Pharm considerations for geriatrics

Question 1

Elderly patient physiology

Answer 1

• Increased fat-to-lean body mass ratio
• Decreased total-body water
  – Increased sensitivity to dehydration
• May have Decreased serum albumin
  may have higher free drug levels
• Decreased metabolism
• Decreased renal function (loss of GFR & tubular function
• Decreased cognitive ability
• Decreased cardiac output (HR x SV)
• Altered GI absorption
• Altered tissue sensitivity
• Decreased sensitivity to other drugs

Question 2

Alpha-1 agonists

Answer 2

– Metaraminol (Aramine®)
– Methoxamine (Vasoxyl®)
– Oxymetazoline (Afrin®)
– Phenylephrine (Don’t work®)

Question 3

Alpha-2 agonists

Answer 3

– Brimonidine (Alphagan®)
– Clonidine (Catapres®)
– Dexmedetomidine (Precedex®)
– Guanabenz (Wytensin®)
– Guanfacine (Tenex®)

Question 4

~2/3 of all elderly patient Adverse
Drug Events (ADE) in ER are caused
by:

Answer 4

• Antithrombotic medications
• Antidiabetic medications

Question 5

What is a drug omission?

Answer 5

• A Rx the patient was receiving, before admission, that was not prescribed at
  discharge.
• No clinical explanation for the omission

Question 6

What is a drug substitution?

Answer 6

• Rx, at discharge, using different dosage, route of administration, or frequency from that which the patient received before admission.
• Difference was not justified by a change in the patient’s clinical condition

Question 7

What is a drug commission?

Answer 7

• Rx, at discharge, that the patient did not take before hospitalization.
• No clinical explanation for adding the medication to the patient’s therapy

Question 8

Any symptom in an older adult is a _____ until proven otherwise!

Answer 8

medication side effect

Question 9

Adverse Reactions of drugs

Answer 9

• Type A (more common)
  – Expected yet unwanted or exaggerated physiologic effects of the drug
• Drug-disease effect
• Drug-drug effects
• Type B (less common)
  – Peculiar effects unrelated to the normal effect of the drug
• Allergic reactions
  – Ex// Anaphylaxis

Question 10

Making of a “Poly-provider”

Answer 10

• Patients
  – Underreport symptoms or report vague symptoms
  – Do not know their prescription regimens
• Providers
  – Treat symptoms rather than diagnose the disease
• Effective therapy requires an accurate Dx
• Multiple providers following this pattern
  – Fail to communicate with the PCP

Question 11

Nonadherence leads to:

Answer 11

– failure to control disease
– Misdiagnoses
– ↑ ER visits/hospitalizations
– ↑ costs
– ↑ mortality

Question 12

______ - patient actively
participating in a therapeutic plan agreed upon
by the prescriber & the patient

Answer 12

Medication Adherence

Question 13

Identify drugs that are potentially inappropriate in older adults:

Answer 13

1) Independent of diagnosis
2) Considering diagnosis
3) Drug-drug interactions
4) Renal dosage considerations

Question 14

In a “brown bag” medication review, For each item ask the patient:

Answer 14

– “What are you taking this for?
– “How do you take this?
– “How often do you take this?”
– ”Do you ever miss/skip doses?” ”Why?”
– ”Are you having any problems with this drug?”