Midterm: DSA: Concepts in Geriactrics and Geriatric Pharm

Question 1

What are the categories of elderly?

Answer 1

Young Old: 65-75
Old-Old: 75-85
Very Old: 85+

Question 2

What does the USPSTF recommend to reduce fall risks in elderly?

Answer 2

Exercise or physical therapy and vitamin D supplementation in those 65+

Question 3

What are the three exams used to test for cognitive decline?

Answer 3

MoCA-Montreal Cognitive Assessment
MMSE-MiniMental Status Exam
MiniCOG: three words plus clock drawing test

Question 4

In an elderly patient with a MiniCOG is positive, what can you do next?

Answer 4

do a full MMSE or MoCA

Consider full Neuropsychiatric Evaluation

Question 5

Besides memory defects, what other defect may mimic cognitive decline?

Answer 5

Sensory or behavioral defects (living alone/neglect)

Also look for organic cause (B12, TSH, CBC)

Question 6

Sleep disturbances, fatigue, psychomotor issues, and hopelessness about the future are signs of what in the elderly?

Answer 6

Depression

Question 7

What is a good solution for bladder and bowel issues in patients that it is more of a mobility issue rather than loss of bladder control?

Answer 7

Go to the bathroom at regular times,
exercise to optimize mobility,
pelvic floor exercises

Question 8

whats the rule of thumb for meds in the elderly?

Answer 8

Start at lowest dosages and slowly increase if you must

Question 9

What drug choices should be used with caution?

Answer 9

Direct Oral anticoagunlants (bleeds)
Warfarin (bleeds)
Tramadol (CNS issues)
Antipsychotics in PD (dyskinesias)

Question 10

What does polypharmacy (pt on multiple drugs) increase the risk of?

Answer 10

Drug cascades

-the prescribing of one drug to offset the adverse the effects of another

Question 11

What is the most commonly used criteria in the elderly?

Answer 11

BEER’S

-talks about which drugs could be unsafe for elderly

Question 12

What is a Direct Power of Attorney (DPOA) used for?

Answer 12

Puts decision making into the hands of another person if the individual is unable to

Question 13

What is an advanced directive?

Answer 13

Indicates what treatments patient does/doesn’t want

• code status
• incubate/ventilator
• tube feeding
• etc

Question 14

What medication should be avoided with opioids?

Answer 14

Benzos

-increase OD risk

Question 15

What meds should be used with caution when pt on ACE/ARBs?

Answer 15

Sulfa drugs

TMP-SMX, etc

Question 16

Which drugs should be avoided in pts with delirium?

Answer 16

H2 antagonists

Question 17

Why should aspirin be used with caution when pt is 70+?

Answer 17

Increases risks of bleeding

Question 18

What meds should you avoid if pt has history of falls?

Answer 18

SNRIs