Pharmacology

Question 1

what are components to pharmokinetics

Answer 1

absorption
distribution
metabolism
excretion

Question 2

where does most medication get absorbed through

Answer 2

intestines

Question 3

how does GI motility slowing w age impact absorption

Answer 3

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

Question 4

how does medicine distribution change w age

Answer 4

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

Question 5

how does metabolism of medicine change w age

Answer 5

smaller liver size
dec in blood volume

Question 6

how does medicine excretion change w age

Answer 6

dec thru kidneys

Question 7

what are pharmacodynamics

Answer 7

how does drug effect body

Question 8

what systems are most impacted in pharmacodynamics

Answer 8

CV and CNS

Question 9

side effects vs adverse drug reactions vs adverse drug events

Answer 9

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

Question 10

what is polypharmacy

Answer 10

use of multiple meds for same dx

Question 11

how is colace senna an example of polypharmacy

Answer 11

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

Question 12

what is medication reconciliation

Answer 12

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

Question 13

what is medication reconciliation

Answer 13

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

Question 14

what is the medication cascade effect

Answer 14

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

Question 15

what is co medication and what is the benefit to this

Answer 15

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

Question 16

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

Answer 16

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)

Question 17

what medications do you often see duplication in

Answer 17

analgesics
antiemetics
*anti coags

Question 18

what is medication dependence

Answer 18

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

directly associated w persistent and excessive use of substance

Question 19

what is medication tolerance

Answer 19

builds over time, pts require inc dosage for intended effect

Question 20

what medications is tolerance commonly seen in

Answer 20

antidepressants
anti anxiety
antibiotics

Question 21

what does it mean that medication is adequately controlled

Answer 21

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

Question 22

what are 5 reasons for altered medication responses in the elderly

Answer 22

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

Question 23

what are 4 classes of meds that can cause GI disturbance

Answer 23

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

Question 24

what is importance pt ed w someone prescribed narcotics

Answer 24

hydration

Question 25

why are NSAIDs prescribed carefully in older age

Answer 25

GI bleeds

Question 26

what is a SE of antibiotics

Answer 26

n/v

Question 27

what is a SE of anti-parkinsons meds

Answer 27

n/v loss of appetite

Question 28

what are s/sx of orthostatic hypotension

Answer 28

dizziness altered VS

Question 29

education for pt w orthostatic hypotension

Answer 29

ankle pumps slow position changes hydration raised HOB if true OH

Question 30

what 6 classes of meds which cause orthostatic hypotension

Answer 30

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

Question 31

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

Answer 31

statins beta blockers benadryl corticosteroids

Question 32

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

Answer 32

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

Question 33

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

Answer 33

timing of dose is important

Question 34

what 4 classes of meds can cause depression

Answer 34

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

Question 35

what is a signficant concern of any meds that cause sedation

Answer 35

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

Question 36

what are 5 classes of meds that cause sedation

Answer 36

sedative hyponotics opioid analgesics anti-psychotics anti-depressants antihistamines

Question 37

what are 5 meds that can cause mental status changes

Answer 37

digoxin tricyclic antidepressants anticholinergic narcotics/opioid analgesics lithium

Question 38

what mental changes can digoxin cause in older adults

Answer 38

anxiety depression delirium hallucination

Question 39

what mental changes can anti-depressants cause in older adults

Answer 39

disorientation/confusion esp in high doses

Question 40

what mental changes can anti-cholinergics cause in older adults

Answer 40

confusion difficulty concentrating agitation memory issues long term use - cog decline and dementia

Question 41

what mental changes can narcotics cause in older adults

Answer 41

dec attention memory issues

Question 42

what mental changes can opioids cause in older adults

Answer 42

neurotoxicity of accumulation of active metabolites in kidneys

Question 43

what mental changes can lithium cause in older adults

Answer 43

brain fog - cluster attention - memory - concentration

Question 44

what are the 2 most common causes of mental status changes

Answer 44

meds UTIs

Question 45

what are extrapyramidal effects (5)

Answer 45

akathisia dystonia pseudoparkinsonism dyskinesia tardive dyskinesia

Question 46

what is akathisia

Answer 46

inner restlessnes and agitation - extrapyramidal effect

Question 47

what is dystonia

Answer 47

ms spasm abnormal posturing extrapyramidal effect

Question 48

what is pseudoparkinsonism

Answer 48

shuffling gait slow mvmts extrapyramidal effect

Question 49

what is dyskinesia

Answer 49

swaying writhing fidgeting extrapyramidal effect

Question 50

what is tardive dyskinesia

Answer 50

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

Question 51

what can extrapyramidal effects be a sign of

Answer 51

over medication w PD

Question 52

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

Answer 52

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

Question 53

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

Answer 53

opioid analgesics antipsychotics antihypertensives nitrates diuretics sedatives antihistamines

Question 54

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

Answer 54

OH

Question 55

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

Answer 55

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

Question 56

what is a general way to describe cholinergic side effects

Answer 56

appears like pt is over exercising when they are not

Question 57

what are examples of cholinergic side effects

Answer 57

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

Question 58

how is anti cholinergic used in PD

Answer 58

to dec tremor

Question 59

how might anti cholinergic use present in an eye exam

Answer 59

cause pupil dilation

Question 60

what are 4 paths that cholinergic meds are used to treat

Answer 60

glaucoma MG alzheimers GI and bladder atonia

Question 61

how are anticholinergics used in the respiratory tract

Answer 61

to open airways

Question 62

how is anticholinergics used in the urinary tract

Answer 62

treat incontinence and overactive bladder

Question 63

what are anticholinergic side effects

Answer 63

dry mouth blurred vision urinary retention constipation tachycardia CNS toxicity - confusion, dizzy, drowsy long term use - dementia

Question 64

what are 4 classes of anticholinergic meds

Answer 64

anti-depressants antihistamines antipsychotics some cardiac meds

Question 65

how can NSAIDs worsen renal function

Answer 65

inc vasoconstriction in renal arterioles

Question 66

what are some SE of NSAIDs in older adutls

Answer 66

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

Question 67

what are 5 NSAID medications

Answer 67

ibuprofen aspirin motrin toradol cox 2 inhibitors

Question 68

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

Answer 68

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

Question 69

what are some common SE of anti-anxiety meds

Answer 69

drowsiness in AM HoTN cog impairment dec short term memory

Question 70

what are common benzodiazepine SE

Answer 70

confusion slurred speech dyspnea incoordination weakness

Question 71

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

Answer 71

lorazepam oxazepam

Question 72

how do benzos differ in their metabolism depending on the person

Answer 72

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

Question 73

what is dopamine dysregulation syndrome

Answer 73

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

Question 74

what are sx of dopamine dysregulation syndrome

Answer 74

euphoria delusions paranoia aggressive behavior social relationship breakdown hoarding meds

Question 75

what are SE of anti-parkinsons meds

Answer 75

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

Question 76

what should cardiac meds be monitored for

Answer 76

OH and dizziness

Question 77

what are 5 cardiac meds

Answer 77

digoxin ace inhibitors (lisinopril) furosemide nitrates beta blockers

Question 78

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

Answer 78

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

Question 79

what are immunization adherence in the elderly impacted by

Answer 79

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

Question 80

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

Answer 80

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

Question 81

what are pt education points regarding their medications

Answer 81

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