Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Geriatrics > Pharm for Geri > Flashcards

Pharm for Geri Flashcards

1
Q

Pharmacokinetics vs dynamics

A

Pharmacokinetics
What the body does to the drug

Pharmacodynamics
What the drug does to the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What disorders can change GI?

A

Disorders that change GI motility: DM, IBS, GERD, dumping syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where do you see dumping syndrome after what surgery?

A

Cholecystectomy
All of the bile is no longer stored and it is released

this leads to problems with reabsorbtion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is alchalsia?

A

Narrowing of esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is biliary dyskeniesia?

A

Gallbladder is not working

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is pseudoobstruction aka

A

ileus?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some drugs that delay gastric emptying?

A

Alcohol (vomiting lunch at two in the morning)
Aluminum hydroxide antacids Mylanta
Anticholinergics Atropine, oxybutynin (bladder)
Beta Blockers metoprolol, propranolol
Calcium channel blockers Nifedipine, amlodipine
Cyclosporin(transplants Prografttacrolimus
Diphenydramine Benadryl
GLP1 Byetta,
GLP2 Tirzeptaide, semaglutide
H2 receptor antagonists Famotidine, ranitidine,
Levadopa Sinemet ( Parkinson’s )
Lithium Bi polar disorder
Ondansetron Zofran
Opioids
Phenothiazines Antipsychotics, Compazine
Proton pumpinhibitors omeprazole
Tricyclic antidepressants Elavil amitriptyline(can

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is zofran for, what is something to know about what will happen a couple days later?

A

Will have constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can tricyclics be used for as well?

A

Migraines and sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is distribution altered by aging?

A

Impacted by lean muscle replaced with adipose tissue, reduction in total-body water content (less fluids), decreased serum albumin

Inc adipose tissue: lipophilic drugs (BZD) = dec serum level, inc vol of distribution, inc metabolism, inc elimination _-life

Low total-body water content = dec vol of distribution for Hydrophilic meds (e.g., digoxin, lithium) = higher serum levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is metabolism affected in older?

A

Impacted by Reduction in cytochrome P450 metabolism due to age-related reduced hepatic blood flow and liver size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is excretion affected in older?

A

Due to by decrease in Renal tubular function and GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is important to know about the levels of creatinine in older patients?

A

loss of muscle mass means that it might be normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why should you not give an NSAID to geriatric on anticoagulation

A

GI bleed
Inability to break it down
Hard to control BP, so they are on HTN therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is polypharmacy?

A

The simultaneous use of multiple drugs by a single patient, for one or more conditions; > 5 drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Approx. ___ of patients 57 years and older take ≥ 5 meds/day
Approx. ____ of patients 65 years and older take ≥ 10 meds/day

A

50%
20%

important stat (probably on test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What typically leads to adverse drug reactions in elderly?

A

Due to polypharmacy
Most often related to the use of multiple medications and the number of chronic illnesses present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the MC reason why elderly patients are hospitalized for drug use?

A

Anticoagulants and hyperglycemics (insulin) are responsible for 2/3 of all medication related hospitalizations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some narrow therapeutic index drugs?

A

digoxin
warfarin
lithium
theophylline
clyclosporine
tacrolimus
gentamicin

20
Q

How many ED visits each year for adverse drug reactions?

A

450,000

21
Q

What are some adverse drug reactions?

A

Bradycardia leading to syncope with B-blocker use
Diarrhea related to abx use
Bleeding associated with anticoagulants

22
Q

What are some adverse drug events?

A

An injury/harm resulting from the use of a pharmacologic agent
Adverse drug reaction
Unintentional overdose
Withdrawal reaction after abrupt discontinuation (benzos, seizure from withdrawls)

23
Q

What is the MC drug-drug interaction in elderly?

A

Inhibition of P450 system

24
Q

What is an important inhibition of 450 that will likely be on the exam?

A

Inhibition of P450 slows metabolism of atorvastatin leading to toxic levels of statin resulting in liver dysfunction, myalgias, and rhabdomyolysis

25
Q

What are some common P450 inhibitors?

A

rifampin, barbiturates, carbamazepine, phenytoin

26
Q

What is an example of an underlying disease increases susceptibility to unwanted physiologic effects of a drug

A

Example:
Patient with severe COPD or asthma is prescribed a Beta-Blocker for hypertension because an ACE-inhibitor alone is not controlling BP
May result in worse pulmonary symptoms

27
Q

What is poly-provider syndrome?

A

Multiple providers

28
Q

How much does each provider increase the odds of a DDI?

A

29%

29
Q

How do you prevent poly-providers?

A

Limit the number of pharmacy (should go to 1 if possible)
Electronic prescribing (drug/drug already included)

30
Q

When you have a geriatric patient, what are some additional questions you should ask before prescribing?

A
  1. Is there an indication for the drug?
  2. Is the medication effective for the condition?
  3. Is the dosage correct?
  4. Are the directions correct?
  5. Are the directions practical? (is it 4 times a day?)
  6. Are there clinically significant drug–drug interactions?
  7. Are there clinically significant drug–disease/condition interactions?
  8. Is there unnecessary duplication with other drugs?
  9. Is the duration of therapy acceptable?
  10. Is this drug the least-expensive alternative compared with others of equal utility (IMPORTANT TO KNOW)
31
Q

What is important to adjust for elderly patients? Based on what?

A

Dosages - adjusted based on creatinine clearance

32
Q

What is the serum creatinine for elderly patients?

A

Serum creatinine levels often remain within normal limits despite a decrease in GFR – older people typically have less muscle mass and are physically less active than younger adults and thus produce less creatinine
Don’t be misled by following serum creatine levels

33
Q

What percentage of of geriatric patients use at least 1 drug that consensus criteria recommends avoiding in older patients?

A

20-30%

34
Q

What is the BEERS criteria cover?

A

Drugs to avoid in most older patients
Drugs to avoid in patients with specific health conditions
Drugs to avoid in combination with other treatments due to concern for drug-drug interactions
Drugs to use with caution because of risk of harmful side effects
Drugs to dose differently or avoid in patients with renal insufficiency

35
Q

What is the MC medication implicated for ER visits d/t adverse drug reactions? 2nd?

A

Warfarin
Insulin is 2nd

36
Q

What are long-acting sulfonureas worry of?

A

All have potential to cause hypoglycemia
Risk is greater in older adults due to decreased drug clearance

Glipizide should be avoided

37
Q

Why is digoxin avoided in elderly?

A

Very narrow therapeutic window - toxicity common
Impaired renal function and drug-drug interactions lead to elevated serum digoxin levels

38
Q

What are NSAIDs CI in?

A

Heart failure
Renal dysfunction
High risk of peptic ulcer induced GI bleeding

39
Q

What are some alternatives to NSAIDs?

A

acetaminophen (Tylenol)
diclofenac gel (Voltaren)
Topical NSAID with relatively minimal systemic absorption

Use at the lowest dose, for the shortest duration possible
Co-administer PPI
Take with food

40
Q

What are some high risk medications that begin with anti-?

A

Antihistamines
Antidepressants
Antipsychotics (clozapine)
Antiemetics (promethazine)

41
Q

What are other classes of medications that you should be caution of?

A

Bladder and GI antispasmodics
Muscle relaxants

42
Q

Anticholinergics can lead to an increase in these three problems in elderly

A

Falls
Functional decline
Impaired cognition

43
Q

What is worrisome about opioids in elderly?

A

Safety concerns
Psychomotor impairment
Increased risk of delirium
impaired gait/falls
sedation
N/V/C
Respiratory depression
Central sleep apnea

44
Q

When do you use antispychotics?

A

Dementia, sometimes post-op

45
Q

What do antipsychotics increase the risk of in the elderly?

A

MI, stroke, VTE
Falls, fractures
Mortality

46
Q

Nonadherence Affects approx. ___ older adults. Contributes to ____ of outpatient adverse drug reactions

A

50%
20%

47
Q

What are some things that may make someone not adhere in elderly?

A

Asymptomatic disease
Medication side effects
Inadequate follow-up
Lack of patient understanding of the value of treatment
poor patient education
poor provider–patient relationship
low literacy
poor hearing, cognitive impairments
Missed appointments and transportation difficulties
Complicated dosing regimens
Polypharmacy
Financial hardships

Geriatrics (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions