Pharmacotherapy and Polypharmacy Flashcards
what are the biological mechanisms associated with the process of aging
damage to mitochondrial and nuclear DNA caused by increased oxidative stress
increased lipid peroxidation
telmoere shortening
altered gene expression
upregulation of cell apoptosis
What describes the manner in which the body affects a drug
Pharmacokinetics
what described the manner in which the drug affects the body
pharmacodynamics
What term is used to describe the ratio of total drug in the body to the amount od drug in plasma
volume of distribution
What is directly related to the volume of distribution
plasma half life of a drug
if volume of distrubition increases the drug is retained LONGER in the body
What antibiotics require adjustment in renal dysfunction
aminoglycosides, cephalosporins, fluoroquinolones, PCN
What anticonvulsants require adjustment in renal dysfunction
gabapentin, oxcarbazepine, primidone
what cardiovascular agents require adjustment in renal dysfunction
lisniopril, ramipril, satolol, diuretics, digoxin
What is the study of the phsyiologic and biochemical effects that drugs have on the body
pharmacodynamics
an increase in sensitivty to what medication increases the risk of falls and hip fractures
bnezodiazipines
how is polypharmacy defines
taking atleast 2-9 medications concurrently
definition is controversial
how is excessive polypharmacy diagnosed
taking >10 medications concurrently
What are the potential consequences of polypharmacy
adverse drug reactions
increased direct costs
drug interactions
no-adherence
diminished functioanl status
geriatric syndromes
why are geriatric patients at high risk for drug-drug inteactions
- polypharmacy
- comorbidities
- decreased nutritional status
what are the most common drug-disease interactions
- aspirin and PUD
- CCB and HF
- BB and DB
what are drug-drug interactions significant
may …
- decrease efficacy of drug
- increased risk of drug toxicity
what are outcomes of non-adherence
- disease progression
- treatment failure
- hospitalization
- ADRs
What are the drugs most commonly associated with delirium
opioids
benzodiazepines
anticholinergics
What drug classes can exacerbate dementia
benzodiazepines
anticonvulsants
anticholinergic drugs (TCAs, in particular)
What medications are most concerning for falls
psychotropic and cardiovascular medications
What is higher medication use associated with in regards to nutrition
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
What is the SAIL method
used to reduce polypharmacy
Simple, Adverse effects, Indications, List
What is the TIDE method
used to reduce polypharmacy
Time, individualize, drug interactions, educate.
What dermatologic diseases are associated with chronic pain
pressure/ischemic ulcers, burns, scleroderma
What GI diseases are associated with chronic pain
Constipation, IBS, diverticulitis, IBD
What CV diseases are associated with chronic pain
advanced heart disease, peripheral vascular disease
what pulmonary diseases are associated with chronic pain
advanced COPD. pleurisy
what rhematologic diseases are associated with chronic pain
OA, RA, gout, pseudogout, Spinal stenosis, etx
what endocrine diseases are associated with chronic pain
diabetic neuropathy, pagets disease
what nephrologic diseases are associated with chronic pain
chronic cystitis, ESRD
what immune diseases are associated with chronic pain
HZV, post-herpetic neuralgia, HIV/AIDS neuropathy
what neurologic diseases are associated with chronic pain
HA, peripheral neuropathy, compressive neuropathies, parkinsons, post-stroke pain
What are risk factors for chornic pain
advancing age
female
lower SES/ education
obesity
tobacco use
hx injury/physically strenuous job
childhood trauma
depression/anxiety
What are elements of a comprehensive geriatric pain assessment
sensory
emotional
functional
sleep
attitudes/beliefs
coping styles
tx expectations/goals
resources
what type of medicatiosn can be effective in some patients for pain flares
NSAIDS
What needs to be checked with NSAID use in geriatric populations
blood pressure checks
renal function tests
assess for GI adveser effects
for those taking oral NSAIDS > 2 weeks
what should be considered for nociceptive pain in those who do not respond to acetaminophen/NSAIDs
Tramadol
what drug drug interactions are seen with tramadol
SSRI and SNRIs
increased risk of seizures and serotinin syndrome when taken in combo
What TCA should be avoided in geriatrics
amitriptyline becuase of adverse effects
What are non-pharmacologic interventions for pain
CBT
self management programs
exercise intervetnions
