Pharm: Geriatrics Flashcards
***Any symptom in an elderly patient should be considered (WHAT?) until proven otherwise.
a drug side effect
What are medication related problems (MRP)?
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.
Why are older patients at a greater risk to MRPs?
- 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
How does age affect pharmacodynamics?
- Age causes ↑ receptor sensitivity in: benzos, warfarin, opiods and anticholinergics
- Age causes ↓ receptor sensitivity in beta-blockers
***Benzos are similar to (WHAT?) in the elderly?
The effects of alcohol
***This crazy lady specifically said that anticholinergics (Aricept) cause what?
Bradycardia
***Clinical response = (WHAT?) + (WHAT?) + (WHAT?)
Pharmacokinetics + Pharmacodynamics + Individual Variance
What are some of the symptoms of medication related problems that affect the elderly?
Change in speech, confusion, delirium, depression, falls, incontinence, insomnia, loss of appetite, Parkinson’s-like symptoms, weakness or lethargy, weight gain/loss.
How does aging effect the body: Functional changes?
Vision, taste, smell, hearing, dry mouth, dentures, hypochlorhydria, constipation, slow metabolism
How does aging effect the body: Absorption?
- 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
How does aging effect the body: Volume of distribution?
- ↓ 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
How does aging effect the body: Protein binding?
(outcome = ↑ in free/active drugs who are usually protein-bound, ex. Coumadin)
• ↓ serum albumin
• ↓ protein affinity binding
• ↑ alpha-1-acid glycoprotein
How does aging effect the body: Metabolism?
- ↓ 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.
How does aging effect the body: Renal excretion?
↓ renal blood flow and GFR
What are the drug-drug interactions w/ Warfarin?
sulfa drugs, macrolides, quinolones
What are the drug-drug interactions w/ ACE inhibitors?
Spironolactone
What are the drug-drug interactions w/ Digoxin?
amiodarone
***What is the #1 reason for an ER visit in the elderly? #2?
#1=Insulin #2=Warfarin
***What is the #1 side effect of Varapimil?
Constipation
How much should old people drink?
7 standard drinks per week w/ a maximum of 2 drinks per occasion
***What is ARMOR?
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.
***What does the use of ARMOR report?
- 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.
Herbal products: what are the facts?
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.
Herbal Products: Black Cohosh: MOA, Uses, Overdose SE, SE?
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)
