Intro to Geriatrics - Block 4 Flashcards
How do you assess geriatric status?
Describe the absorption of geriatric?
- Decreased gastric acid
- SLower GI motility
- Delayed gastric emptying
Medications:
* Passive diffusion -> less likely to be affected
* Active transport -> more likely to be affect
* Drugs affected by gastric pH are affected in a small proportion of adults
Describe distribution in geriatrics?
- Augmented blood flor
- Plasma protein binding
- Body composition
- CNS permeability
Describe the metabolism in geriatric?
- FLow limited
- Capacity limited
How does flow-limited metabolism affect drugs?
- Affects drugs dependent on high intrinsic clearance
- High intrinsic clearance is due to grug’s structure mimicking endogenous agents
- Poor metabolism of these drugs is due to decreased hepatic perfusion
Examples: metoprolol, propranolol, lignocaine, nifedipine, fentanyl and verapamil
How does capacity limited metabolism affect drugs?
- Affects drugs that are dependent on low intrinsic clearance
- Enzymatically driven and largely affected by protein binding
Examples: reduced (lorazepam, piroxicam, warfarin), increased (ibuprofen, naproxen, phenytoin) or unchanged (diazepam, temazepam and valproic acid)
Describe phase metabolism in geriatrics?
Phase 1 metabolism is usually more affected by hepatic dysfunction as compared to phase 2
* Reduced phase II dues to inflammation
How is elimination affected by age?
Age related deterioration must be evaluated but decrease in renal function doesnt directionally correspond to age
Decreased muscle mass can affect CrCl calculations; GFR can be skewed by high protein intake
Describe the PK parameters in geriatrics?
Describe the PD changes in elders?
- Changes in concentrations of the drug at the receptor
- Changes in receptor numbers
- Changes in receptor affinity
- Post receptor alterations
- Age-related impairment of homeostatic mechanisms
How might cause CNS changes in elders?
- Changes in brain size and weight
- Increased BBB penetration
- Dopaminergic alterations
What are drugs that are affected by CV changes?
Calcium channel blockers: increased hypotensive and bradycardic effects
β-blockers: reduced blood pressure response
Diuretics: reduced effectiveness
Warfarin: increased risk of bleeding
What is goal of pharmacotherapy in elders?
Cure or palliate disease and enhance HRQOL
What are HRQOL considerations in elders?
- Improvements in physical functioning
- Psychological functioning
- SOcial functioning
- Overall health
What is the definition of polypharm?
- ≥5 or more meds
- Multiple medications that are used for the same indication
- Unnecessary drug use or use without indications
Contributing factors: comorbidities
What is the difference between medication related problem and ADR?
MRP: therapy that interferes with desired outcomes for a patient
ADR: response to a drug that is noxious and unintended and occurs at doses normally for prophylaxis, therapy, or modification of physiological function
Describe the severity of ADRs in elders?
- More sever
- confusion, depression, falls, loss of independence and physical disability
- Higher hospitalization rate
- Atypical prescription
What are the RF associated with Polypharm?
- Using ≥5 medications
- Taking ≥12 doses/day
- Dementia
- Depression
- Female sex
- Low body weight or body mass index <22
- Multiple chronic conditions
- Age ≥85 years
- CrCl <50 mL/min
- Recent hospitalization
- Multiple prescribers
- Multiple pharmacies
- Prior adverse drug event
- Regular use of alcohol
What are the causes of ADRs?
- Improper drug or dosage selection
- Nonadherence to the drug regimen
- ALtered PK
- ALtered PD
- Multiple meds
- Multiple providers
WHat are common sx of ADRs?
- Fatigue
- ALtered mental status
- FAllung
- Constipation
- Blurred vision
- Depression
- DZ
What are the mechanism to combat poly pharm?
- Comprehensive geriatirc assessment
- Pharm-physician relationships
- Frewuent med recs
What are some resources used for geriatric med reviews?
- Beers
- Screening Tool of Older Persons’ Prescriptions (STOPP)
- Screening Tool to Alert doctors to Right Treatment (START)
What is MAI?
Medication Appropriateness Index: measure of potential improvement in prescribing quality due to a clinical pharmacist intervention
Max score: 18 -> indicating inappropriateness
What is the beers list used?
- Improve medication selection
- Educate clinicians and patients
- Reduce ADRs
- Serve as a tool for QoC, cost, paterns of drug use in elders
What are the limitations of using Beers?
- Unable to address the full spectrum of drug-related problems
- Captures only a small fraction of meds
- Very few drugs that cause difficulty for older adults are inherently bad
What are the considerationg for geriatric med safety?
- Prescribe cautiously
- Prescribe appropriately
- Start low, go slow
- Review regularly
- Reduce polypharm
- Remeber the risky medicinces (i.e. Beer’s list)
