Pharm for Geri Flashcards
Pharmacokinetics vs dynamics
Pharmacokinetics
What the body does to the drug
Pharmacodynamics
What the drug does to the body
What disorders can change GI?
Disorders that change GI motility: DM, IBS, GERD, dumping syndrome
Where do you see dumping syndrome after what surgery?
Cholecystectomy
All of the bile is no longer stored and it is released
this leads to problems with reabsorbtion
What is alchalsia?
Narrowing of esophagus
What is biliary dyskeniesia?
Gallbladder is not working
What is pseudoobstruction aka
ileus?
What are some drugs that delay gastric emptying?
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
What is zofran for, what is something to know about what will happen a couple days later?
Will have constipation
What can tricyclics be used for as well?
Migraines and sleep
How is distribution altered by aging?
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 is metabolism affected in older?
Impacted by Reduction in cytochrome P450 metabolism due to age-related reduced hepatic blood flow and liver size
How is excretion affected in older?
Due to by decrease in Renal tubular function and GFR
What is important to know about the levels of creatinine in older patients?
loss of muscle mass means that it might be normal
Why should you not give an NSAID to geriatric on anticoagulation
GI bleed
Inability to break it down
Hard to control BP, so they are on HTN therapy
What is polypharmacy?
The simultaneous use of multiple drugs by a single patient, for one or more conditions; > 5 drugs
Approx. ___ of patients 57 years and older take ≥ 5 meds/day
Approx. ____ of patients 65 years and older take ≥ 10 meds/day
50%
20%
important stat (probably on test)
What typically leads to adverse drug reactions in elderly?
Due to polypharmacy
Most often related to the use of multiple medications and the number of chronic illnesses present
What is the MC reason why elderly patients are hospitalized for drug use?
Anticoagulants and hyperglycemics (insulin) are responsible for 2/3 of all medication related hospitalizations
What are some narrow therapeutic index drugs?
digoxin
warfarin
lithium
theophylline
clyclosporine
tacrolimus
gentamicin
How many ED visits each year for adverse drug reactions?
450,000
What are some adverse drug reactions?
Bradycardia leading to syncope with B-blocker use
Diarrhea related to abx use
Bleeding associated with anticoagulants
What are some adverse drug events?
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)
What is the MC drug-drug interaction in elderly?
Inhibition of P450 system
What is an important inhibition of 450 that will likely be on the exam?
Inhibition of P450 slows metabolism of atorvastatin leading to toxic levels of statin resulting in liver dysfunction, myalgias, and rhabdomyolysis
What are some common P450 inhibitors?
rifampin, barbiturates, carbamazepine, phenytoin
What is an example of an underlying disease increases susceptibility to unwanted physiologic effects of a drug
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
What is poly-provider syndrome?
Multiple providers
How much does each provider increase the odds of a DDI?
29%
How do you prevent poly-providers?
Limit the number of pharmacy (should go to 1 if possible)
Electronic prescribing (drug/drug already included)
When you have a geriatric patient, what are some additional questions you should ask before prescribing?
- Is there an indication for the drug?
- Is the medication effective for the condition?
- Is the dosage correct?
- Are the directions correct?
- Are the directions practical? (is it 4 times a day?)
- Are there clinically significant drug–drug interactions?
- Are there clinically significant drug–disease/condition interactions?
- Is there unnecessary duplication with other drugs?
- Is the duration of therapy acceptable?
- Is this drug the least-expensive alternative compared with others of equal utility (IMPORTANT TO KNOW)
What is important to adjust for elderly patients? Based on what?
Dosages - adjusted based on creatinine clearance
What is the serum creatinine for elderly patients?
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
What percentage of of geriatric patients use at least 1 drug that consensus criteria recommends avoiding in older patients?
20-30%
What is the BEERS criteria cover?
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
What is the MC medication implicated for ER visits d/t adverse drug reactions? 2nd?
Warfarin
Insulin is 2nd
What are long-acting sulfonureas worry of?
All have potential to cause hypoglycemia
Risk is greater in older adults due to decreased drug clearance
Glipizide should be avoided
Why is digoxin avoided in elderly?
Very narrow therapeutic window - toxicity common
Impaired renal function and drug-drug interactions lead to elevated serum digoxin levels
What are NSAIDs CI in?
Heart failure
Renal dysfunction
High risk of peptic ulcer induced GI bleeding
What are some alternatives to NSAIDs?
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
What are some high risk medications that begin with anti-?
Antihistamines
Antidepressants
Antipsychotics (clozapine)
Antiemetics (promethazine)
What are other classes of medications that you should be caution of?
Bladder and GI antispasmodics
Muscle relaxants
Anticholinergics can lead to an increase in these three problems in elderly
Falls
Functional decline
Impaired cognition
What is worrisome about opioids in elderly?
Safety concerns
Psychomotor impairment
Increased risk of delirium
impaired gait/falls
sedation
N/V/C
Respiratory depression
Central sleep apnea
When do you use antispychotics?
Dementia, sometimes post-op
What do antipsychotics increase the risk of in the elderly?
MI, stroke, VTE
Falls, fractures
Mortality
Nonadherence Affects approx. ___ older adults. Contributes to ____ of outpatient adverse drug reactions
50%
20%
What are some things that may make someone not adhere in elderly?
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
