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Geriatrics > Pharmacotherapeutics - Exam 1 > Flashcards

Pharmacotherapeutics - Exam 1 Flashcards

1
Q

_______ is altered by individual’s diseases, environment, and other medications

A

Pharmacokinetics

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2
Q

What are the 4 keys to pharmacokinetics?

A

Metabolism
Elimination
Absorption
Distribution

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3
Q

Name some factors that influence medication absorption. Are they affected by age or diseases/medication?

A

Absorptive surface
gastric pH
splanchnic blood flow
GI tract motility

mostly NOT affected by age and GREATLY affected by certain diseases and medications

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4
Q

Reduction in normal ______ leads to decreased absorption of some meds. Name 3 in particular

A

active transport mechanisms

B12, calcium and iron

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5
Q

What are 3 age related changes that effect medication distribution.

A

reduced lean muscle mass

decreased total-body water content

decreased serum albumin

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6
Q

How does having a reduced lean muscle mass change how medication is distributed?

A

Results in increased adipose tissue

Increased volume of distribution for lipophilic drugs (ex. BZDs).

Results in lower serum levels and prolonged clearance rates

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7
Q

How does having decreased total- body water content change how medication is distributed?

A

Decreased volume of distribution for hydrophilic medications (Digoxin, lithium)

Results in higher serum levels

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8
Q

How does having decreased serum albumin content change how medication is distributed?

A

Results in increased “free” drug levels which leads to increase risk of SE’s when high protein binding drugs are used

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9
Q

Decreased serum albumin can be seen the elderly, name 2 other conditions in which you may also see decreased serum albumin

A

Can be seen in patients with poor nutritional states, impaired renal function, and many other chronic conditions

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10
Q

How does ages effect the CYP450 metabolism? Why?

A

reduces CYP450 metabolism

Due to age related decrease in hepatic blood flow and overall liver size

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11
Q

What happens when CYP450 enzyme is inhibited? Induced?

A

toxic accumulation of other drugs that require P450 for metabolism

rapid metabolism of P450 drugs leading to decreased efficacy

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12
Q

_____ is most common cause of altered pharmacokinetics in elderly patients
_____ and ____ decrease with age. Serum creatinine may be _____ in geriatric patients despite renal impairment due to loss in ______

A

Renal impairment

Tubular function

GFR

normal

muscle mass

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13
Q

When prescribe certain medications to the elderly, need to check ________.

T/F: You can have normal creatinine and abnormal CrCl.

A

creatinine clearance

True!!

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14
Q

**What is the Cockcroft-Gault formula for estimating creatinine clearance?

A
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15
Q

Define pharmacodynamics. How does it change with aging?

A

Defined as how a drug affects the body

Altered receptor affinity or numbers, postreceptor alterations, and/or impairment of homeostatic mechanisms

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16
Q

**Specifically, geriatric patients are more sensitive to _______. What can it result in?

A

CNS depressants

delirium, confusion, agitiation

(example in class was Benadryl)

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17
Q

Define polypharmacy

A

Defined as simultaneous use of multiple medications by a single patient (more than 5 meds)

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18
Q

What re the risks/complications of polypharmacy

A

Increased adverse drug reactions, drug-drug interactions, drug-disease interaction

Increase cost burden

Increase risk of hospitalizations

Decreased quality of life

Adherence

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19
Q

**What is an adverse drug reaction? Adverse drug event?

A

Unwanted effects of drugs at NORMAL DOSAGE AND USE!!

An injury/harm resulting from the use of a pharmacologic agent (adverse drug reactions fall into adverse drug events)
- unintentional overdose, withdrawal reaction

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20
Q

Hospitalization rates due to adverse drug events are approximately ____ higher in geriatric patients

A

4x

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21
Q

Adverse drug reactions are most often related to ______ and ________. _____and _____ are two common meds responsible for >60% of all medication-related hospitalizations

A

multiple medications

number of chronic illnesses present

Anticoagulants

hyperglycemics (insulin)

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22
Q

(inhibiting/inducing) the P450 system is MC. Give one example. Why?

A

Inhibition of the P450 system

verapamil (CCB) and atorvastatin

Inhibition of P450 slows metabolism of atorvastatin leading to toxic levels of statin → liver dysfunction, myalgias, rhabdomyolysi

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23
Q

What does induction of the P450 result in? What are 4 common medications?

A

Results in rapid clearance and decreased effectiveness of drugs that are metabolized by P450

rifampin, barbiturates, carbamazepine, phenytoin

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24
Q

When considering drug-disease interactions. underlying disease _____ to unwanted physiologic effects of a drug. Give an example.

A

increases susceptibility

patient with severe COPD or asthma is prescribed a beta-blocker that may result in worse pulmonary symptoms but does NOT have to occur. NOT every potential interaction results in harm

25
Q

Name 3 tools providers can use to help avoid misuse/overuse/underuse of prescription drugs

A

Beers criteria

STOPP: Screening Tool of Older Person’s Prescriptions

START: Screening Tool to Alert providers to Right Treatment

26
Q

Name the medication classes that were listed on the Beers criteria in lecture

A

1st gen antihistamines
Digoxin >0.125 mg/day
TCAs
Antipsychotics
Benzos
Sleep medications (zolpidem, eszopiclone, etc)
Male androgens (testosterone)
Long-acting sulfonylureas ( glyburide, chlorpropamide)
Meperidine (Demerol) opioid pain med
NSAIDs (unless taken with PPI)
Skeletal muscle relaxants

27
Q

What are the 5 categories of drugs in the Beers criteria.

A
  1. Medications that are potentially inappropriate (avoid)
  2. Medications that are potentially inappropriate in patients with certain diseases or syndromes
  3. Medications to be used with caution
  4. Potentially inappropriate drug-drug interactions
  5. Medications that require dosage adjustment based on renal function
28
Q

What are some complications of nonadherence?

A

-Inadequate disease control
-Misdiagnosis
-Increased ER visits and hospitalizations
-Increased health care costs
-Higher mortality

29
Q

What are some contributing factors to non-adherence?

A

-Asymptomatic disease
-Medication side effects
-Inadequate follow-up
-Lack of patient understanding of the value of treatment
-Missed appointments
-Transportation difficulties
-Complicated dosing regimens; polypharmacy
-Financial hardships

30
Q

Give 3 examples of how we can make prescribing safer?

A

Thoroughly evaluate each patient individually

brown bag review

deprescribing or unprescribing

31
Q

_____ is the MC medication implicated in ER visits and hospitalizations for ADRs. Why?

A

Warfarin

Complicated, frequently changing dosing and the need for close monitoring to keep pts in target range

32
Q

Older age is associated with increased risk of drug-induced ______. ______ is the 2nd MC cause of ADRs the lead to ER visits

A

hypoglycemia

insulin

33
Q

What are 3 factors that contribute to hypoglycemia in the elderly?

A

Diminished renal function

Medications that interact with insulin’s effects

Impaired cognitive function

34
Q

Why do you want to avoid long-acting sulfonylureas in the elderly? If you have to give one choose ______ and avoid _____

A

greater risk of hypoglycemia due to decreased drug clearance that leads to an accumulation of the drug

give glipizide (short-acting sulfonylureas)

AVOID glyburide

35
Q

_______ has a very narrow therapeutic window and toxicity common. What are the s/s of toxicity? What do you need to monitor?

A

Digoxin

fatigue, confusion, GI disturbances

serum levels

36
Q

What are the potential risks of NSAIDs in the elderly? When are they contraindicated?

A

Peptic ulcer disease
Renal impairment
Exacerbate HTN
Promote fluid retention

Heart failure
Renal dysfunction
High risk of peptic ulcer induced GI bleeding

37
Q

If NSAIDs have to be used, what are the prescribing guidelines? When do you need to f/u? What are the NSAID alternatives?

A

Use at the lowest dose, for the shortest duration possible
Co-administer PPI
Take ASA upon awakening, NSAID at least 2 hours later

Follow up in 2-4 weeks after starting NSAID to evaluate for renal dysfunction, fluid retention, BP elevation

Acetaminophen (Tylenol), diclofenac gel (Voltaren)

38
Q

What are the antihistamines that should be avoided in the elderly?

A

Diphenhydramine (Benadryl)
Meclizine (Antivert)
dimenhydrinate (Dramamine)

39
Q

What are the antidepressants that should be avoided in the elderly?

A

Amitriptyline (Elavil)
doxepin
paroxetine (Paxil)

40
Q

What are the antipsychotics that should be avoided in the elderly?

A

Clozapine (Clozaril)
olanzapine (Zyprexa)
quetiapine (Seroquel)

41
Q

What are the bladder/GI antispamodics that should be avoided in the elderly?

A

GU : oxybutynin (Ditropan), tolterodine (Detrol)

GI: dicyclomine (Bentyl)

42
Q

the muscle relaxant _____ should be avoided in the elderly. The antiemetic ____ should be avoided in the elderly.

A

cyclobenzaprine

promethazine

43
Q

Use of multiple anticholinergic drugs has been associated with increased risk of ______, ______ and ______.

A

Falls
Functional decline
Impaired cognition

44
Q

______ have safety concerns for the elderly that include Psychomotor impairment, increased risk of delirium, impaired gait, falls, sedation, N/V/C, respiratory depression, central sleep apnea

A

opioids

45
Q

antipsychotics are considered especially high risk in the elderly when used for ______. What is the preferred tx option? What happens if antipsychotics are deemed necessary?

A

dementia

non-pharm

discuss risks/benefits with family, document the discussion!!, use for minimum duration of therapy

46
Q

using antipsychotics in dementia increases the pt’s risk of ? (6 things)

A

MI
Stroke
VTE (venous thromboembolism)
Falls
Fractures
Mortality

47
Q

What age group defines the geriatric population?

A

65 and older

48
Q

Define gerontology

A

The branch of science that deals with aging and the problems of aged persons

49
Q

Why is the presentation of disease different in the elderly population?

A

Elderly patients have a decreased ability to respond to stress.

50
Q

Name 3 factors that are considered critical for successful aging?

A

Regular exercise
Social engagement
Moderation of food intake

51
Q

Define frailty (frailty phenotype)

A

Dysregulation of multiple organ systems due to distinct physiologic changes, increased vulnerability to stressors, and decreased ability to adapt to external stressors

52
Q

What percent of the U.S. population age 65 to 79 years reports having two or more chronic diseases?

A

35%

53
Q

List some common problems seen in the geriatric population

A

Immobility, Instability, Incontinence, Intellectual impairment, Infection, Impairment of vision and hearing, Irritable colon, Isolation (depression), Inanition (malnutrition), Iatrogenesis, Insomnia, Immune deficiency, Impotence

54
Q

What are the major demographic trends in the geriatric population?

A

The geriatric population is growing (due to the baby boomer era and increased life span) with less population coming behind them - leading to a lack of financial support for Social Security and Medicare and fewer healthcare providers.

55
Q

How will demographic trends affect future health care?

A

People are living longer - leads to higher geriatric population and longer management of chronic conditions - resulting in more patients who are classified as “disabled” resulting in higher healthcare costs

56
Q

Name some factors that may affect an older person’s access to healthcare?

A

Access to transportation
Insurance coverage
Social support

57
Q

Which entity pays for the majority of nursing home care?

A

Medicaid

58
Q

List some predictors of nursing home placement

A

Older age, functional impairment prior to nursing home admission, lower perceived health, cognitive impairment, and lack of social supports

59
Q
A

Geriatrics (8 decks)

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