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Lifespan > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

what are components to pharmokinetics

A

absorption
distribution
metabolism
excretion

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2
Q

where does most medication get absorbed through

A

intestines

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3
Q

how does GI motility slowing w age impact absorption

A

pain meds or quicker needed meds need inc time to take action

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4
Q

how does medicine distribution change w age

A

overall dec in total body water, lean ms mass, inc in % of body fat

water soluble meds or meds distributed into lean ms given at same concentration as younger adults could be toxic in older

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5
Q

how does metabolism of medicine change w age

A

smaller liver size
dec in blood volume

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6
Q

how does medicine excretion change w age

A

dec thru kidneys

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7
Q

what are pharmacodynamics

A

how does drug effect body

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8
Q

what systems are most impacted in pharmacodynamics

A

CV and CNS

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9
Q

side effects vs adverse drug reactions vs adverse drug events

A

SE - tolerable
ADR - not well tolerated (ie hives)
- warrants alter dosage or removal
ADE - noxious, unintended, dosage given wrong
- therapeutic failure

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10
Q

what is polypharmacy

A

use of multiple meds for same dx

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11
Q

how is colace senna an example of polypharmacy

A

2 meds work together to prevent a bowel obstruction

colace = draw water and fat into stool to make it softer

senna = stimulant laxative which inc activity of intestines to cause bowel mvmt

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12
Q

what is medication reconciliation

A

process of going thru and reviewing ordered meds and what pt has been taking
- ensures compliance
- prevents duplication

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13
Q

what is medication reconciliation

A

process of going thru and reviewing ordered meds and what pt has been taking
- ensures compliance
- prevents duplication

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14
Q

what is the medication cascade effect

A

when new medication prescribed to treat adverse reaction to another drug w the mistaken belief that the reaction is actually a new medical condition

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15
Q

what is co medication and what is the benefit to this

A

medication given together to help each other
- this way don’t have to do high dose of either

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16
Q

what is duplication and what is needed for this to be allowed

A

2 meds given for the same thing

need to have clear doc about if they are bridging from one med to another or if both are required (multi-modal)

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17
Q

what medications do you often see duplication in

A

analgesics
antiemetics
*anti coags

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18
Q

what is medication dependence

A

chronic progressive dz characterized by significant impairment
- ex: can’t move w/o lidocaine patch

directly associated w persistent and excessive use of substance

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19
Q

what is medication tolerance

A

builds over time, pts require inc dosage for intended effect

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20
Q

what medications is tolerance commonly seen in

A

antidepressants
anti anxiety
antibiotics

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21
Q

what does it mean that medication is adequately controlled

A

med is working at appropriate level
- ex: pain med working so that pain is manageable w/o taking pain away

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22
Q

what are 5 reasons for altered medication responses in the elderly

A
  1. inc in total body fat
  2. dec in lean ms mass
    –> less ms to absorb meds
  3. dec gastric acid/empty/motility
  4. dec in total water weight
    –> less water traveling thru liver
  5. dec in liver and renal function
    –> dec excretion
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23
Q

what are 4 classes of meds that can cause GI disturbance

A

narcotics (oxy, morphine)
NSAIDs (ibuprofen, aspirin)
antibiotics (penicillin, tetracycline)
anti-parkinsons (sinemet)

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24
Q

what is importance pt ed w someone prescribed narcotics

A

hydration

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25
Q

why are NSAIDs prescribed carefully in older age

A

GI bleeds

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26
Q

what is a SE of antibiotics

A

n/v

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27
Q

what is a SE of anti-parkinsons meds

A

n/v
loss of appetite

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28
Q

what are s/sx of orthostatic hypotension

A

dizziness
altered VS

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29
Q

education for pt w orthostatic hypotension

A

ankle pumps
slow position changes
hydration
raised HOB if true OH

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30
Q

what 6 classes of meds which cause orthostatic hypotension

A

beta blockers (-lol)
nitrates (nitroglycerin)
diuretics (furosemide)
anti-parkinsons (sinemet)
tricyclic antidepressants
narcotics (oxy)

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31
Q

what are the 4 main meds that can cause fatigue and weakness

A

statins
beta blockers
benadryl
corticosteroids

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32
Q

what are the 7 classes of meds that can cause fatigue and weakness

A

statins
diuretics (furosemide)
muscle relaxants (baclofen)
beta blockers (-lol)
antihistamines (benadryl)
corticosteroids (hydrocortisone)
benzos (xanax, valium)

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33
Q

what is a consideration about meds that can cause fatigue and weakness

A

timing of dose is important

34
Q

what 4 classes of meds can cause depression

A

antipsychotics (haldol)
barbiturates (phenobarbital)
antihypertensives (-lol, clonidine)
antidepressants (citalopram)

35
Q

what is a signficant concern of any meds that cause sedation

A

impacts fall risk, need to be monitored for safety issues
- need to be conscientious of timing for safe performance of ADLs

36
Q

what are 5 classes of meds that cause sedation

A

sedative hyponotics
opioid analgesics
anti-psychotics
anti-depressants
antihistamines

37
Q

what are 5 meds that can cause mental status changes

A

digoxin
tricyclic antidepressants
anticholinergic
narcotics/opioid analgesics
lithium

38
Q

what mental changes can digoxin cause in older adults

A

anxiety
depression
delirium
hallucination

39
Q

what mental changes can anti-depressants cause in older adults

A

disorientation/confusion esp in high doses

40
Q

what mental changes can anti-cholinergics cause in older adults

A

confusion
difficulty concentrating
agitation
memory issues

long term use - cog decline and dementia

41
Q

what mental changes can narcotics cause in older adults

A

dec attention
memory issues

42
Q

what mental changes can opioids cause in older adults

A

neurotoxicity of accumulation of active metabolites in kidneys

43
Q

what mental changes can lithium cause in older adults

A

brain fog
- cluster attention
- memory
- concentration

44
Q

what are the 2 most common causes of mental status changes

A

meds
UTIs

45
Q

what are extrapyramidal effects (5)

A

akathisia
dystonia
pseudoparkinsonism
dyskinesia
tardive dyskinesia

46
Q

what is akathisia

A

inner restlessnes and agitation
- extrapyramidal effect

47
Q

what is dystonia

A

ms spasm
abnormal posturing

extrapyramidal effect

48
Q

what is pseudoparkinsonism

A

shuffling gait
slow mvmts

extrapyramidal effect

49
Q

what is dyskinesia

A

swaying
writhing
fidgeting

extrapyramidal effect

50
Q

what is tardive dyskinesia

A

twitching, shaking, jerking of hands, feet, and torso
involuntary blinking
tongue mvmts
unintentional mvmts

extrapyramidal effects

51
Q

what can extrapyramidal effects be a sign of

A

over medication w PD

52
Q

what is it important to isolate parkinsonism sx from and how is this done

A

from PD and NPH (normal pressure hydrocephalus) sx

brain MRI shows NPH
PD dx w sx report, neuro exam
- sx will improve w meds
- if r/o, pseudo parkinsonism can be r/i

53
Q

what are 7 classes of meds that can cause dizziness and falls

A

opioid analgesics
antipsychotics
antihypertensives
nitrates
diuretics
sedatives
antihistamines

54
Q

what SE do may of the meds causing dizziness/falls also cause

A

OH

55
Q

what does a fall risk assessment look like depending on the setting: acute vs SNF vs community dwelling

A

acute = morris
SNF = DFI, berg
community = ABC, BESTtest

56
Q

what is a general way to describe cholinergic side effects

A

appears like pt is over exercising when they are not

57
Q

what are examples of cholinergic side effects

A

exaggerated parasymp activity
n/v, diarrhea, ab cramps
inc salivation
bronchoconstriction
bradycardia
visual disturbances
inc sweating
facial flushing

58
Q

how is anti cholinergic used in PD

A

to dec tremor

59
Q

how might anti cholinergic use present in an eye exam

A

cause pupil dilation

60
Q

what are 4 paths that cholinergic meds are used to treat

A

glaucoma
MG
alzheimers
GI and bladder atonia

61
Q

how are anticholinergics used in the respiratory tract

A

to open airways

62
Q

how is anticholinergics used in the urinary tract

A

treat incontinence and overactive bladder

63
Q

what are anticholinergic side effects

A

dry mouth
blurred vision
urinary retention
constipation
tachycardia
CNS toxicity
- confusion, dizzy, drowsy

long term use - dementia

64
Q

what are 4 classes of anticholinergic meds

A

anti-depressants
antihistamines
antipsychotics

some cardiac meds

65
Q

how can NSAIDs worsen renal function

A

inc vasoconstriction in renal arterioles

66
Q

what are some SE of NSAIDs in older adutls

A

GI distress
hepatic and renal toxicity
HTN
confusion
impaired bone healing
skin rashes
anemia/bleeding

67
Q

what are 5 NSAID medications

A

ibuprofen
aspirin
motrin
toradol
cox 2 inhibitors

68
Q

what is the rebound effect that can be seen w anti-anxiety medds

A

if pt removes self off of meds too quickly, can have episodes of anxiety worse than what they were treated for

69
Q

what are some common SE of anti-anxiety meds

A

drowsiness in AM
HoTN
cog impairment
dec short term memory

70
Q

what are common benzodiazepine SE

A

confusion
slurred speech
dyspnea
incoordination
weakness

71
Q

what are the best benzos to administer to elderly or those w hepatic / renal dysfunction

A

lorazepam
oxazepam

72
Q

how do benzos differ in their metabolism depending on the person

A

their half lives and how they metabolize is affected by renal and hepatic dysfunction

73
Q

what is dopamine dysregulation syndrome

A

pt treated w dopaminergic, compulsive use of drugs beyond that needed to relieve those motor sx

74
Q

what are sx of dopamine dysregulation syndrome

A

euphoria
delusions
paranoia
aggressive behavior
social relationship breakdown
hoarding meds

75
Q

what are SE of anti-parkinsons meds

A

motor fluctuations
confusion/hallucination
osteoporosis
dopamine dysregulation syndrome
orthostatic hypotension
dyskinesia

76
Q

what should cardiac meds be monitored for

A

OH and dizziness

77
Q

what are 5 cardiac meds

A

digoxin
ace inhibitors (lisinopril)
furosemide
nitrates
beta blockers

78
Q

what are things to look at to make a differential dx as to if it is med related or related to an existing/new condition

A

HoTN
pain control
endurance
dizziness
CV/respiratory exercise response
level of alertness
coordination/motor planning

79
Q

what are immunization adherence in the elderly impacted by

A

med efficacy data
confidence in prescribing MD
perceptions to vax
personal beliefs
self-efficacy

80
Q

what are recommended immunizations for individuals >50yo by the CDC

A

pneumococcal conjugate
shingles
tetanus, diphtheria, pertussis
- (Tdap)
influenza

81
Q

what are pt education points regarding their medications

A
  1. what they are
  2. on safety w functional mobility
  3. on ADRs and facilitate convo w MD prn
  4. schedule PT appropriately w med timing
  5. ed on indications for med use and encourage compliance
  6. use of alcohol

Lifespan (20 decks)

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