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Geriatrics > polypharm > Flashcards

polypharm Flashcards

1
Q

BP changes in older adults

A

systolic HTN

orthostatic HTN

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2
Q

hear rate and rhythm in older adults

A

packmaker cells and maximal heart rate decline

more likely to have abnormal heart rate

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3
Q

temperature changes in older adult

A

more susceptible to hypothermia

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4
Q

skin changes in the older adult

A

vascularity of the dermis decreases
skin may appear thin, fragile, loose and transparent
actinic purpura-blood that has leaded through the capillaries

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5
Q

eye changes in the older adults

A

fewer lacrimations

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6
Q

visual acuity in the older adult

A

gradually diminished between 50 and 70

near vision blurs for all older adults

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7
Q

lens affects in the older adult

A

increase risk for cataracts, gluacoma, macular degeneration

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8
Q

head and neck changes in older adults

A

decrease salivary secretions and sense of taste often med related
teeth disease

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9
Q

lung and thorax changes in older adult

A

chest wall stiffens and hard to move
respiratory muscle may weaken
lungs lose some elastic recoil
cough is less effective

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10
Q

cadiovascular changes in the older adult

A

neck and vesels-systolic bruits in middle to upper portion of the carotid arteries suggest arterial obstruction from atherosclerosis
Extra heart sounds (S3 and S4)
S3 suggestive of CHF
S4 suggest decreased ventricle compliance
Murmurs

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11
Q

what is the most common complaint in the older adults

A

memory loss

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12
Q

what is mini mental status used to examine?

A 
test cognitive function among older adults
Orientation
Attention
Memory
Language
Visual-spatial skills
score 0-30
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13
Q

what type of patient typically scores 19-24 on a MMSE

A

alzheimers

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14
Q

GI changes in older adult

A 
decreased gastric acid
delayed gastric emptying
slowed intestinal transit time
reduced GI blood flow
decreased stomach acid leafs to decreased absorption of some meds
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15
Q

pharmacokinetic changes

A

increased body fat and decreased muscle mass
meds distribute into have have increased volume of distribution
caution with meds like
-diazepam and chlordiazepoxide
meds that distribute into muscle or body water have decreased distribution
-Lithium

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16
Q

protein binding in the older adults

A

serum albumin usually unchanged in healthy older adults but low in frail or malnourished elderly patients

17
Q

liver changes

A

metabolism primarily occurs in the liver
liver can be 20-40% smaller and accompanied by a 35% decrease in hepatic flow
meds with higher 1st pass will shower higher bioavailability
metoprolol, verapamil, morphine, diazepam

18
Q

GU changes

A

reduction in renal mass, renal blood flow, GFR, filtration fraction and tubular secretions
Scr derived from muscle mass and assess kidney function not accurate in older adults d/t decreased muscle mass

19
Q

what will happen to an adult taking at least 5 meds

A

1 in 3 will experience ADR

95% predictable and 28% preventable

20
Q

causes of ADR in older adults

A

polypharmacy
multiple comorbid conditions
poor med adherence
age related pharmacokinetics

21
Q

what is polypharmacy

A

over utilization or inappropriate use of multiple meds

22
Q

RF for polypharmacy

A 
Women>men
Institutionalized>independent
co-morbiditied>healthier elderly
>65yrs old
Un-insured
cognitive impairment
23
Q

reason for polypharm

A

MD/PA/NP are instructed to treat according to guidelines
HTN, DM, COPD, Mental illness
Practitioners/pts/families may want to treat all symptoms
Prescribing Cascades
Treating medication side effects with another drug

24
Q

examples of prescribing cascades

A

antipsychotics-extrapyramidal signs-antiparkinson therapy

NSAID-inceased BP-HTN Tx

25
Q

contributing factors

A 
lack of med renconciliation after hospital discharge
lack of continuity of care
multiple PCP
Mulpt Docs and pharmacies
quick med changes- start low go slow
26
Q

complications of polypharm

A

functional ability- financial, communication, food shopping, cooking, transport
nutritional status- wt loss, trouble eating, mobility
cognition- temporal orientation, calculation
associated with depression and increased suicides

27
Q

hepatic enzyme inducer and examples of them

A

inducers can increase metabolism and decrease Rx concentration
-Grapefruit, Herbal prep- st jogn wort, alcohol, tobacco, cannabis, barbiturates, tegretol, dilantin

28
Q

drugs that decrease metabolism and increase Rx conc

A

Prozac
Erythromycin
CCB

meds with long half life and narrow therapeutic window
Lithium,Digoxin,Wafarin

29
Q

Increased sensitivity

A

psychoactive meds
long acting benzo
antipsychotic agents
TCA

Adverse effects
falls are major risk
orthostatic HTN
confusion

30
Q

age related receptor site changes can increase sensitivity

A

opioids
wafarin
Diphenhydramine
NSAID

31
Q

how to prevent ADR

A

always start with lowest dose check for geriatric dosing recommendations
Identify RF
medication review regimen

32
Q

what is medication regiment review (MMR)

A

Evaluation of medication regimen
Promoting positive outcomes
Minimizing adverse events

33
Q

MRR indications

A 
Indication/reason for medication
Effectiveness
Dose
Presence of monitoring
Presence of duplicative therapy
Food and or drug interactions
Presence of potential adverse drug reactions (ADR)
34
Q

when to do a MRR

A

Review of patient’s medications should be done at initial assessment, every 3 to 6 months thereafter, and with any medication change
check to make sure Rx are not just treating symptoms
need to establish accurate diagnosis

35
Q

beers criteria

A

For patients > 65 years of age
Based on expert consensus developed through an extensive literature review evaluated by experts in geriatric care, clinical pharmacology, and psychopharmacology
Adopted by the Centers for Medicare and Medicaid Services in July 1999 for nursing home regulation

Geriatrics (9 decks)

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