Senior Care Flashcards
What is the “age” sub-group for:
old-young
young-old
middle old
old-old
centenarians
super centenarians
50-64
65-74
75-84
85+
100+
110+
Geriatric/elderly/older adults refers to?
age 65 and older
frail elderly refers to?
over 85 with multiple comorbidities
define long-term care
care provided for a long time. Not environment specific
define nursing facility
aka nursing home, care based on a medical/nursing model—extended stay
what’s the difference b/w nursing facility and skilled nursing facility?
a skilled nursing facility is medicare-certified
what is subacute care?
intense post-hospital care
define assisted living
community-based care
a pharmacist that specializes in advocating for patients who solves drug therapy problems is called?
a consultant pharmacist
what is the difference between life span and life expectancy?
life span is the longest period of time an organism can live, whereas live expectancy is the estimated time that an organism is likely to live
who is the oldest recorded human and hw old are they?
Jeanne Calment, 122 y/o
Who is the current oldest living man/woman?
Juan Perez -112
Maria Morera - 115
what’s the name/age of the oldest dog?
Toby Keith 21 y/o
T/F there is significant variation in life expectancy at birth between countries
true
what’s the average life expectancy in the US?
around 77
which country has the highest life expectancy? avg age?
Hong Kong, 84
which country has the highest population over 65?
Japan
what are the theories of aging?
-error theory
-wear and tear theory
-cross-linking theory
-biological clock
-free-radical theory
-telomere hypothesis
what is the telomere hypothesis?
shortening of telomeres occurs until threshold length is achieved. replicative senescence “mitotic clock” blocks further cell division. essentially, telomeres have a major influence on the aging process
what is progeria (Hutchinson-Gilford syndrome)?
a rare genetic disorder that causes children to age rapidly, starting in their first 2 years of life. children in the first year start to have slowed growth and hair loss
what are the power 9 principles for living longer?
Down shift: relieve stress
Purpose: wake up with a purpose
Plant Slant: less meat and more plants
Wine @ five: enjoy a daily glass of wine with friends
Family first: invest time with family
80% rule: eat mindfully and stop when 80% full
Move naturally: move more!
Right tribe: surround yourself with people who support you
Belong: belong to a faith-based community
what are the top 3 causes of death in adults over 65 (in order)?
- Heart disease
- Cancer
- COPD
what is the ranking of care in regards to highest -> lowest cost + highest-> lowest caregiver skills?
a. Subacute, Home Health Care, Assisted Living, Nursing Facility, Hospital
b. Hospital, Subacute, Home Health Care, Nursing Facility, Assisted Living
c. Hospital, Subacute, Nursing Facility, Assisted Living, Home Health Care
d. Home Health Care, Assisted Living, Hospital, Subacute
e. Home Health Care, Subacute, Nursing Facility, Assisted Living
c
What are the opportunities for Pharmacists in regards to:
-Hospital and subacute
-Nursing Facility
-Assisted Living
-Home Health Care
-Independent Living
H/A: specialty pharmacy practice opportunities
NF: MMRs
AL: similar to NF
HHC: prevention of re-hospitalization
IL: tons of opportunities
what is the federal requirement in regards to Pharmacy in Nursing Facilities?
pharmacists must perform a MRR (aka DRR) for each resident at least monthly
how do nursing facilities and assisted living faculties differ?
-nursing facilities tend to have more skilled staff.
-nursing facilities are federally regulated whereas assisted living is state regulated
-nursing facilities have mandated MRR due to being federally regulated whereas assisted living MRR mandates vary based on state
which state has the most expensive nursing home costs?
Alaska
age-related pharmacokinetic changes in absorption:
decreased production of ______
slower __________
actively absorbed compounds such as ____________ may have decreased absorption
_________ drug delivery not well-studied
HCl (achlorhydria)
gastric emptying
calcium, iron, and B12
transdermal drug
age-related pharmacokinetic changes in distribution:
increased _______ and decreased _________
alterations in _____________
water-soluble drugs such as digoxin, morphine, and lithium may have a smaller ______________
fat soluble drugs may have a larger _____________
_____________ decrease common, many drugs are _______ bound
body fat, total body water
volume of distribution
volume of distribution
volume of distribution
-serum protein, protein
age-related pharmacokinetic changes in metabolism:
liver decreases in _____ and __________
may have altered _______ function
______ changes more neccesary
size, blood flow
liver
drug dose
why is a dose reduction in geriatric pts req. for alprazolam?
it has higher plasma concentrations in geriatric pts due to reduced clearance
age-related pharmacokinetic changes in excretion:
_______ function decreases with age (25-50%). measured using _________ or ____ to estimate drug elimination
__________ adjustments often made
kidney, creatinine clearance, GFR
renal dose
age-related pharmacodynamic changes:
may enhance and/or impede _________
changes in _________ affinity
altered ________ control
increased sensitivity to _____ effects
increased ___________ toxicity
change in _____________ response
drug action
receptor
homeostatic
CNS
anticholinergic
baroreceptor
how does the pharmacokinetics of glimepiride change as renal function declines?
serum levels decrease and its metabolites (M1 and M2) increase. pts with CrCl <20 had a much larger amount of M1 metabolite compared to pts with CrCl >50
what would be an example of when a patient has a medical condition (a drug indication) that requires drug therapy but is not receiving a drug for that indication?
pt med compliance or rather non-compliance/adherence
what are examples of non-compliance/adherence?
-under use
-over use
-intelligent non-compliance (self-adjusting meds)
-premature discontinuation
-not filling rx
what would be an example of when a patient has a medical condition for which the wrong drug is being taken?
error in dispensing the wrong prescription based on a look-alike sound-alike error
how can we prevent look-alike/sound-alike drug errors?
TALL man lettering
what would be some examples of when a patient has a medical condition for which too little of the correct drug is being given?
-pt is taking pain meds but pain is not controlled
-pt dose of antidepressant isn’t high enough… titration=longer time of therapy before pt experiences beneficial effects from the drug
what would be some examples of when a patient has a medical condition for which too much of the correct drug is being given?
-methotrexate: it can ben prescribed daily for RA sx, but it is indicated for once weekly for RA. it has immunosuppressive properties, and if dosed too high makes pt at an extremely higher risk of infection
-sedatives: give pt a sedative for a psychotic episode, pt continues to take daily despite no longer experiencing psychotic episodes
what would be some examples of when a patient has a medical condition that is the result of not receiving the prescribed drug?
-can’t affort rx
-can’t access drug
-can’t arrange refills
-can’t use med correctly
why should bisphosphonates be taken with a full glass of water?
why should pt practice good oral hygiene?
how much does OJ and coffee reduce the bioavailability? what about with food?
can cause esophagitis if it gets stuck in the throat
so that med doesn’t absorb in mouth: prevents osteonecrosis
around 60%. bioavailability becomes negligible
what would be an example of when a patient has a medical condition that is the result of taking a drug for which there is no valid medical indication?
for example: a pt had acute delirium and was given haloperidol which was continued when pt went back to her NF. she is now taking an antipsych drug daily for an acute episode
why are PPIs commonly prescribed in the hospital to older pts?
there is increasing evidence that PPIs may increase the risk of?
to prevent stress ulcers
fractures and c. diff infections
what is an example of when a patient has a medical condition resulting from an adverse drug reaction?
older pts could be taking a seemingly harmless OTC med such as Tylenol PM. Tylenol PM contains Benadryl which has cholinergic effects causing confusion and cardiac rhythm disturbances
why are stereotypes of the elderly unfair, such as confusion, weakness, constipation, dry mouth, tremor, urinary issues, etc…?
these stereotypes are also the same as SEs from a lot of medications seniors take
what are the concerns when a patient has a medical condition resulting from a drug-drug, drug-food, drug-laboratory interaction?
can potentially cause serious harm to the pt and it may be difficult to pinpoint the cause of the adverse reaction
A 75 yo pt with history of respiratory disease developed a skin infection for which a quinolone antibiotic was prescribed. med history includes use of a corticosteroid inhaler. within 2 weeks he developed bilateral Achilles tendon ruptures with unsuccessful surgery. Pt became disabled, deconditioned, depressed and died. what went wrong?
quinolones have been associated with tendinopathy. pts over 60 have an increased risk, and pts over 60 using corticosteroids are at a significantly increased risk
