Lecture 4 Medications and polypharmacy

Question 1

Adverse medication effects are often overlooked in older adults because _

Answer 1

They are mistakenly attributed to aging or pathologic conditions.

Question 2

Prescribing cascade

Answer 2

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.

Question 3

Pharmacokinetics

Answer 3

How a drug is absorbed, distributed, metabolized, and excreted.

Question 4

Pharmacodynamics

Answer 4

How the body is affected by the drug at the cellular level and in relation to the target organ.

Question 5

Absorption

Answer 5

The passage of a medication from its site of introduction (e.g., gastrointestinal tract) into the general circulation.

Question 6

Most oral medications are absorbed by _ across the _

Answer 6

Passive diffusion; small intestine.

Question 7

Penicillin and ferrous sulfate are two examples of medications that are _

Answer 7

pH-sensitive.

Question 8

Age-related changes that may impact medication effects

Answer 8

1. ↓ body water.
2. ↓ lean tissue.
3. ↑ body fat.
4. ↓ serum albumin.
5. ↓ liver and renal function.
6. Altered receptor sensitivity.

Question 9

A patient taking anticoagulants should avoid the herbs _, due to their similar bioactivity.

Answer 9

Garlic and ginkgo biloba.

Question 10

Monoamine oxidase inhibitors (MAOIs) can interact with the herbal supplements _

Answer 10

Ginseng and St. John’s wort.

Question 11

Surgeons generally recommend that all herbs and supplements be discontinued at least _ prior to surgery.

Answer 11

2 weeks.

Question 12

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.

Answer 12

1-2%.

Question 13

A decline in the GFR is especially problematic for medications that are highly _ and have a narrow _

Answer 13

Water soluble; therapeutic range.

Question 14

Hepatic blood flow declines progressively beginning around the age of _

Answer 14

40 years.

Question 15

Low serum _ levels, which are common in older adults, lead to an increased amount of the active portion of protein-bound substances.

Answer 15

Albumin.

Question 16

_ 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.

Answer 16

Lithium.

Question 17

The Beers Criteria

Answer 17

1. 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.
2. Three major categories of medications: (1) By organ system/therapeutic category; (2) drug effects that may exacerbate the disease or syndrome; (3) use cautiously.

Question 18

Adverse drug reaction (ADR)

Answer 18

An unintended and unwanted response to a drug.

Question 19

Adverse drug event (ADE)

Answer 19

1. Injury that occurs as a result of taking a drug; part of a larger group of issues called adverse medical events.
2. Largely preventable; many occur in the nursing home setting.

Question 20

Treatment regimens in older adults must begin with _ strategies, which form the foundation for any other successful intervention, and _ is a priority.

Answer 20

Nonpharmacologic; safety.

Question 21

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.

Answer 21

Digoxin.

Question 22

_ can interfere with iron absorption.

Answer 22

Caffeine.

Question 23

Most common medications affected by herbs

Answer 23

1. Warfarin.
2. Insulin.
3. Aspirin.
4. Digoxin.
5. Cyclosporine.
6. Ticlopidine.

Question 24

_ is an example of a medication that is ineffectively cleared from the body as renal function declines.

Answer 24

Digoxin.

Question 25

_ is not a reliable indicator of renal function in older adults.

Answer 25

Serum creatinine.

Question 26

_ are examples of medications that are ineffectively cleared from the body as hepatic function declines.

Answer 26

1. Acetaminophen (Tylenol).
2. Amitriptyline (Elavil).
3. Benzodiazepines, including diazepam (Valium).
4. Salicylates (aspirin).
5. Warfarin (Coumadin).

Question 27

_ are examples of medications that are distributed in body water and lean body mass.

Answer 27

1. Digoxin.

2. Lithium.

Question 28

_ is an example of a medication that is distributed in lipids.

Answer 28

Diazepam (Valium).

Question 29

_ is an example of a medication that has a high binding affinity for albumin.

Answer 29

Warfarin (Coumadin).

Question 30

Anticholinergics are contraindicated in older adults unless absolutely necessary (e.g., surgery), because they may lead to side effects such as _

Answer 30

1. Constipation.

2. Urinary retention.

Question 31

Older adults are more sensitive to benzodiazepines (Valium, Xanax, flurazepam, lorazepam) and are rarely prescribed them, as they can cause side effects such as _

Answer 31

1. Psychomotor impairment.
2. Ataxia.
3. Delayed reaction time.
4. Increased body swaying.
5. Decreased proprioception (perception of one’s position and limbs).

Question 32

_ of adult Americans are functionally illiterate.

Answer 32

20%.

Question 33

The Beers Criteria states that barbiturates should be avoided except as _

Answer 33

Anticonvulsants.

Question 34

Four examples of high-risk drugs according to the Centers for Medicare and Medicaid Services (CMS) are _

Answer 34

1. Estrogen.
2. Digoxin - 0.25 mg.
3. Ambien.
4. Elavil.

Question 35

Two examples of medications that should never be taken with alcohol are _

Answer 35

1. Isosorbide mononitrate (Imdur) - enhanced vasodilation.

2. Glipizide (Glucotrol) - potentiates oral hypoglycemia.

Question 36

The “brown bag method” refers to _

Answer 36

Asking patients to bring all of their medications with them, go over them with the provider, and explain how they take the medications.

Question 37

The leading reason why some older adults have problems refilling their medications is _

Answer 37

Transportation issues.

Question 38

The “donut hole” (Medicare Part D coverage gap)

Answer 38

1. When annual medication costs are between $2,700 and $6,100, all medication costs are out-of-pocket.
2. Below $295, all costs are also out-of-pocket. Between $295 and $2,700, Medicare pays 75%. After $6,100, Medicare pays 95%.
3. Most patients are in the “donut hole” around August/September.

Question 39

Polypharmacy

Answer 39

1. The use of more medications than are clinically indicated.
2. 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.

Question 40

Medication nonadherence

Answer 40

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.

Question 41

The result of decreased baroreceptor response and failure of cerebral blood flow auto-regulation is _

Answer 41

Orthostatic hypotension.