Lecture 2: Geriatric Medicine

Question 1

What are 3 causes of affected pharmacokinetics in elderly pt’s?

Answer 1

• Decrease 1st pass clearance in liver
• Decrease in body fat
• Serum protein levels (malnutrition or dietary issues)

Question 2

What are the 3 categories of the Beers Criteria?

Answer 2

• Meds to always avoid for older pt’s
• Meds that are potentially inappropriate for older pt’s with certain medical conditons
• Meds used with caution

Question 3

What are the STOPP and START criteria for medication in the geriatric population?

Answer 3

• STOPP = similar to Beers criteria but also includes drug-drug interaction and duplication of drugs within class
• START = consists of 22 evidence-based prescribing indicators in older pt’s

Question 4

Which 2 instances would warrant an opthalmologist referral for geriatric pt?

Answer 4

• Diabetic pt for monitoring of diabetic retinopathy
• Pt w/ ↑ risk glaucoma i.e., family hx, etc…

Question 5

What are the 2 assessment tools that can be used for functional ability of geriatric pt?

Answer 5

• Katz Index of Independence in Activities of daily living
• Lawton Instrumental Activities of Daily Living Scale

Question 6

What are 2 fall risk assessment tools available?

Answer 6

• Tinetti Balance and Gait Evaluation
• ‘Get Up and Go’ test

Question 7

What are 2 specific questions that can be asked to every pt in every office visit to screen for depression; when is use of a more detailed PHQ-9 questionnaire indicated?

Answer 7

• “During the past month, have you been bothered by feeling down, depressed, or hopeless?”
• “During the past month, have you been bothered by little interest or pleasure in doing things?”
• If “yes” to these quesitons prompts use of Patient Health Questionnaire-9 (PHQ-9)

Question 8

What is the USPSTF recommendation for using a DEXA scan to screen for osteoporosis?

Answer 8

• DEXA scan on woman 65 years or older
• Screening women <65 y/o whose 10-year fracture risk is high –> Use FRAX (Fracture Risk Assessment Tool)

Question 9

At what age are colonoscopy, pap smear, and mammograms stopped?

Answer 9

• Colonoscopy stopped after 75 y/o
• Pap smear and mammogram stopped after 65 y/o

Question 10

Pt’s 65 years and older should be up to date on which 4 vaccines?

Answer 10

• Tetanus or tetanus w/ pertussis vaccine
• Influenza vaccine
• Pneumococcal vaccine
• Herpes Zoster vaccine