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Clin Med IV: Geriatrics and Hospital Medicine > Pharmacotherapy and Polypharmacy > Flashcards

Pharmacotherapy and Polypharmacy Flashcards

1
Q

what are the biological mechanisms associated with the process of aging

A

damage to mitochondrial and nuclear DNA caused by increased oxidative stress
increased lipid peroxidation
telmoere shortening
altered gene expression
upregulation of cell apoptosis

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2
Q

What describes the manner in which the body affects a drug

A

Pharmacokinetics

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3
Q

what described the manner in which the drug affects the body

A

pharmacodynamics

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4
Q

What term is used to describe the ratio of total drug in the body to the amount od drug in plasma

A

volume of distribution

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5
Q

What is directly related to the volume of distribution

A

plasma half life of a drug

if volume of distrubition increases the drug is retained LONGER in the body

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6
Q

What antibiotics require adjustment in renal dysfunction

A

aminoglycosides, cephalosporins, fluoroquinolones, PCN

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7
Q

What anticonvulsants require adjustment in renal dysfunction

A

gabapentin, oxcarbazepine, primidone

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8
Q

what cardiovascular agents require adjustment in renal dysfunction

A

lisniopril, ramipril, satolol, diuretics, digoxin

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9
Q

What is the study of the phsyiologic and biochemical effects that drugs have on the body

A

pharmacodynamics

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10
Q

an increase in sensitivty to what medication increases the risk of falls and hip fractures

A

bnezodiazipines

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11
Q

how is polypharmacy defines

A

taking atleast 2-9 medications concurrently

definition is controversial

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12
Q

how is excessive polypharmacy diagnosed

A

taking >10 medications concurrently

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13
Q

What are the potential consequences of polypharmacy

A

adverse drug reactions
increased direct costs
drug interactions
no-adherence
diminished functioanl status
geriatric syndromes

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14
Q

why are geriatric patients at high risk for drug-drug inteactions

A
  • polypharmacy
  • comorbidities
  • decreased nutritional status
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15
Q

what are the most common drug-disease interactions

A
  • aspirin and PUD
  • CCB and HF
  • BB and DB
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16
Q

what are drug-drug interactions significant

A

may …
- decrease efficacy of drug
- increased risk of drug toxicity

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17
Q

what are outcomes of non-adherence

A
  • disease progression
  • treatment failure
  • hospitalization
  • ADRs
18
Q

What are the drugs most commonly associated with delirium

A

opioids
benzodiazepines
anticholinergics

19
Q

What drug classes can exacerbate dementia

A

benzodiazepines
anticonvulsants
anticholinergic drugs (TCAs, in particular)

20
Q

What medications are most concerning for falls

A

psychotropic and cardiovascular medications

21
Q

What is higher medication use associated with in regards to nutrition

A

decreased intake of soluble and no soluble fiber
decreased intake of fate-soluble vitamins, B Vitamins and minerals
increased intake of cholesterol and glucose
increased intake of sodium

22
Q
A
23
Q

What is the SAIL method

A

used to reduce polypharmacy
Simple, Adverse effects, Indications, List

24
Q

What is the TIDE method

A

used to reduce polypharmacy
Time, individualize, drug interactions, educate.

25
Q

What dermatologic diseases are associated with chronic pain

A

pressure/ischemic ulcers, burns, scleroderma

26
Q

What GI diseases are associated with chronic pain

A

Constipation, IBS, diverticulitis, IBD

27
Q

What CV diseases are associated with chronic pain

A

advanced heart disease, peripheral vascular disease

28
Q

what pulmonary diseases are associated with chronic pain

A

advanced COPD. pleurisy

29
Q

what rhematologic diseases are associated with chronic pain

A

OA, RA, gout, pseudogout, Spinal stenosis, etx

30
Q

what endocrine diseases are associated with chronic pain

A

diabetic neuropathy, pagets disease

31
Q

what nephrologic diseases are associated with chronic pain

A

chronic cystitis, ESRD

32
Q

what immune diseases are associated with chronic pain

A

HZV, post-herpetic neuralgia, HIV/AIDS neuropathy

33
Q

what neurologic diseases are associated with chronic pain

A

HA, peripheral neuropathy, compressive neuropathies, parkinsons, post-stroke pain

34
Q

What are risk factors for chornic pain

A

advancing age
female
lower SES/ education
obesity
tobacco use
hx injury/physically strenuous job
childhood trauma
depression/anxiety

35
Q

What are elements of a comprehensive geriatric pain assessment

A

sensory
emotional
functional
sleep
attitudes/beliefs
coping styles
tx expectations/goals
resources

36
Q

what type of medicatiosn can be effective in some patients for pain flares

A

NSAIDS

37
Q

What needs to be checked with NSAID use in geriatric populations

A

blood pressure checks
renal function tests
assess for GI adveser effects
for those taking oral NSAIDS > 2 weeks

37
Q

what should be considered for nociceptive pain in those who do not respond to acetaminophen/NSAIDs

A

Tramadol

38
Q

what drug drug interactions are seen with tramadol

A

SSRI and SNRIs
increased risk of seizures and serotinin syndrome when taken in combo

39
Q

What TCA should be avoided in geriatrics

A

amitriptyline becuase of adverse effects

40
Q

What are non-pharmacologic interventions for pain

A

CBT
self management programs
exercise intervetnions

Clin Med IV: Geriatrics and Hospital Medicine (8 decks)

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