Population-specific considerations in drug therapy (part 2)

Question 1

older adults/elderly are commonly referred to as what age???

Answer 1

65 and older

Question 2

“young-old”

Answer 2

65-74

Question 3

“old-old”

Answer 3

75-84

Question 4

“very-old-old”

Answer 4

85+

Question 5

currently, how many million individuals are greater than 65 in the US

Answer 5

greater than 54 million

Question 6

by 2030, nearly __ in 5 residents is expected to be >65

Answer 6

1 in 5

Question 7

what is the most RAPIDLY GROWING AGE GROUP

Answer 7

seniors 85 and older

Question 8

name 6 reasons as to why older adults are at risk for medication-related problems

Answer 8

-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

Question 9

true or false

pharmacokinetics and pharmacodynamics have relatively the same predictability as we age

Answer 9

false – more viariable and unpredicatable. organ function changes

Question 10

what does the cockcroft-gault equation measure?

Answer 10

creatinine levels — kidney function

Question 11

true or false

pharmodynamics are not as well understood as pharmokinetics

Answer 11

true

Question 12

in the elderly, what changes are seen in regards to pharmodynamics?

Answer 12

change in # of receptors, sensitivity of receptors, and counter regulatory mechanisms

Question 13

when dosing in older adults, what motto should you follow

Answer 13

“start low and go slow”

Question 14

when should you avoid prescribing estended released products?

Answer 14

if pts cannot swallow a whole tablet and need to have meds crushed (dysphagia = difficulty swallowing)

Question 16

Name 3 types of absorption that are affected by age

Answer 16

Gastrointestinal
Intramuscular
Transdermal

Gastrointestinal is delayed but its not significant
Intramuscular is delayed
Transdermal is possible decrease

Question 17

In the elderly, there is a larger _____ for fat soluble meds

Answer 17

Vd — volume distribution

Question 18

With age, albumin goes up or down? What about free fraction? What pharmacokinetic property is this related to?

Answer 18

Albumin Dow, free fraction up
Distribution

Question 19

True or false

With age, some metabolic. Pathways decline

Answer 19

True

Question 20

What is the concern about “elimination” as we age

Answer 20

Renal function declines

Question 21

When using the cockcroft-gault equation for estimating creatinine clearance and kidney function, what are 3 important factors to consider

Answer 21

-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)

Question 22

When pharmokinetic changes do not explain alterations in elderly, what is assumed to be the issue?

Answer 22

Pharmacodynamic changes

Question 23

Which are more variable — pharmacokinetic or pharmacodynamic changes associated with age?

Answer 23

Pharmacodynamic

Question 24

Name 5 important factors to consider when prescribing for older adults

Answer 24

-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

Question 25

If there is not a clear indication for the DUR gin the elderly, what should be done

Answer 25

Discontinued or the dose decreased

Question 26

BCGP

Answer 26

Board certified geriatrics pharmacist

Question 27

True or false

A BCGP can help to prevent medication related problems in older adults

Answer 27

True

Question 28

What are 2 explicit criteria in choosing medication for older adults

Answer 28

Beers criteria and STOPP and START

Question 29

What is Beers criteria

Answer 29

Potentially inappropriate medications

Question 30

What does STOPP stand for

Answer 30

Careening tool of Oder persons potentially inappropriate prescriptions

Question 31

What does START stand for

Answer 31

Screening tool to alert doctors to right treatment

Question 32

Name the 4 types of caps for medication vials

Answer 32

Child resistant
Snap cap
Dual purpose
Non-lock twist

Question 33

Name 4 adherence aids for the elderly

Answer 33

Dosing boxes
Beepers and timers
Medication calendars
Administration aids (eye drop guides and inhaler devices)

Question 34

Name 6 common age related mpairents in vision

Answer 34

Presbyopia
Cataracts
Macular degeneration
Retinopathy
Glaucoma
Detached retina

Question 35

Give 2 examples of talking medical equipment

Answer 35

Bloo glucose monitors and blood pressure machines

Question 36

Give 2 websites that have talking prescriptions vials and labels

Answer 36

Spoken RX and script talk

Question 37

What are ways of resolving a hearing impairment issue as it relates to medication

Answer 37

TTD — telecommunication devices for the deaf
TTY —- aka text telephones
Sign language interpreters
Texting
Lip reading
Pocket talkers

Question 38

What does polymorphism mean

Answer 38

Genetic factors which determine normal differences in drug response

Question 39

If pt has been on gender affiliated hormones for > how long? Calculate CrCl and IBW based on….

Answer 39

> 6 months, gender identity

Question 40

What is cultural competency

Answer 40

The ability to recognize differences, identify similar patterns of response, avoid stereotyping”
Requires proper knowledge, attitude and skills

Question 41

What phrase should we learn in othe language

Answer 41

Typical greeting, “i dont understand” or “speak slower please”