pharm Flashcards
goals
-Mastering prescribing for older pts requires expertise in technical elements of drug use and synthesizing evidence and biomedical and psychosocial factors into a coordinated plan of care that meets each individual’s unique needs
-use combo products
-make sure the bottles are easy to open
-any symptom in an older adults is a med SE until proven otherwise
adults > 65
-fastest growing population in US
-faster still is >75
-20% of hospitalizations for those >65 are due to meds theyre taking
effects of aging on Rx use (absorption)
-Reduced gastric acid production
-Raises gastric pH
-May alter solubility of some drugs (ASA etc) -> decrease absorption
-Longer gastric emptying
-Delay or reduce absorption
-Decreased esophageal motility
-Capsules more difficult to swallow
-Loss of subcutaneous fat
-Increased rate of absorption of topical medications
-Increased fragility of veins
-IV administration more difficult
effects of aging on Rx use (distribution)
-Decreased CO/circulation changes
-May delay onset or extend effect of meds
-Decrease of lean body mass/increase of fatty tissue where meds are stored
-Prolong medication’s action
-Increase sensitivity
-Increase toxic effects
-Higher plasma levels/more erratic distribution
effects of aging on Rx use (metabolism)
-Difficult to predict, depends on
-General health & nutritional status
-Use of alcohol, medications
-Long term exposure to environmental toxins/pollutants
-Aging causes decreased liver mass/ hepatic blood flow
-Delayed/reduced metabolism of drugs- kidneys
-Higher plasma levels
-Lower serum protein levels
-Loss of protein binding
-Idiosyncratic reactions
effects of aging on Rx use (excretion)
-Reduction in number of functioning nephrons/decreased GFR
-Longer half-life of medications
-Increased side effects
-Increased potential for toxicity
geriatric therapeutics
-Epidemiology & Risk Factors
-Causes of Adverse Drug Reactions
-Type A ADRs- from expected yet unwanted or exaggerated physiologic effects of drug.
-Type B ADRs- less common, result from idiosyncratic effects unrelated to the drug’s usual physiologic targets; for example, anaphylaxis to penicillin
-Drug-drug interactions
-Drug-disease interactions
beers criteria
-Avoid most antipsychotics in pts with Parkinson disease complicated by psychosis -> quetiapine, clozapine, and pimavanserin may be used with caution.
-Avoid using rivaroxaban and dabigatran bc of higher bleeding risk than warfarin and other direct oral anticoagulants.
-Avoid tramadol use bc of risk of hyponatremia from SIADH secretion.
-Avoid prescribing opioids with benzos or gabapentinoids bc the combinations increase risk of severe respiratory depression
removed from beers list
-Bupropion, pseudoephedrine, vasodilators, and caffeine
-For pts with dementia, histamine H2 receptor antagonists were removed bc evidence against them is weak and the panel did not want to restrict alternatives to PPI, which have strong evidence of increasing risks of Clostridioides difficile infection and fracture
modifications (recommendations)
-Nonbenzodiazepine sedative-hypnotics (i.e., the “z-drugs” zolpidem [Ambien], eszopiclone [Lunesta], and zaleplon [Sonata]), like benzodiazepines, should be avoided in patients with delirium.
-Small changes were made regarding the use of alpha blockers and clonidine to specify the high risk of orthostatic hypotension in older patients
-Digoxin is not preferred for treating afib or HF
-The recommendation to avoid sliding-scale insulin was edited to specify the increased risk of hypoglycemia.
-Avoid using metoclopramide (Reglan) for longer than 12 weeks was added to match FDA recommendation
polypharmacy
-Concurrent use of multiple medications
-Definition
-Consume 30% of all prescription drugs [average person takes 4-5 prescription meds]
-Consume 40% of OTCs
-Excessive use of medication
-Overdose of medication
-Under use of medication
-Potential Harms & Benefits of Using Multiple Medicines
-Prescribing cascade- different specialists keep adding meds
-Overuse, Misuse, and Underuse of Medications
-drugs-to-avoid lists
-Beers criteria
negative consequences of polypharmacy
-Prescribers are more likely to prescribe medications for older clients than young ones
altered response to meds: cumulative effect on physiology of aged
-aging
-disease
-stress
-trauma
elderly rely on various meds to control or relieve a range of age related problems
-Cardiovascular disease (dyslipidemia, hypertension, dysrhythmias)
-Diabetes (T2DM)
-Degenerative joint disease (OA, RA)
-Autoimmune disorders
risk of problems: polypharmacy
-Medication errors
-Wrong person, drug, time, route
-Adverse effects from each drug
-Polypharmacy primary reason for adverse reactions
-Adverse interactions between drugs
managing complexity
-regular med review
-brown bag review- bring the actual bottles in with them
-med reconciliation
-critically reviewing the med list
-interprofessional care- diff people arnt prescribing the same thing
