Pharm - Geriatrics

Question 1

ID underuse or under-prescribing of medication for a diagnosed condition

Answer 1

some facts:

• MC under-prescribed drugs are blood pressure medications, anticoagulants, and cholesterol lowering agents
• Two criteria for medication underuse: ACOVE and START
• Approx 60% of elderly do not receive meds for diagnosed indication

Question 2

What are the four practices that can decrease the risk of an ADR for patient in community care

Answer 2

1. Keep an accurate list of all medications that a patient is currently using in their medical record
2. Advice periodic brown bag checkups
3. Inform patients of both generic and brand names, including spelling, as well as the reason for taking the medication
4. Use medication organizers filled by the patient, family, or caregiver to facilitate adherence with drug regimens. Blister packs are also an option.
   * *Community pharmacists are great resources!

Question 3

ID interventions most likely to improve medication adherence

Answer 3

• Forgetting the medication is a common reason for non-adherence – usually a simple reminder will have a large impact
• Assess for depression
• Reduce number of medications when drugs are ineffective
• Simplify medication regimens: use combo products dosed less frequently
• Assess for ADR
• Financial: decrease number of medications, use generic meds, use lower “tier” medications, 90 day supplies, mail-order options are commonly less expensive, $4 walmart meds, combination products
• If cognitive functionality or decline ID support within family, community, health care system

Question 4

ID reasons medications are on the Beers Criteria list

Answer 4

• For patients ≥ 65
• Risk exceeds the benefit
• Safer alternatives are available
• Use of meds on the list is associated with decreased quality of life and increased hospitalizations

Question 5

Select the reason why anticholinergic medications should be avoided or use limited in the elderly.

Answer 5

• Associated ADR: memory impairment, confusion, hallucinations, dry mouth, blurred vision, constipation, nausea, urinary retention, impaired sweating, and tachycardia
• Increased risk for cognitive decline and dementia

Question 6

List the drug classes that can increase risk of falls in the elderly

Answer 6

• Atypical antipsychotics
• First generation antipsychotics
• Sedatives and hypnotics
  o Benzodiazepines
  o Non-benzodiazepines
  o First generation antihistamines
• Antidepressants: all classes (TCA, SSRI, SNRI, etc.)
• Antihypertensives and cardiovascular medications
  o Vasodilators:
  • Hydralazine
  • Alpha-1-blockers
  • Nitrates
  • Dihydropyridine CCB
• Parkinsonian medications: Esp Levodopa
• Phosphodiesterase-5 inhibitors
• Alcohol

Question 7

ID an example of a prescribing cascade initiated dt an ADR

Answer 7

A drug ADR is misinterpreted as a new medical issue and is treated with an additional drug therapy

Question 8

Medication modifications to decrease risk of ADR

- hypertension

Answer 8

• Choose peripherally acting agents to avoid orthostatic hypertension
• Avoid centrally actiting agents like methyldopa, clonidine, propranolol
• Avoid short acting dihydropyridine like nifedipine

Question 9

Medication modifications to decrease risk of ADR

- A. fib (anti-arrhythmic)

Answer 9

• Avoid Amiodarone and Dronedarone as first line for a. fib

- Alter dose of digoxin based on renal function