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Geriatrics Final > Pharm: Geriatrics > Flashcards

Pharm: Geriatrics Flashcards

1
Q

***Any symptom in an elderly patient should be considered (WHAT?) until proven otherwise.

A

a drug side effect

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2
Q

What are medication related problems (MRP)?

A

Undesirable event experienced by a patient.
Involves or is suspected to involve drug therapy.
Actually or potentially interferes with a desired patient outcome.
Categories:
• Wrong drug for patient’s medical condition
• Correct drug – dose too low (***start low, go slow)
• Correct drug – dose too high
• Adverse drug reaction
• Patient not taking drug correctly
• Patient taking unnecessary drugs given present condition.

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3
Q

Why are older patients at a greater risk to MRPs?

A
  • Multiple chronic diseases
  • Multiple prescribers
  • Multiple medications
  • Types of medications prescribed
  • Not many clinical trials in patients > 75 years
  • Shortage of trained professionals in geriatric pharmacotherapy
  • Pharmacokinetic (what the body does to the drug) and Pharmacodynamic (what the drug does to the body) changes
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4
Q

How does age affect pharmacodynamics?

A
  • Age causes ↑ receptor sensitivity in: benzos, warfarin, opiods and anticholinergics
  • Age causes ↓ receptor sensitivity in beta-blockers
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5
Q

***Benzos are similar to (WHAT?) in the elderly?

A

The effects of alcohol

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6
Q

***This crazy lady specifically said that anticholinergics (Aricept) cause what?

A

Bradycardia

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7
Q

***Clinical response = (WHAT?) + (WHAT?) + (WHAT?)

A

Pharmacokinetics + Pharmacodynamics + Individual Variance

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8
Q

What are some of the symptoms of medication related problems that affect the elderly?

A

Change in speech, confusion, delirium, depression, falls, incontinence, insomnia, loss of appetite, Parkinson’s-like symptoms, weakness or lethargy, weight gain/loss.

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9
Q

How does aging effect the body: Functional changes?

A

Vision, taste, smell, hearing, dry mouth, dentures, hypochlorhydria, constipation, slow metabolism

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10
Q

How does aging effect the body: Absorption?

A
  • Passive diffusion not effected by age.
  • Decreased 1st pass effect (e.g. Morphine, propranolol) → increased bioavailability
  • Decreased transdermal absorption d/t: ↓ skin hydration, ↓ surface lipids, ↓ peripheral circulation, ↑ keratinization
  • GI absorption d/t: (no change except for possible delay) ↓ gastric emptying rate, ↓ intestinal motility, ↓ intestinal blood flow and surface area, ↓ gastric acid output → ↑ gastric pH
  • Decreased IM absorption d/t: ↓ muscle mass, ↓ peripheral circulation, ↑ connective tissue
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11
Q

How does aging effect the body: Volume of distribution?

A
  • ↓ in total body water–> ↓ volume of distribution of hydrophilic drugs
  • ↓ in lean body mass (muscle mass)
  • ↓ cardiac output
  • ↑ body fat –> ↑ volume of distribution of lipophilic drugs
  • ↓ albumin
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12
Q

How does aging effect the body: Protein binding?

A

(outcome = ↑ in free/active drugs who are usually protein-bound, ex. Coumadin)
• ↓ serum albumin
• ↓ protein affinity binding
• ↑ alpha-1-acid glycoprotein

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13
Q

How does aging effect the body: Metabolism?

A
  • ↓ Liver function d/t ↓ hepatic mass and blood flow to liver
  • ↓ Phase I metabolism (oxidation) → ↓ clearance and ↑ half-life
  • Phase II metabolism (conjugative) not affected
  • CYP 450 activity not affected.
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14
Q

How does aging effect the body: Renal excretion?

A

↓ renal blood flow and GFR

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15
Q

What are the drug-drug interactions w/ Warfarin?

A

sulfa drugs, macrolides, quinolones

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16
Q

What are the drug-drug interactions w/ ACE inhibitors?

A

Spironolactone

17
Q

What are the drug-drug interactions w/ Digoxin?

A

amiodarone

18
Q

***What is the #1 reason for an ER visit in the elderly? #2?

A 
#1=Insulin
#2=Warfarin
19
Q

***What is the #1 side effect of Varapimil?

A

Constipation

20
Q

How much should old people drink?

A

7 standard drinks per week w/ a maximum of 2 drinks per occasion

21
Q

***What is ARMOR?

A 
Assess
Review
Minimize
Optimize
Reassess
Avoids Polypharmacy; A tool used to emphasize quality of life as a key factor for making decisions on changing or discontinuing medication.
22
Q

***What does the use of ARMOR report?

A
  • consistent decline in the use of nine or more medications
  • reduction in falls and behaviors with harm to self
  • decline in number of hospital admissions, geriatric psychiatry admissions and consultations
  • Use of antipsychotics and antidepressants has been reduced.
23
Q

Herbal products: what are the facts?

A

No quality control; avoid in pregnancy and lactation (except ginger for morning sickness)
Herb = A flowering plant or plant part valued for its medicinal, savory or aromatic qualities.
Botanical Medicine/Phytomedicine = A substance derived from plants. A vegetable drug especially in the crude state that has a medicinal use.

24
Q

Herbal Products: Black Cohosh: MOA, Uses, Overdose SE, SE?

A

MOA = binds to estrogen receptors and suppresses LH
Uses = menopause (hot flashes)
Overdose SE: N/V, dizzy, bradycardia, increased respiration, CNS and visual changes.
SE: Miscarriage (***DON’T USE IN PREGNANCY)

25
Q

Herbal Products: Cranberry: MOA, Uses, ADR?

A

MOA: proanthocynidins inhibit E. coli from attaching to urinary tract.
Uses: UTI and urinary odor
ADR: diarrhea, GI, urinary stones

26
Q

Herbal Products: Echinacea: MOA, Uses, ADR?

A

Uses: immune stimulant (prevent/treat common cold)
MOA: maybe up-regulation of TNF-alpha mRNA or anti-inflammatory
Take at onset of cold symptoms; ***only works in tea form.
ADRs: N/V, tingling tongue, HA, allergic rxn (sunflower seeds and daisies).

27
Q

Herbal Products: Garlic: MOA, Uses, ADR?

A

Uses: hyperlipidemia, HTN, DM II, prevent certain cancers
MOA: alliin (in garlic) → allicin → reduce activity of CoA and HMG-CoA (lipid synthesis enzymes)
ADRs: N/V, increased bleeding risk, heartburn, bad breath, body odor

28
Q

Herbal Products: Ginkgo Biloba: MOA, Uses, ADR, D-D rxn?

A

Uses: Alzheimer’s, asthma, antioxidant/neuroprotective, stress/anxiety, vascular dementia, claudication, tinnutis and vertigo
MOA: contains flavonoids and terpenoids → ↑ blood flow to brain, antioxidant power, reduce capillary rigidity, inhibit platelet aggregation
ADRs: allergic rxn, N/V, dizzy, bleeding, HA, seizures, palpitations
Rx rxn w/ ASA, Coumadin and antidepressants.

29
Q

Herbal Products: Ginseng: MOA, Uses, ADR?

A

Uses: memory, physical stress, insomnia, DM, impotence
MOA- Ginsenosides responsible for ginseng’s activity (Asian and American have different ones)
ADR’s – ( large or overdose CNS stimulation, N/V ) Headache, ***blood pressure, tachycardia, anorexia, bleeding

30
Q

Herbal Products: Milk Thistle: MOA, Uses, ADR?

A

Uses: gallbladder and liver problems, dyspeptic conditions (heartburn and bloating).
Suppresses cell growth and anti-cancer effects.

31
Q

Herbal Products: Saw Palmetto: MOA, Uses, ADR?

A

Uses: urinary tract problems, BPH, testicular atrophy, sex hormone disorders
MOA: inhibits 5-alpha-reductase (testosterone → DHT)
ADRs: HA, GI disturbances

32
Q

Herbal Products: Soy: Uses, ADR?

A

Uses: cancer prevention, menopausal symptoms, osteoporosis, CV disease
ADR: stomach cramping, bloating

33
Q

Herbal Products: St. John’s Wort: Uses, ADR?

A

Uses: depression, anxiety, pain
MOA: 5HT, dopamine, NE reuptake inhibition + antagonism of BZD, GABA
ADRs: paresthesias, HA, N

34
Q

***What herb should be avoided in pregnancy b/c it can cause miscarriage?

A

Black Cohosh

35
Q

***What herb only works in tea form? Who should it not be given to?

A

Echinacea. Don’t give to people w/ autoimmune disease.

36
Q

***What herb should only be used in men?

A

Saw Palmetto

Geriatrics Final (10 decks)

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