Module 2 Exam 1 Lecture 1 Flashcards
A1c tx goal for geriatrics
7-8%
What is a key assumption that is made when treating a patient with chronic medical condition
low life expectancy
How long of a treatment of diabetes treatment is needed to avoid organ failure
10 years
How do we treat diabetic patients for patients that have a chronic medical condition with low life expectancy
Control for hypoglycemia, while treating the polyuria and polydipsia
Why are sulfonylureas not 1st line for older adults
Due to risk of hypoglycemia, older adults are more likely to experience side effects
Also more likely to experience falls and CVD death relative to younger adults
common geriatric syndromes
Sensory impairment (vison and hearing)
Incontinence
Constipation
Poor nutrition
depression
insomnia
Poverty
falls
Delirium
Dementia
Weakness
Immobility
What are the two functional categories of abilities in older adults
ADLs and IADLs
(activity of daily living vs Instrumental activities for daily living)
What are some ADLs
Dressing
bathing
feeding
toileting
walking/ambulation
What are some IADLs
Handling finances
shopping for groceries
meal preparations
using a telephone
house keeping/laundry
handling meds
using transportation
What are some medications that can cause a risk of falls
Sedative/hypnotics
Neuroleptics/antipsychotics
antidepressants
opioids
loop diuretics
alpha blockers
What is the beers criteria
Because of age, relative to a younger population, are you at a higher risk of adverse medical conditions
What are 3 medication problems in older adults
Polypharmacy
Non-adherence
PK changes with aging
Why can polypharmacy be a problem in older adults
Multiple medications without an indication
Medications treating ADRs
Older patients are more adherent to meds than younger ones
TrueW
What are some physiologic changes that occur when we age that can affect the PK of drugs
Decrease in TBW
Decrease in lean body mass
Increase in body fat
Decrease in baroreceptor response activity (sitting down for 8 hours and standing up dizzy)
decrease in HR variability
Decrease in hepatic blood and renal blood flow
decreased neurotransmitter volume (Increased sensitivity to CNS adverse effects
What happens to tmax in older adults
Slows down
What happens Vd and concentration of water soluble drugs in older patients
decrease in volume of distribution and increase in concentration of drug due to the decrease in total body water. (atenolol)
What happens to Vd and t1/2 of lipid soluble drugs in older patients
Increased Vd and increased t1/2 of lipid soluble drugs (rifampin)
what happens to clearence and t1/2 of hepatically cleared drugs in older patients
Decreased clearence and increased t1/2 of most hepatically cleared drugs (propanolol)
What happens to clearence and t1/2 of most renally cleared drugs
decreased clearence, increased t1/2 of most renally cleared drugs
beers criteria is for adults aged above
65 and up
Which type of medications should we evaluate risks for in older adults
Meds with anticholinergic properties
Sedatives with CNS effects
Diabetic agents
What should we focus on when assesing risk of anticholinergic agents in older adults
Focus on risk of cognitive impairment
What should we focus on when assessing risk of diabetic drugs in older adults
Sliding scale insulin, long acting sulfonylureas
Beers criteria diabetes drugs
Sulfonylureas (glipizide, glyburide, glimepride)
SGLT2s (flozins)Sliding scale insulin)
What is a big recommendation for rational prescribing
recognize new symptoms as potential adverse rxns
considerations in choosing medications
Remaining life expectancy
time to benefit
Goal of care
Tx targets
What is palliative care
after diagnosis of terminal illness, disease not responsive to curative tx or tx does not exist
What are some goals for palliative care
Optimize QOL and focus on sx only not on prolonging life
stop meds not improving QOL
What is hospice care
provides at home facility. Life expectancy is 6 months or less
Does beers criteria apply to palliative or hospice care?
no
What does ACD stand for
advanced care directives
what is an ACD
Verbal and written instructions about future medical care and tx (allows you to make a choice of if I am in a life threatining situation, do I want chest compressions, intubated? ETC…)
ACDs include
healthcare representatives- names someone to make decisions in patient is not able
psychiatric advanced directives- sets preferences during periods of incapacity
power of attorney- financial or healthcare power to other people you choose
