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Geriatrics > Polypharmacy > Flashcards

Polypharmacy Flashcards

1
Q

Define Polypharmacy

A

4 or more medications

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2
Q

What increases the chance of having an adverse drug event?

A

The more medications the patient takes

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3
Q

Adverse Drug Reaction Events

A 
Falls
Orthostatic hypotension
Heart failure
Delirium
GI bleeding
Intracranial bleeding
Renal failure
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4
Q

Most Common Causes of Death from Adverse Drug Reactions

A

GI bleeding
Intracranial bleeding
Renal failure

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5
Q

Problem with Polypharmacy

A

New prescriptions

Failure to discontinue old prescriptions

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6
Q

Most Common Drugs Associated with Adverse Events

A

Antithrombotics
Antidiabetics
Diuretics
NSAIDs

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7
Q

Common Symptoms Secondary to an Adverse Drug Reaction

A

Falls
Orthostatic hypotension
Heart Failure
Delirium

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8
Q

Drug Metabolism & Older Adults: Liver

A

Hepatic blood flow decreases by 40%

Decreased 1st pass metabolism

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9
Q

Drug Metabolism & Older Adults: Kidneys

A

Renal blood flow decreases by about 1/2 at 80 years old

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10
Q

Drug Metabolism & Older Adults

A 
Hepatic
Renal
Decreased lean body weight to fat ratio
Decreased serum protein
Substance abuse
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11
Q

Decreased Lean Body Weight to Body Fat Ratio & Drug Metabolism

A

Alters the distribution of drugs in body compartments

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12
Q

Decreased Serum Protein & Drug Metabolism

A

Protein bound drugs are free to roam around

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13
Q

Substance Abuse & Drug Metabolism

A

10% are problem drinkers

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14
Q

Prevention of Hospitalization Due to Drug Reactions

A

Medication review & reconciliation

Be familiar with Beers criteria

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15
Q

What does STOPP stand for?

A

Screening Tool of Older Persons’ potentially inappropriate Prescriptions

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16
Q

What does START stand for?

A

Screening Tool to Alert prescribers to Right Treatment

17
Q

Beers Criteria

A

2 lists of medication to be avoided in older adults

1 list of medications that should be used with caution

18
Q

Examples of Potentially Inappropriate Medication Use

A 
Nitrofurantoin (Macrobind)
Digoxin in doses >0.125 mcg
Sliding scale insulin
Sulfonylureas
Non-Cox-selective NSAIDs
19
Q

Reasons not to Use Nitrofurantoin in the Elderly

A

Potential for pulmonary toxicity

Lack of efficacy with CrCl less than 30

20
Q

Reasons not to Use Digoxin in the Elderly

A

Increased risk of toxicity
Decreased renal clearance
Decreased protein binding

21
Q

Reasons not to Use the Insulin Sliding Scale in the Elderly

A

High risk of hypoglycemia without improvement of hyperglycemia management

22
Q

Reason not to Use Sulfonylureas in the Elderly

A

Prolonged hypoglycemia

23
Q

Reasons not to Use Non-Cox-Selective NSAIDs

A

Increased risk of GI bleeding, PUD

Use of PPI or misoprostol decreases risk

24
Q

Drugs That May Worsen Constipation

A

Antimuscarinics for urinary incontinence
Non-dihydropyridine CCBs
First generation antihistamines

25
Q

Medications to Use Cautiously in Older Adults Because it can cause SIADH or Exacerbate SIADH

A

SNRIs
SSRIs
Antipsychotics

26
Q

Inappropriate Drugs in the Elderly

A 
Diphenhydramine (Benadryl)
Amitriptyline (Elavil)
Alprazolam (Xanax)
Diazepam (Valium)
Chlorpropamide & Glyburide
Digoxin in doses  >0.125
GI antispasmodics
Merperidine (Demerol)
Methyldopa (Aldomet)
27
Q

Reasons Diphenhydramine is Inappropriate in the Elderly

A 
Dry mouth
Confusion
Urinary retention
Constipation
Source of in-hospital mobility/delirium
In many OTC products
28
Q

Reasons Digoxin is Inappropriate in the Elderly

A

Anorexia
Confusion
Renal excretion changes over time

29
Q

START Most Common Omissions

A

Statins
Warfarin
Anti-platelet therapy
Calcium/Vit. D

30
Q

“Choose Wisely” Criteria

A

Don’t use antipsychotics as a 1st choice treatment for dementia
Avoid meds to achieve A1C of less than 7.5%
Don’t use benzos or other sedative hypnotics as 1st choice for insomnia, agitation, or delirium
Don’t use antimicrobials to treat bacteriuria unless symptoms present
Don’t prescribe cholinesterase inhibitors for dementia without assessment for cognitive benefits & adverse GI effects
Avoid using appetite stimulants or high-calorie supplements for anorexia or cachexia
Don’t prescribe meds without a med review

31
Q

Reduce Adverse Drug Reactions

A

Look for meds started at young age that may need to be adjusted
Check dose for chronic therapy after a hospitalization
Avoid adding meds to treat AE’s of another med
Capture all herbal & OTC meds
Verify compliance prior to increasing dose
Avoid long term treatment for pain, behavior, & cognition
Start low & go slow
Regular follow up
Avoid starting 2 meds at one time
Incorporate a standardized method for medication review

Geriatrics (15 decks)

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