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Special Pops - Geriatrics > Polypharm > Flashcards

Polypharm Flashcards

1
Q

Vital sign changes in the elderly

A
  • BP (systolic HTN, ortho hypo)
  • HR slows
  • Hypothermia
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2
Q

Skin changes in the elderly

A
  • Vascularity of dermis decreases
  • Thin, fragile, loose skin
  • Actinic purpura (blood that has leaked through poorly supported capillaries)
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3
Q

Head and neck changes in the elderly

A
  • Dry eyes
  • Visual acuity diminishes
  • Lens changes increasing risk for cataracts, glaucoma, macular degeneration
  • Decreased salivation, taste
  • Periodontal disease
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4
Q

Lungs and thorax changes in the elderly

A
  • Stiffer chest wall
  • Resp muscles weaken
  • Lungs lose elastic recoil
  • Cough less effective
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5
Q

CV system changes in the elderly

A
  • Systolic bruits in carotids
  • Extra heart sounds
  • Cardiac murmurs
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6
Q

MC complaint of the elderly?

A

Memory changes

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7
Q

Scoring of MMSE

A

0-30

Scores over 25 are normal

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8
Q

Typical MMSE score of Alzheimer’s patients?

A

19-24

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9
Q

Pharmacokinetic absorption changes in the elderly

A
  • Decreased acid secretion
  • Delayed emptying
  • Slowed transit time
  • Reduce blood flow
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10
Q

Pharmacokinetic distribution changes in the elderly

A
  • Body fat increases, muscle mass decreases
  • Meds that distribute into fat stick around longer (e.g. Diazepam, chlordiazepoxide)
  • Meds that distribute into muscle or body water don’t distribute as much (e.g. Lithium)
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11
Q

Pharmacokinetic protein binding changes in the elderly

A
  • Serum albumin usually doesn’t change in healthy older adults, but REDUCED in frail or malnourished elderly
  • A lot more drug distributing freely and not protein bound (e.g. phenytoin, warfarin, diazepam)
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12
Q

Pharmacokinetic metabolism changes in the elderly

A

Liver mass and blood flow can be reduced (meds with a high first pass rate will show higher bioavailability so lower doses should be given)

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13
Q

Pharmacokinetic excretion changes in the elderly

A
  • Reduction in renal mass, BF, GFR

- Serum Cr is NOT accurate in older adults due to decreased muscle mass (so use CrCl instead)

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14
Q

Describe ADEs in the elderly

A

95% are predictable

28% preventable

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15
Q

What causes ADRs in the elderly?

A
  • Polypharm
  • Multiple comorbidities
  • Poor med adherence
  • Age related PK and PD changes
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16
Q

Risk factors for polypharmacy

A
  • Females
  • Institutionalized
  • Comorbidities
  • Over 65 yo
  • Cognitive impairments
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17
Q

Why does polypharm occur?

A
  • Providers treating according to guidelines
  • Providers/family/pt wants to treat all symptoms
  • Prescribing cascades (treating med side effects w/another drug)
18
Q

How is functional ability measured?

A

IADLs

19
Q

Common CYP450 inducers

A
  • Grapefruit juice
  • St Johns wort
  • Alcohol
  • Tobacco
  • Cannabis
  • Barbiturates
20
Q

Common CYP450 inhibitors

A
  • Prozac
  • CCBs
  • Erythromycin
21
Q

What meds are the elderly more sensitive to?

A
  • Anticholinergics
  • Psychoactive meds (long acting BZDs, antipsychotics, TCAs)
  • Opioids
  • Warfarin
  • Diphenhydramine
  • NSAIDs
22
Q

What is a medication regimen review?

A
  • Eval of med regimen
  • Promoting positive outcomes
  • Minimizing ADEs
23
Q

What is responsible for most medical errors?

A

Inaccurate diagnosis

24
Q

What is used to identify inappropriate meds?

A

Beers Criteria (updated in 2012)

25
Q

What is the Beers Criteria?

A
  • For pts over 65 yo
  • Identify inappropriate meds
  • Classifies meds by “avoid use” and “caution”
26
Q

What does the MMSE test?

A
  • Orientation
  • Attention
  • Memory
  • Language
  • Visual spatial skills
27
Q

Normal serum albumin levels?

A

3.2 - 5 g/dL

28
Q

What meds have a high first pass rate causing higher bioavailability in elderly?

A

Metoprolol
Verapamil
Morphine
Diazepam

29
Q

Common complications a/w polypharmacy

A
  • Functional ability
  • Nutritional status
  • Cognition (MMSE)
  • Depression (and possible suicide)
30
Q

What common meds have narrow therapeutic index?

A

Lithium
Digoxin
Warfarin

31
Q

Meds with anticholinergic properties?

A
  • Antihistamines
  • Antipsychotics
  • Antispasmodics
  • Antiparkinsonians
  • TCAs
  • Ophthalmic drugs
  • Plants
32
Q

How do psychoactive meds affect the elderly?

A
  • Falls are a major risk (even SSRIs)
  • Orthostatic hypotension
  • Confusion
33
Q

Which meds affect the elderly due to age-related receptor site changes?

A
  • Opioids
  • Warfarin (lower doses)
  • Diphenhydramine
  • NSAIDs
34
Q

How are the elderly more sensitive to NSAIDs?

A
  • Increased risk for impaired GFR
  • Decreased gastric mucosal repair
  • HTN may worsen
35
Q

How to prevent ADEs in the elderly?

A
  • Always start at lowest effective dose
  • Identify risk factors
  • Med regimen review
36
Q

Medication Regimen Review indicators

A
  • Reason for med
  • Effectiveness
  • Dose
  • Presence of monitoring
  • Presence of duplicative therapy
  • Food and/or drug interactions
  • Presence of potential ADEs
37
Q

When reviewing meds, what should the patient/caregiver understand?

A
  • Why, how, when to take Rx
  • Common side effects
  • Written/visual culturally and language appropriate instructions
  • Accessibility of Rxs
  • Set realistic goals
38
Q

When should a review of meds occur?

A
  • Initial assessment
  • Every 3-6 months after
  • With any med change
39
Q

How often should a med list be checked?

A

2 times a year

40
Q

Why do elderly patients purposely underreport symptoms?

A
  • Afraid or embarrassed
  • Financial issues
  • Discomfort of procedures and treatments
  • Overlook or attribute to aging
41
Q

Explain why it is necessary to differentiate between ADEs and aging (prescribing cascades)?

A
  • Make sure HTN is not NSAIDs induced
  • Make sure cough is not from ACEI
  • Make sure insomnia is evaluated

Special Pops - Geriatrics (9 decks)

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