinson’s disease (2)

A
  1. Antiemetics (metoclopramide, prochloperazine, promethazine)
  2. Antipsychotics (except clozapine and quetiapine)

Potential to worsen parkinsonism

30
Q

What medications should be avoided in elderly with LUTS and BPH (2)

A
  1. Anticholinergics
  2. Antimuscarinics (like oxybutynin)

Decreased urinary flow causing urinary retention

31
Q

What drugs have potential interactions with RAS inhibitors and K-sparing diuretics (ACEi, ARB, ARNi, spironolactone, triamterene)?

What does it cause?

What is the recommendation?

A

Other RAS inhibitors and K-sparing diuretics (ACEi, ARB, ARNi, spironolactone, triamterene)

Increased risk of hyperkalemia

Avoid routinely using 2 or more RAS agents and K-sparing diuretics

32
Q

What drugs have potential interactions with opioids? (2)

What does it cause?

What is the recommendation?

A
  1. BZD - risk of OD
  2. pregabalin, gabapentin - increased risk of severe sedation, only ok if transitioning from opioids to preg or gaba
33
Q

What drugs have potential interactions with lithium? (4)

What does it cause?

What is the recommendation?

A

ACEi, ARB, ARNi, loop diuretics

Increased risk of lithium toxicity

avoid / monitor lithium levels if necessary

34
Q

What drugs have potential interactions with non-selective peripheral alpha-blockers? (1)

What does it cause?

What is the recommendation?

A

Loop diuretics

Increased risk of urinary incontinence in older women

Avoid in older women unless necessary

35
Q

What drugs have potential interactions with phenytoin? (1)

What does it cause?

What is the recommendation?

A

Trimethoprim-sulfamethoxazole

Increased risk of phenytoin toxicity

Avoid

36
Q

What drugs have potential interactions with theophylline? (1)

What does it cause?

What is the recommendation?

A

Ciprofloxacin

Increased risk of theophylline toxicity

Avoid

37
Q

What drugs have potential interactions with warfarin? (5)

What does it cause?

What is the recommendation?

A
  1. trimethoprim-sulfamethoxazole
  2. ciprofloxacin
  3. amiodarone
  4. macrolides
  5. SSRIs

Increased risk of bleeding

Avoid, if not monitor INR

38
Q

Which 3 Abx should have reduced doses in impaired renal function? What is the threshold CrCl level?

A

Ciprofloxacin, Nitrofurantoin, Trimethoprim-sulfamethoxazole

< 30 ml/min

39
Q

Which 5 CV drugs should have reduced doses in impaired renal function? What is the threshold CrCl level?

A

Dabigatran, Enoxaparin, Rivaroxaban
Spironolactone, Triamterene

< 30ml/min
Rivaroxaban is < 50 ml/min

40
Q

Which 2 hyperuricemia drugs should have reduced doses in impaired renal function? What is the threshold CrCl level?

A

Colchicine, Probenecid

< 30 ml/min

41
Q

Which 3 CNS drugs should have reduced doses in impaired renal function? What is the threshold CrCl level?

A

Duloxetine < 30
Gabapentin < 60
Levetiracetam < 80

42
Q

Which 3 analgesics should have reduced doses in impaired renal function? What is the threshold CrCl level?

A

NSAIDs < 30
Pregabalin < 60
Tramadol < 30

43
Q

What are the 8 broad classes of drugs with high anticholinergic activity?

A
  1. Antidepressants
  2. Antipsychotics
  3. Antiemetics
  4. Antispasmodics
  5. 1st gen antihistamines
  6. Antimuscarinics
  7. Skeletal muscle relaxants
  8. Anti-parkinsonian agents

PR4152 GERI (8 decks)

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