Lecture 4 Medications and polypharmacy Flashcards
Adverse medication effects are often overlooked in older adults because _
They are mistakenly attributed to aging or pathologic conditions.
Prescribing cascade
A situation in which an adverse drug reaction is misinterpreted as a new medical condition, a drug is prescribed for this condition, another adverse drug effect occurs, etc.
Pharmacokinetics
How a drug is absorbed, distributed, metabolized, and excreted.
Pharmacodynamics
How the body is affected by the drug at the cellular level and in relation to the target organ.
Absorption
The passage of a medication from its site of introduction (e.g., gastrointestinal tract) into the general circulation.
Most oral medications are absorbed by _ across the _
Passive diffusion; small intestine.
Penicillin and ferrous sulfate are two examples of medications that are _
pH-sensitive.
Age-related changes that may impact medication effects
- ↓ body water.
- ↓ lean tissue.
- ↑ body fat.
- ↓ serum albumin.
- ↓ liver and renal function.
- Altered receptor sensitivity.
A patient taking anticoagulants should avoid the herbs _, due to their similar bioactivity.
Garlic and ginkgo biloba.
Monoamine oxidase inhibitors (MAOIs) can interact with the herbal supplements _
Ginseng and St. John’s wort.
Surgeons generally recommend that all herbs and supplements be discontinued at least _ prior to surgery.
2 weeks.
An age-related decline in glomerular filtration rate, which begins in early adulthood and progresses at an annual rate of _ to _, can decrease renal clearance and increase serum levels of medications.
1-2%.
A decline in the GFR is especially problematic for medications that are highly _ and have a narrow _
Water soluble; therapeutic range.
Hepatic blood flow declines progressively beginning around the age of _
40 years.
Low serum _ levels, which are common in older adults, lead to an increased amount of the active portion of protein-bound substances.
Albumin.
_ is an example of a medication that is particularly sensitive to fluid and electrolyte balance, and its action can be altered by inefficient fluid regulation.
Lithium.
The Beers Criteria
- A list of potentially inappropriate (i.e., posing more risks than benefits, particularly when safer alternatives exist) medications, which should be avoided in frail older adults.
- Three major categories of medications: (1) By organ system/therapeutic category; (2) drug effects that may exacerbate the disease or syndrome; (3) use cautiously.
Adverse drug reaction (ADR)
An unintended and unwanted response to a drug.
Adverse drug event (ADE)
- Injury that occurs as a result of taking a drug; part of a larger group of issues called adverse medical events.
- Largely preventable; many occur in the nursing home setting.
Treatment regimens in older adults must begin with _ strategies, which form the foundation for any other successful intervention, and _ is a priority.
Nonpharmacologic; safety.
A person can develop _ toxicity due to the fact that this drug has a half-life of 36 hours, but it is typically taken daily.
Digoxin.
_ can interfere with iron absorption.
Caffeine.
Most common medications affected by herbs
- Warfarin.
- Insulin.
- Aspirin.
- Digoxin.
- Cyclosporine.
- Ticlopidine.
_ is an example of a medication that is ineffectively cleared from the body as renal function declines.
Digoxin.
_ is not a reliable indicator of renal function in older adults.
Serum creatinine.
_ are examples of medications that are ineffectively cleared from the body as hepatic function declines.
- Acetaminophen (Tylenol).
- Amitriptyline (Elavil).
- Benzodiazepines, including diazepam (Valium).
- Salicylates (aspirin).
- Warfarin (Coumadin).
_ are examples of medications that are distributed in body water and lean body mass.
- Digoxin.
2. Lithium.
_ is an example of a medication that is distributed in lipids.
Diazepam (Valium).
_ is an example of a medication that has a high binding affinity for albumin.
Warfarin (Coumadin).
Anticholinergics are contraindicated in older adults unless absolutely necessary (e.g., surgery), because they may lead to side effects such as _
- Constipation.
2. Urinary retention.
Older adults are more sensitive to benzodiazepines (Valium, Xanax, flurazepam, lorazepam) and are rarely prescribed them, as they can cause side effects such as _
- Psychomotor impairment.
- Ataxia.
- Delayed reaction time.
- Increased body swaying.
- Decreased proprioception (perception of one’s position and limbs).
_ of adult Americans are functionally illiterate.
20%.
The Beers Criteria states that barbiturates should be avoided except as _
Anticonvulsants.
Four examples of high-risk drugs according to the Centers for Medicare and Medicaid Services (CMS) are _
- Estrogen.
- Digoxin - 0.25 mg.
- Ambien.
- Elavil.
Two examples of medications that should never be taken with alcohol are _
- Isosorbide mononitrate (Imdur) - enhanced vasodilation.
2. Glipizide (Glucotrol) - potentiates oral hypoglycemia.
The “brown bag method” refers to _
Asking patients to bring all of their medications with them, go over them with the provider, and explain how they take the medications.
The leading reason why some older adults have problems refilling their medications is _
Transportation issues.
The “donut hole” (Medicare Part D coverage gap)
- When annual medication costs are between $2,700 and $6,100, all medication costs are out-of-pocket.
- Below $295, all costs are also out-of-pocket. Between $295 and $2,700, Medicare pays 75%. After $6,100, Medicare pays 95%.
- Most patients are in the “donut hole” around August/September.
Polypharmacy
- The use of more medications than are clinically indicated.
- The term applies more to the appropriateness of medications than to the number of medications; this is assessed by ensuring that the medication is not causing adverse effects and that the benefits outweigh the risks.
Medication nonadherence
Medication-taking patterns that differ from the prescribed pattern, including missed doses, failure to fill prescriptions, or medications taken too frequently or at inappropriate times.
The result of decreased baroreceptor response and failure of cerebral blood flow auto-regulation is _
Orthostatic hypotension.
