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PT: Nutrition Exam 2 > Introduction to Geriatric PT > Flashcards

Introduction to Geriatric PT Flashcards

1
Q

What are the three primary goals of health care in the elderly?

A
  1. Improve physical function and prevent disability
  2. Maintain independence (Avoid institutionalization)
  3. Prevent drug-related adverse consequences
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2
Q

As we age, the number of receptors ____________. The sensitivity of the receptors _________.

A

a. decreases

b. increases

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3
Q

Why does the BBB have increased permeability as we age?

A

Decrease in p-gp efflux transporter activity

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4
Q

What happens to the liver as we age?

A

Mass decreases
Blood flow decreases
Phase I metabolism activity decreases (1st pass effect)

PHASE II METABOLISM= NO CHANGE

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5
Q

What happens to the kidneys as we age?

A

Loss of function due to:
decreased mass and blood flow
decreased filtration and secretion
decreased GFR

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6
Q

What is the net effect of aging that can alter the body’s clinical response to medications?

A 
Age-related changes
PK and PD changes
Concurrent medication use increases
Comorbidities
Frailty due to limited reserve capacity
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7
Q

As we age __________ transport activity decreases. What is the effect on PK?

A

ACTIVE; results in decreased bioavailability of nutrients, vitamins and ions

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8
Q

As we age hepatic first pass extraction ________________, which will increase what PK parameter?

How does this affect dosing?

A

Decreases; bioavailability for non-prodrugs.

Use lower doses in the elderly

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9
Q

As we age, we have lower lean body mass and total body water. How does this affect medication therapy?

A

Decreased volume of distribution which will increase plasma concentrations of hydrophilic drugs

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10
Q

As we age, we have a _________ in body fat. How does this affect medication therapy?

A

INCREASE

- Increased volume of distribution and half-life for lipophilic drugs

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11
Q

How does aging affect albumin levels? How does this affect medication therapy?

A

No change or decrease in serum albumin

- Increased amount of free, active drug resulting in more activity

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12
Q

Due to the decrease in Phase _____ metabolism, how are clearance and half-life affected?

A

Phase I metabolims

  • Clearance = decreased
  • Half-life = increased
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13
Q

Explain why as we age, we have decreased hepatic first pass extraction and how this affects drug metabolism.

A

a. Due to decreased number of receptors

b. This decreases clearance of the drugs while INCREASING bioavailability

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14
Q

Lorazepam is a safer option to use in the elderly for anxiety. Why?

A

It undergoes Phase II reactions readily (due to existing polarity) which are unchanged as we age so accumulation and toxicity risks are decreased compared to drugs who must undergo Phase I reactions for excretion

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15
Q

Why is SCr not a good measure of kidney function in the elderly?

A

Their SCr may look normal but in fact may not be due to:

  1. Lower lean body mass = decreased creatinine production
  2. Have a decreased GFR
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16
Q

What do we use to estimate GFR?

A

CrCl

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17
Q

Rounding an elderly patients CrCl to 1 may __________________ their renal function.

A

UNDERESTIMATE

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18
Q

If Cl is decreased and half-life is increased due to decreased GFR as we age, what are we more likely to notice with medication therapy?

A

Increase in side effects and active metabolites of drugs

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19
Q

Why do we want to avoid benzodiazepine use in elderly? What other medication class can we use for anxiety?

A

Increased sensitivity to CNS effects
a. sedation and psychomotor impairment
Use SSRIs/SNRIs instead

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20
Q

Why do we want to avoid Opioid analgesic use in the elderly?

A

Have higher level and duration of pain relief which means using lower doses

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21
Q

Why are we concerned about B-blocker use in the elderly?

A

Decreased HR and BP response resulting in a HIGHER DOSE NEEDED

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22
Q

Why are we concerned about B-agonist use in the elderly?

A

Decreased bronchodilation response resulting in a HIGHER DOSE NEEDED

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23
Q

Why are we concerned about digoxin use in the elderly?

A

Increased sensitivity of the heart; USE LOWER DOSE

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24
Q

Why are we concerned about anticoagulant therapy in the elderly?

A

Increased bleeding risk to due increased response

USE A LOWER DOSE

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25
Q

Why do we want to avoid anticholinergic agents in the elderly?

A

Increased sensitivity to adverse effects, confusion and sedation being the main effects we want to avoid

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26
Q

What are the 4 major drug related problems that occur when treating elderly patients?

A
  1. Polypharmacy: Administration of more medications than are indicated (55 to 59%)
  2. Inappropriate prescribing when the risk of using a drug outweighs the benefit
  3. Medication underuse: Omission of a medication that is indicated
  4. Non-adherence: ~40 to 86% of patients that INCREASES health care use/cost
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27
Q

Who is considered a geriatric patient?

A

Adults age 65+

28
Q

List the drug classes associated with STRONG ANTICHOLINERGIC Properties. (9)

A
  1. Antihistamines
  2. Antidepressants
  3. Antiparkinsonian agents
  4. Antiemetics
  5. Antipsychotics
  6. Skeletal muscle relaxants
  7. Antiarrhythmics
  8. AntiMUSCARINCS
  9. Antispasmodics
29
Q

Drug Class: Clozapine

A

Antipsychotic

30
Q

Drug Class: Olanzapine

A

Antipsychotic

31
Q

Drug Class: Benztropine

A

Antiparkinsonian agents

32
Q

Drug Class: Cyclobenzaprine

A

Skeletal muscle relaxants

33
Q

Drug Class: Dicyclomine

A

Antispasmodics

34
Q

Drug Class: Oxybutynin

A

AntiMUSCARINCS

35
Q

Drug Class: Tolteridine

A

AntiMUSCARINCS

36
Q

Drug Class: Trospium

A

AntiMUSCARINCS

37
Q

Drug Class: Hyoscyamine

A

Antispasmodic

38
Q

Drug Class: Scopolamine

A

Antispasmodic

39
Q

Drug Class: Nortriptyline

A

SSRI (Antidepressant)

40
Q

Drug Class: Dimenhydrinate

A

Antihistamine

41
Q

Drug Class: Doxylamine

A

Antihistamine

42
Q

Drug Class: Meclizine

A

Antihistamine

43
Q

Drug Class: Chloropheneriamine

A

Antihistamine

44
Q

Drug Class: Cyproheptadine

A

Antihistamine

45
Q

Drug Class: Clemastine

A

Antihistamine

46
Q

Drug Class: Amitriptyline

A

Antidepressant

47
Q

Drug Class: Doxepin

A

Antidepressant

48
Q

The BEERS Criteria is a resource used to identify what?

A

Potentially inappropriate medications to be avoided in elderly patients

49
Q

BEERS: What 3 classes mentioned in class should be avoided due to high anticholinergic side effects?

A

1st Gen Antihistamines
Antispasmodics
Antidepressants

50
Q

BEERS: Why should we avoid using Peripheral alpha blockers for HTN in the elderly?

A

Increased risk of orthostatic hypertension

51
Q

BEERS: Why should we avoid using digoxin for AFib/CHF in the elderly?

A

Narrow therapeutic window easily resulting in toxicity due to decreased Cl as we age

52
Q

BEERS: Why should we avoid using amiodarone as an antiarrhythmic in the elderly?

A

Easily results in toxicity due to decreased Cl as we age; Use only if rhythmic control is preferred over rate control

53
Q

BEERS: Why should we avoid using antipsychotics for behavior modification in the elderly?

A

Increased risk of congnitive decline in dementia and CV risk resulting in pneumonia
Use only when behavior interventions fail AND there is risk of harm to self or others is present

54
Q

BEERS: Why should we avoid benzodiazepines and benzo receptor agonists in the elderly?

A

Increased risk of cognitive impairment, falls and fractures as well as motor vehicle accidents

55
Q

BEERS: Why should we avoid long term use of nitrofurantion in elderly patients with a CrCl of <30 mL/min?

A

Can result in toxicity:

a. pulmonary, liver, kidney and peripheral neuropathy

56
Q

BEERS: Why should we avoid PPIs in the elderly?

A

Increased risk of C. Diff infection and fractures due to decreased BMD

57
Q

BEERS: Why should we avoid metoclopramide in the elderly?

A

Increased risk of Extrapyramidal symptoms (EPS) and dyskinesia

58
Q

BEERS: Why should we avoid NSAIDs in the elderly?

A

Increased risk of GI bleeding, peptic ulcer disease and fluid retention

59
Q

BEERS: Why should we avoid Indomethacin in the elderly?

A

Increased risk of GI bleeding, peptic ulcer disease, acute kidney injury AND CNS adverse effects

60
Q

BEERS: Why should we avoid skeletal muscle relaxants in the elderly?

A

Excessive sedative effects which can increased fall risk

61
Q

BEERS: What drugs should not be used in patients with Parkinson’s disease?

A

Dopamine antagonists that may worsen symptoms

62
Q

BEERS: Why should we avoid estrogen and peripheral alpha blockers in elderly women?

A

Increased risk of urinary incontinence

63
Q

What is SIADH?

A

Syndrome of Inappropriate ADH secretion

- Due to hyponatremia and hypo-osmolality signalling excess ADH secretion

64
Q

BEERS: Give a few examples of drugs that may induce SIADH. What lab parameter should you monitor?

A

Monitor SODIUM levels!

  • SSRIs/SNRIs
  • Antipsychotics
  • Oxcarbazepine / Carbamazepine
  • Diuretics
  • TCAs
  • Mirtazapine
65
Q

Which drug class used to treat HTN may increase syncope episodes in the elderly with a history of syncope?

A

Vasodilators

PT: Nutrition Exam 2 (10 decks)

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