Psychopharm

Question 1

Polypharmacy

Answer 1

~10 drugs/person
This cut off point of 5 medications has been shown to be associated with the risk of adverse outcome such as falls, frailty, disability, and mortality in older adults

Question 2

Challenges in Prescribing for Older Adults

Answer 2

Age-related changes, chronic medical conditions, the use of multiple medications, and the presence of cognitive impairment complicate diagnosis and treatment of older adults.

Signs and symptoms may be less obvious with older adults as they often present with vague complaints and often perceive changes as normal aging.

Older adults perceive their health as ability to function rather than on number of health problems – cultural and generational response.

Drug-drug interaction is often an issue as older adults often take considerable numbers of prescription and non-prescription drugs.

Ex:
Polypharmacy ~10 drugs/person
Drug metabolism
Dysphagia – med can’t be crushed,
Sundowning
Complex health concerns
Drug interactions –supplements, alcohol, tobacco
Forgetful / Med timing / Scheduling

Question 3

Pharmacokinetics

Answer 3

what the body does to the drug

involves the movement of drugs through the body. As our bodies age, drug absorption, distribution, metabolism, and excretion is altered.

Question 4

Pharmacodynamics

Answer 4

what the drug does to the body.

involves the effects of the drug on an aging body and an aging person: age related sensitivity to therapeutic and toxic effects of drugs (adverse effects).

Question 5

Absorption

Answer 5

delayed gastric emptying and reduced intestinal motility, increased gastric pH, decreased mucosal surface area,  drugs are in the body longer.

Question 6

Distribution

Answer 6

decreased muscle mass, increased fat to muscle ratio leads to prolonged action of lipid-soluble drugs, decreased total body water (cells and fluids) leads to higher blood and tissue concentration (also of water-soluble drugs)  drugs have more impact, use lower doses.

Question 7

Metabolism

Answer 7

decreased liver size, hepatic flow, and metabolizing enzymes (caffeine, tobacco, enzyme inhibitors or inducers… e.g. grapefruit juice) not well understood.

Question 8

Excretion

Answer 8

decreased renal capacity, age-related sensitivity to therapeutic and toxic drug effects, potential for drug interactions  use fewer drugs for shorter periods of time, or use alternative strategies and therapies, and not herbal remedies.

Question 9

Pharmacokinetic interaction

Answer 9

one medication affects the plasma concentration of the other medication.

Question 10

Anticholinergic syndrome

Answer 10

All drugs that have anticholinergic properties, should, when possible, be avoided in older people (anti-depressants, neuroleptic medications, GI medications, allergy mediations , insomnia medications and cold medications). May cause urinary retention, constipation, tachycardia, blurred vision, confusion, memory loss and diminished cognitive function. This may be confused with symptoms of dementia and may be overlooked.

more common in people who are on multiple medications, and older adults tend to be in that category.

Question 11

Serotonin syndrome

Answer 11

Many drugs/herbal remedies, such as SSRI’s, Effexor, trazadone opioids, antibiotics, St. John’s wort, ginseng increase levels of serotonin in the brain, resulting in: restlessness, tremors, tachycardia, confusion, high blood pressure, dilated pupils, loss of coordination, muscular rigidity, shivering, diarrhea. Severe symptoms include high fever, seizures, irregular heartbeat, unconsciousness.

more common in people who are on multiple medications, and older adults tend to be in that category.

Question 12

Strategies for Safer Medication Use Among Older Peopl

Answer 12

• Avoid and reduce the use of prescription and non-prescription medications ( i.e. de-prescribe) when possible.
• Seek, use, and teach clients and their families about alternative strategies to manage the challenges and illnesses.
• Create a societal and institutional culture where clients, professionals, and others do not believe that medication is the answer or… the only answer.
• Encourage using pharmacist as a resource.
• Educate clients and their support system re: safe administration
• For older persons who are in hospital/facility care, safety processes, such as medication reconciliation, should be utilized. Each facility should have its own process.
• Strategies … blister packs, medication diaries, regular review of medications with providers, he introduction of strategies to de-prescribe whenever possible….

Question 13

The Beers Criteria

Answer 13

for Potentially Inappropriate Medication Use in Older Adults (Beers List), are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults.

Question 14

Which meds are psychotropic

Answer 14

antidepressants, anti-anxiety medications, stimulants, antipsychotics, and mood stabilizers

Question 15

Which meds are antidepressives

Answer 15

duloxetine
venlafaxine (Effexor )
mirtazapine
trazadone
vortioxetine