Population-specific considerations in drug therapy (part 2) Flashcards
older adults/elderly are commonly referred to as what age???
65 and older
“young-old”
65-74
“old-old”
75-84
“very-old-old”
85+
currently, how many million individuals are greater than 65 in the US
greater than 54 million
by 2030, nearly __ in 5 residents is expected to be >65
1 in 5
what is the most RAPIDLY GROWING AGE GROUP
seniors 85 and older
name 6 reasons as to why older adults are at risk for medication-related problems
-comorbidities
-multiple prescribers/sites of care
-multiple pharmacies/medication sources
-use of many medications (called polypharmacy)
-patient nonadherence
-inadequate pt education on RX and OTC
true or false
pharmacokinetics and pharmacodynamics have relatively the same predictability as we age
false – more viariable and unpredicatable. organ function changes
what does the cockcroft-gault equation measure?
creatinine levels — kidney function
true or false
pharmodynamics are not as well understood as pharmokinetics
true
in the elderly, what changes are seen in regards to pharmodynamics?
change in # of receptors, sensitivity of receptors, and counter regulatory mechanisms
when dosing in older adults, what motto should you follow
“start low and go slow”
when should you avoid prescribing estended released products?
if pts cannot swallow a whole tablet and need to have meds crushed (dysphagia = difficulty swallowing)
Name 3 types of absorption that are affected by age
Gastrointestinal
Intramuscular
Transdermal
Gastrointestinal is delayed but its not significant
Intramuscular is delayed
Transdermal is possible decrease
In the elderly, there is a larger _____ for fat soluble meds
Vd — volume distribution
With age, albumin goes up or down? What about free fraction? What pharmacokinetic property is this related to?
Albumin Dow, free fraction up
Distribution
True or false
With age, some metabolic. Pathways decline
True
What is the concern about “elimination” as we age
Renal function declines
When using the cockcroft-gault equation for estimating creatinine clearance and kidney function, what are 3 important factors to consider
-Reno function must be stable for formula to work
-if actual body weight (ABW) is less than ideal body weight (IBW), use ABW
-CAUTION using in elderly when serum creatinine is low due to decreased muscle mass — (can overestimate the clearance)
When pharmokinetic changes do not explain alterations in elderly, what is assumed to be the issue?
Pharmacodynamic changes
Which are more variable — pharmacokinetic or pharmacodynamic changes associated with age?
Pharmacodynamic
Name 5 important factors to consider when prescribing for older adults
-evidence based (what research has been done in elderly)
-risk-benefit of treatment vs watchful waiting vs non pharmacological
-they might not be able to administer the meds or be adherent
-socioeconomic barriers/affordability and access
-impact of DTC advertising
If there is not a clear indication for the DUR gin the elderly, what should be done
Discontinued or the dose decreased
BCGP
Board certified geriatrics pharmacist
True or false
A BCGP can help to prevent medication related problems in older adults
True
What are 2 explicit criteria in choosing medication for older adults
Beers criteria and STOPP and START
What is Beers criteria
Potentially inappropriate medications
What does STOPP stand for
Careening tool of Oder persons potentially inappropriate prescriptions
What does START stand for
Screening tool to alert doctors to right treatment
Name the 4 types of caps for medication vials
Child resistant
Snap cap
Dual purpose
Non-lock twist
Name 4 adherence aids for the elderly
Dosing boxes
Beepers and timers
Medication calendars
Administration aids (eye drop guides and inhaler devices)
Name 6 common age related mpairents in vision
Presbyopia
Cataracts
Macular degeneration
Retinopathy
Glaucoma
Detached retina
Give 2 examples of talking medical equipment
Bloo glucose monitors and blood pressure machines
Give 2 websites that have talking prescriptions vials and labels
Spoken RX and script talk
What are ways of resolving a hearing impairment issue as it relates to medication
TTD — telecommunication devices for the deaf
TTY —- aka text telephones
Sign language interpreters
Texting
Lip reading
Pocket talkers
What does polymorphism mean
Genetic factors which determine normal differences in drug response
If pt has been on gender affiliated hormones for > how long? Calculate CrCl and IBW based on….
> 6 months, gender identity
What is cultural competency
The ability to recognize differences, identify similar patterns of response, avoid stereotyping”
Requires proper knowledge, attitude and skills
What phrase should we learn in othe language
Typical greeting, “i dont understand” or “speak slower please”
