Topic 17 Flashcards
What are some differences between adrs and ades?
Adr is adverse drug reaction. They are the direct side effects of the drug taken at appropriate levels, often unintended and noxious.
Ade is adverse drug event. It is a broader category, could be some event that occurs due to some event which occurs due to a s/e.
They are usually more preventable.
They are both common causes of hospitalization especially in geriatric patients.
What are 3 things to consider when considering evaluation of benefits
Comprehensive geriatric assessment
Prioritize outcomes (what is most important to patient )
Life expectancy
What are some definitions of polypharmacy and what are some results?
Taking at least one unnecessary drug. Taking 5 or more drugs, etc.
Increased ADR, increased hospitalization, increased severity of adrs poorer compliance increased medication errors
,
What 8 side effects are most worried about in Geriatric
Fall, incontinence, weakness fatigue delirium/dementia anorexia weight loss dizziness
Why is polypharmacy common?
Drs learn to prescribe not the opposite. Patients expect meds. Meds for adrs. Severe illnesses
What does avoid too many Stand for?
Alternatives
Vague sx
OTC/prns
Interactions
Duration
Therapeutic insteAd of preventative
Once a day
Other mds
Money to buy most important drugs
Adrs - don’t treat with drugs
Need?
Yes/no? Compliance
What drugs should not be used in geriatric patients?
Indomethacin-worst cns effects of NSAIDs
Muscle relaxants-anti cholinergic and sedative
Tricyclics-same as above.
Digoxin-renal toxicity
Benzodiazepines-increased half life in elderly=sedation and falls
Meperidine-not as effective as other narcotics
What should be considered with absorption in gero pts.
It pretty much the same.
Some decrease in gastric motility and blood flow
And increase in ph
What are some things to consider with pharmacodynamics in gero? What usually happens with sensitivity, an example? What things vary in gero? Whats an example of an exception? What are 3 things that increase sensitivity in the elderly? Examples?
Sensitivity to drug usually increases with age…sedatives
But sometimes decreases….beta blockers
It is all variable…person to person, med to med
Also, age related changes, underlying illnesses, or frailty can increase sensitivity:
Orthostatic hypotension
Delirium
Frail patients have diminished reserve capacity.
What two things should be considered in distribution in gero? examples of drugs?
Serum albumin decreases in sick and malnourished patients making some drugs more toxic (phenytoin)
With age, total body water decreases leading to less distribution of water soluble drugs and thus more drug in plasma and more side effects (digoxin)
With age, fat increases leading to more distribution of fat soluble drugs and thus longer half lives and thus more side effects (amiodarone)
What should be remembered concerning liver metabolism in gero patients?
Some drugs (not all) are made inactive in the liver. More rarely, drugs are activated in the liver (pro drugs such as plavix and codeine)
Cytcochrome p450 goes through age related decline so phase 1 metabolized drugs are effected but phase 2 not as much.
What is an example of an inhibitor in the liver?
Haloperidol (antipsychotic) inhibits cyp2d6 thus preventing the metabolism of metoprolol (a beta blocker)
