module 8 geriatric

Question 1

pharmacology considerations associated with aging

Answer 1

Diminished glomerular filtration
Changes in density and activity of target receptors
Reduced liver size and hepatic blood flow
Decreased cardiac output
polypharmacy
cognitive decline/confusion

Question 2

first-line treatment for depression in elderly

Answer 2

SSRIs

Question 3

difference in typical starting dose of antidepressants for elderly

Answer 3

half the minimal efficacious dosage- then double after one week.

Question 4

All SSRIs can be given in single daily dose except _____

Answer 4

fluvoxamine: Should be given in two divided doses

Question 5

Risks of SNRIs in elderly

Answer 5

increased BP
Orthostatic hypotension
syncope
arrythmias

Question 6

Helpful for sleep and appetite stimulation

Answer 6

mertazapine

Question 7

SNRI of choice for cognitive stimulation

Low motivation, and pain

Answer 7

cymbalta (duloxetine)

Question 8

Big problem with TCAs in the elderly

Answer 8

anticholinergic effects

Question 9

BBW on all antipsychotics

Answer 9

Nearly two-fold increase in the rate of deaths in older patients with behavioral and psychological symptoms of dementia

Question 10

Acetylcholinesterase inhibitors

Answer 10

Donepezil (Aricept)
rivastigmine (Exelon)
Galantamine (Razadyne)

Question 11

modulates nicotinic receptors and inhibits acetylcholinesterase

Answer 11

Galantamine

Question 12

found in snowdrops and daffodils

Answer 12

galantamine (Razadyne)

Question 13

side effects of AchE inhibitors

Answer 13

GI side effects- nausea, vomiting, diarrhea, appetite loss

Question 14

How long can it take for donepezil to work?

Answer 14

6 weeks

Question 15

May exacerbate asthma, increase risk of ulcers, cause bradycardia or heart block

Answer 15

donepezil (Aricept)

Question 16

released in excess during alzheimer’s disease

Answer 16

glutamate

Question 17

type of NMDA antagonist

Answer 17

Memantine (Namenda)

Question 18

Often used together for Alzheimer’s disease

Answer 18

Menantine (NMDA antagonist) and

AchE inhibitor such as Donepezil (Aricept)

Question 19

preferred to use with dementia w/behavioral symptoms if antipsychotic is warranted

Answer 19

Risperdal (in low doses)

Question 20

Do not give antipsychotic for which type of dementia?

Answer 20

Lewy-body dementia

Question 21

First-line treatment of agitation and aggression in dementia

Answer 21

SSRI/SNRI - citalopram, Zofran

Question 22

second-line treatment for agitation and aggression in dementia

Answer 22

beta blockers, valproate, gabapentin, Lyrica