Pharmacology Flashcards
what are components to pharmokinetics
absorption
distribution
metabolism
excretion
where does most medication get absorbed through
intestines
how does GI motility slowing w age impact absorption
pain meds or quicker needed meds need inc time to take action
how does medicine distribution change w age
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
how does metabolism of medicine change w age
smaller liver size
dec in blood volume
how does medicine excretion change w age
dec thru kidneys
what are pharmacodynamics
how does drug effect body
what systems are most impacted in pharmacodynamics
CV and CNS
side effects vs adverse drug reactions vs adverse drug events
SE - tolerable
ADR - not well tolerated (ie hives)
- warrants alter dosage or removal
ADE - noxious, unintended, dosage given wrong
- therapeutic failure
what is polypharmacy
use of multiple meds for same dx
how is colace senna an example of polypharmacy
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
what is medication reconciliation
process of going thru and reviewing ordered meds and what pt has been taking
- ensures compliance
- prevents duplication
what is medication reconciliation
process of going thru and reviewing ordered meds and what pt has been taking
- ensures compliance
- prevents duplication
what is the medication cascade effect
when new medication prescribed to treat adverse reaction to another drug w the mistaken belief that the reaction is actually a new medical condition
what is co medication and what is the benefit to this
medication given together to help each other
- this way don’t have to do high dose of either
what is duplication and what is needed for this to be allowed
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)
what medications do you often see duplication in
analgesics
antiemetics
*anti coags
what is medication dependence
chronic progressive dz characterized by significant impairment
- ex: can’t move w/o lidocaine patch
directly associated w persistent and excessive use of substance
what is medication tolerance
builds over time, pts require inc dosage for intended effect
what medications is tolerance commonly seen in
antidepressants
anti anxiety
antibiotics
what does it mean that medication is adequately controlled
med is working at appropriate level
- ex: pain med working so that pain is manageable w/o taking pain away
what are 5 reasons for altered medication responses in the elderly
- inc in total body fat
- dec in lean ms mass
–> less ms to absorb meds - dec gastric acid/empty/motility
- dec in total water weight
–> less water traveling thru liver - dec in liver and renal function
–> dec excretion
what are 4 classes of meds that can cause GI disturbance
narcotics (oxy, morphine)
NSAIDs (ibuprofen, aspirin)
antibiotics (penicillin, tetracycline)
anti-parkinsons (sinemet)
what is importance pt ed w someone prescribed narcotics
hydration
why are NSAIDs prescribed carefully in older age
GI bleeds
what is a SE of antibiotics
n/v
what is a SE of anti-parkinsons meds
n/v
loss of appetite
what are s/sx of orthostatic hypotension
dizziness
altered VS
education for pt w orthostatic hypotension
ankle pumps
slow position changes
hydration
raised HOB if true OH
what 6 classes of meds which cause orthostatic hypotension
beta blockers (-lol)
nitrates (nitroglycerin)
diuretics (furosemide)
anti-parkinsons (sinemet)
tricyclic antidepressants
narcotics (oxy)
what are the 4 main meds that can cause fatigue and weakness
statins
beta blockers
benadryl
corticosteroids
what are the 7 classes of meds that can cause fatigue and weakness
statins
diuretics (furosemide)
muscle relaxants (baclofen)
beta blockers (-lol)
antihistamines (benadryl)
corticosteroids (hydrocortisone)
benzos (xanax, valium)
what is a consideration about meds that can cause fatigue and weakness
timing of dose is important
what 4 classes of meds can cause depression
antipsychotics (haldol)
barbiturates (phenobarbital)
antihypertensives (-lol, clonidine)
antidepressants (citalopram)
what is a signficant concern of any meds that cause sedation
impacts fall risk, need to be monitored for safety issues
- need to be conscientious of timing for safe performance of ADLs
what are 5 classes of meds that cause sedation
sedative hyponotics
opioid analgesics
anti-psychotics
anti-depressants
antihistamines
what are 5 meds that can cause mental status changes
digoxin
tricyclic antidepressants
anticholinergic
narcotics/opioid analgesics
lithium
what mental changes can digoxin cause in older adults
anxiety
depression
delirium
hallucination
what mental changes can anti-depressants cause in older adults
disorientation/confusion esp in high doses
what mental changes can anti-cholinergics cause in older adults
confusion
difficulty concentrating
agitation
memory issues
long term use - cog decline and dementia
what mental changes can narcotics cause in older adults
dec attention
memory issues
what mental changes can opioids cause in older adults
neurotoxicity of accumulation of active metabolites in kidneys
what mental changes can lithium cause in older adults
brain fog
- cluster attention
- memory
- concentration
what are the 2 most common causes of mental status changes
meds
UTIs
what are extrapyramidal effects (5)
akathisia
dystonia
pseudoparkinsonism
dyskinesia
tardive dyskinesia
what is akathisia
inner restlessnes and agitation
- extrapyramidal effect
what is dystonia
ms spasm
abnormal posturing
extrapyramidal effect
what is pseudoparkinsonism
shuffling gait
slow mvmts
extrapyramidal effect
what is dyskinesia
swaying
writhing
fidgeting
extrapyramidal effect
what is tardive dyskinesia
twitching, shaking, jerking of hands, feet, and torso
involuntary blinking
tongue mvmts
unintentional mvmts
extrapyramidal effects
what can extrapyramidal effects be a sign of
over medication w PD
what is it important to isolate parkinsonism sx from and how is this done
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
what are 7 classes of meds that can cause dizziness and falls
opioid analgesics
antipsychotics
antihypertensives
nitrates
diuretics
sedatives
antihistamines
what SE do may of the meds causing dizziness/falls also cause
OH
what does a fall risk assessment look like depending on the setting: acute vs SNF vs community dwelling
acute = morris
SNF = DFI, berg
community = ABC, BESTtest
what is a general way to describe cholinergic side effects
appears like pt is over exercising when they are not
what are examples of cholinergic side effects
exaggerated parasymp activity
n/v, diarrhea, ab cramps
inc salivation
bronchoconstriction
bradycardia
visual disturbances
inc sweating
facial flushing
how is anti cholinergic used in PD
to dec tremor
how might anti cholinergic use present in an eye exam
cause pupil dilation
what are 4 paths that cholinergic meds are used to treat
glaucoma
MG
alzheimers
GI and bladder atonia
how are anticholinergics used in the respiratory tract
to open airways
how is anticholinergics used in the urinary tract
treat incontinence and overactive bladder
what are anticholinergic side effects
dry mouth
blurred vision
urinary retention
constipation
tachycardia
CNS toxicity
- confusion, dizzy, drowsy
long term use - dementia
what are 4 classes of anticholinergic meds
anti-depressants
antihistamines
antipsychotics
some cardiac meds
how can NSAIDs worsen renal function
inc vasoconstriction in renal arterioles
what are some SE of NSAIDs in older adutls
GI distress
hepatic and renal toxicity
HTN
confusion
impaired bone healing
skin rashes
anemia/bleeding
what are 5 NSAID medications
ibuprofen
aspirin
motrin
toradol
cox 2 inhibitors
what is the rebound effect that can be seen w anti-anxiety medds
if pt removes self off of meds too quickly, can have episodes of anxiety worse than what they were treated for
what are some common SE of anti-anxiety meds
drowsiness in AM
HoTN
cog impairment
dec short term memory
what are common benzodiazepine SE
confusion
slurred speech
dyspnea
incoordination
weakness
what are the best benzos to administer to elderly or those w hepatic / renal dysfunction
lorazepam
oxazepam
how do benzos differ in their metabolism depending on the person
their half lives and how they metabolize is affected by renal and hepatic dysfunction
what is dopamine dysregulation syndrome
pt treated w dopaminergic, compulsive use of drugs beyond that needed to relieve those motor sx
what are sx of dopamine dysregulation syndrome
euphoria
delusions
paranoia
aggressive behavior
social relationship breakdown
hoarding meds
what are SE of anti-parkinsons meds
motor fluctuations
confusion/hallucination
osteoporosis
dopamine dysregulation syndrome
orthostatic hypotension
dyskinesia
what should cardiac meds be monitored for
OH and dizziness
what are 5 cardiac meds
digoxin
ace inhibitors (lisinopril)
furosemide
nitrates
beta blockers
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
HoTN
pain control
endurance
dizziness
CV/respiratory exercise response
level of alertness
coordination/motor planning
what are immunization adherence in the elderly impacted by
med efficacy data
confidence in prescribing MD
perceptions to vax
personal beliefs
self-efficacy
what are recommended immunizations for individuals >50yo by the CDC
pneumococcal conjugate
shingles
tetanus, diphtheria, pertussis
- (Tdap)
influenza
what are pt education points regarding their medications
- what they are
- on safety w functional mobility
- on ADRs and facilitate convo w MD prn
- schedule PT appropriately w med timing
- ed on indications for med use and encourage compliance
- use of alcohol
