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547 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

ADLs

DEATH mnemonic

A

ADLs

Dressing
Eating 
Ambulation
Toileting
Hygiene
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2
Q

IADLs

SHAFTT mnemonic

A

IALDs

Shopping
Housekeeping
Accounting (money)
Food prep
Transportation
Telephone
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3
Q

3 common iatrogenic problems in geriatrics

A
  • adverse drug events
  • acute kidney injury
  • adverse surgical outcomes
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4
Q

what are four components of pharmacokinetics?

which one is least impacted by age?

A
  • absorption (least impacted by age)
  • distribution
  • metabolism
  • elimination
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5
Q

older adults have (higher/lower) total body water and (higher/lower) body fat

What is the effect on lipophilic medications?

  • (smaller/larger) volume of distribution?
  • (shorter/longer) elimination phase?
  • (shorter/prolonged) therapeutic effect?
A

OA have LOWER total body water and HIGHER body fat

effect on lipophilic meds:

  • larger volume of distribution
  • longer elimination phase
  • prolonged therapeutic effect
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6
Q

albumin (increases/decreases) with prolonged illness

What is the effect on free fraction of highly bound acidic drugs (eg naproxen, phenytoin, warfarin)?

A

albumin DECREASES with prolonged illness

causes INCREASE in free fraction (unbound) medication

  • more likely to experience ADE or toxic effect
  • free fraction may be toxic range
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7
Q

Impact of aging on liver size and function:

phase I metabolism of medications is via ______

phase II metabolism is via ______

A

Liver: decreases in size, decreased perfusion
-quantitative changes in LFT minimal

phase I: CYP450
*high variability between patients even in young adults

phase II: glucuronidation, acetylation, sulfation (to create water soluble metabolites for elimination)
**this phase not affected by aging

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8
Q

Serum creatinine (increases/decreases) in older adults due to (increased/decreased) muscle mass

A

decreased serum Cr

decreased muscle mass

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9
Q

What are the 4 criteria to start/continue a medication in older adults?

A

Four Criteria to start/continue medication:

(1) a patient’s life expectancy
(2) the time until benefit from medication
(3) goals of care
(4) treatment targets

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10
Q

What should always be included in your list of differential diagnoses when an older adult presents with a new complaint (or increasing dysfunction)?

A

adverse drug effect think polypharmacy

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11
Q

BEERS criteria

what is the recommendation re: use of sliding scale insulin?

A

-higher risk hypoglycemia without improvement in hyperglycemia management

AVOID regimens that only have rapid/short acting insulins WITHOUT basal or long acting insulin

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12
Q

BEERS criteria

what is the recommendation re: use of benzos and benzo-receptor agonists (Z drugs)?

A

AVOID

older adults are more sensitive, decreased metabolism with long acting agents

INCREASE risk cognitive impairment, delirium, falls, fractures, MVC
NO improvement in sleep latency and duration

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13
Q

BEERS criteria

what is the recommendation re: antidepressants eg amitriptyline, paroxetine

A

AVOID

highly anticholinergic
sedating
orthostatic hypotension

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14
Q

BEERS criteria

what is the recommendation re: digoxin?

A

AVOID as first line for afib rate control or heart failure

decreased renal clearance –> high risk of toxic effects

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15
Q

BEERS criteria

what is the recommendation re: nitrofurantoin?

A

AVOID in long term use or if CrCL <30 mL/min

Risk pulmonary toxicity, hepatoxicity, peripheral neuropathy

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16
Q

BEERS criteria

what is the recommendation re: first generation antihistamines eg dimenhydrinate, diphehydramine, hydroxyzine

A

AVOID (unless acute severe allergic reaction)

highly anticholinergic
decreased clearance
tolerance when used as hypnotic

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17
Q

BEERS criteria

what is recommendation re: androgens eg testosterone

A

AVOID

CV risk
contraindicated with prostate ca

18
Q

BEERS criteria

what is recommendation re: use of estrogens +/- progestins

A

AVOID systemic (po or topical)

vaginal estrogen safe and effective for dyspareunia, recurrent UTI, vaginitis

19
Q

BEERS criteria

what is the recommendation re: sulfonylureas eg glyburide

A

AVOID

risk severe hypoglycemia

20
Q

BEERS criteria

what is the recommendation re: metoclopramide

A

AVOID unless for gastroparesis (limit to <12 weeks)

risk extrapyramidal effects tardive dyskinesia

21
Q

BEERS criteria

what is the recommendation re: mineral oil po

A

AVOID

risk of aspiration

22
Q

BEERS criteria

what is the recommendation re: PPI

A

AVOID

Risk C diff, bone loss, fractures
avoid scheduled use > 8 weeks UNLESS high risk (eg oral corticosteroids, chronic NSAIDs, Barrett’s esophagitis etc)

23
Q

BEERS criteria

what is the recommendation re: NSAIDs

A

GI bleed, peptic ulcer in high risk groups (age 75+, on corticosteroids, anticoagulants, antiplatelet agents).

↑ BP and induce acute kidney injury

AVOID long term use unless alternatives not effective
if long term use with PPI

24
Q

BEERS criteria

which NSAIDs has the most adverse effects?

A

indomethacin

GI bleed, PUD, BP, AKI

25
Q

BEERS criteria

what is the recommendation re: skeletal muscle relaxants eg cyclobenzaprine, methocarbamol

A

AVOID

most poorly tolerated
some anticholinergic
sedation, risk fracture

26
Q

BEERS criteria

what is the risk of use of antipyschotics in patients who have delirium or dementia?

A

Antipsychotics associated with ↑ risk of CVA and mortality in patients with dementia

• AVOID use for behavioural problems unless nonpharm have failed/not possible AND older adult is threatening substantial harm to self or others

27
Q

BEERS criteria

drug classes to avoid in patient with delirium?

A
  • anticholinergics
  • antipsychotics
  • corticosteroids (po and systemic)
  • H2-receptor antagonists eg famotidine, ranitidine
  • meperidine
  • BZD
  • non benzo and Z-drugs
28
Q

BEERS criteria

drug classes to avoid in patients with hx of falls or fractures?

associated risks?

A 
History of falls or fractures
•	Antiepileptics
•	Antipsychotics
•	BZD, nonBZD, Z drugs
•	Antidepressants: TCAs, SSRIs, SNRIs
•	Opioids (to be used only in management of acute severe pain)

Risk of ataxia, impaired psychomotor function, syncope

29
Q

BEERS criteria

drug classes to avoid in patients with Parkinson disease?

associated risks?

A
  • antiemetics (metoclopramide, prochlorperazine)
  • all antipsychotics EXCEPT quetiapine, clozapine

dopamine-receptor antagonists can worsen Parkinson symptoms

30
Q

BEERS criteria

drug classes to avoid in patients with hx of gastric or duodenal ulcers?

associated risks?

A

History of gastric or duodenal ulcers
• ASA > 325 mg/day
• Non-COX-2 selective NSAIDS

risk of aggravating / inducing ulcers

31
Q

BEERS criteria

drug class to avoid in patients with CKD or CrCl <30 mL/min)?

A

NSAIDs

-risk of acute kidney injury, worsening kidney function

32
Q

BEERS criteria

what drug classes may cause or exacerbate SIADH or hyponatremia?

A 
Antipsychotics
Carbamazepine
Diuretics
Mirtazapine
Oxcarbazepine
SNRIs SSRIS
TCAs
Tramadol

**monitor Na closely

33
Q

BEERS criteria

what medication poses risk of hyperkalemia when used concurrently with ACE-I or ARB?

A

trimethoprim-sulfamethoxazole

if concurrent ACE-I or ARB in presence of decreased CrCl

34
Q

BEERS criteria

What common drugs may have interactions with warfarin?

A 
Amiodarone
Cipro
Macrolides (except azithro)
TMP-SMX
NSAIDs
  • increased risk of bleeding
  • monitor INR and bleeding
35
Q

BEERS criteria

Potential risk of interaction between corticosteroids (po or parental) and NSAIDs?

A

-increased risk of PUD or GIB

avoid
if not possible to avoid, offer PPI

36
Q

BEERS criteria

what is the risk of using cipro in older adults with decreased renal function?

A

risk of CNS effects (seizures, confusion), tendon rupture

37
Q

BEERS criteria

what is the risk of using Septra in older adults with decreased renal function?

A

risk of worsening renal function, hyperkalemia

  • renal dosing
  • AVOID if CrCl <15
38
Q

BEERS criteria

what is the risk of using cimetidine, famotidine, ranitidine in older adults with decreased renal function?

A

mental status change

*reduce dose

39
Q

BEERS criteria

examples of drugs from each class with strong anticholinergic properties?

  • antidepressants
  • antiemetics
  • antihistamines
  • antimuscarincs
  • antiparkinsons
  • antipsychotics
  • skeletal muscle relaxants
A
  • antidepressants: amitriptyline, doxepine, paroxetine
  • antiemetics: prochlorperazine, promethazine
  • antihistamines: first generation (gravol, benadryl, atarax)
  • antimuscarics: oxybutynin, solifenacin
  • antiparkinsons: benztropine
  • antipsychotics: clozapine, loxapine, olanzapine, chlorpromazine
  • skeletal muscle relaxants: cyclobenzaprine
40
Q

What are some signs and symptoms of digoxin toxicity?

Ocular 
Neuropsychiatric  
Gastrointestinal 
Potassium 
Cardiac
A

Ocular – yellow or green vision, halos, photophobia
Neuropsychiatric – delirium, drowsiness, headache, hallucinations, convulsions
Gastrointestinal – nausea and/or vomiting, abdominal pain, anorexia, weight loss
Potassium levels – low OR high
Cardiac symptoms – brady dysrhythmia (acute toxicity), tachy dysrhythmia (chronic toxicity), ventricular tachycardia.

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