Wk 2 - Older Adults Flashcards
____% of older adults take ___ or more meds per week
40% = 5 or more meds 12% = 10 or more meds
Older adults purchase ___% of all OTC meds
40%
Older adults’ functional reserve of systems _______, resulting in
decline
orthostasis, vision problems, cognitive decline, kidney and hepatic decline
Almost ___% of people with chronic illnesses don’t take meds as prescribed,
50%
About ____ % of patients do not fill prescriptions
30%; this is improved by age, no copay, and close relationship with provider
Among older patients, _______ is least affected in terms of pharmacokinetics
absorption
Drugs that can cause cognitive impairment:
■ All triclycic antidepressants (TCA) ■ Benzodiazepines ■ Metoclopramide ■ Anticholinergics ■ Chlorpromazine ■ Beta-blockers ■ Corticosteroids ■ Digoxin ■ Levodopa ■ H2 receptor antagonist (Cimetidine) ■ Lithium ■ NSAIDs ■ Phenytoin ■ Quinidine ■ Meperidine ■ Zolpidem
Pharmacological concerns with diminished cardiac output in older adults:
- Decreased metabolism / elimination and increased circulation time
- Reduced absorption of oral meds
- Increased time for vaginal and rectal meds to dissolve and maybe expelled prematurely
Altered peripheral vascular tone and reduced baroreceptor activity can result in increased effect of
diuretics and antihypertensives
Oxybutynin used for urinary incontinence can cause _______ in older adults
glaucoma
somnolence
Metformin can cause in older adults:
urinary issues
GI side effects
watch GFR <45
contraindicated with chronic alcohol use
Dosing of medications usually should be _______ for older adults
decreased
Older adults tend to have ______ albumin
decreased
Older adults tend to have ______ free drug
increased
Older adults tend to have ______ liver mass and hepatic blood flow
decreased
Older adults tend to have ______ enzymes
decreased
Highly protein-bound medications will result in ______ free drug levels in older adults
increased
Benzodiazepines are typically ____ in older adults and can cause:
contraindicated
cognition impairment, increase fall risk
Metoclopramide/Reglan can cause ____ in older adults
mental status changes
Older adults tend to have ______ total body water
decreased
Older adults tend to have ______ total body fat
increased, higher concentration of fat soluble drugs in adipose tissue
Older adults tend to have higher gastric pH, delayed emptying and decreased gastric acid, resulting in…
..reduced absorption of low ionized drugs with low pH
Older adults tend to have ______ gastric pH
increased
Older adults tend to have ______ cardiac output
decreased
Older adults tend to have ______ GFR / tubular secretion
decreased
Older adults tend to have ______ risk of adverse drug reactions
increased
Older adults tend to have ______ transfer across blood brain barrier
increased
Older adults tend to have ______ change in receptor properties
increased
Adverse drug events cause _____ among older adults
> 100,000 deaths annually
Strongest predictor of polypharmacy and adherence issues in older adults
Number of meds
Between ______% of older adults have polypharmacy and adherence issues
25-50%
Beers Criteria is intended to
- Improve medication selection
- Reduce adverse drug events
- Educate both patients and clinicians
What pharmacokinetic property is least affected among older adults?
Absorption
By 2050, the elderly population will reach ___% and ___% of population will be >79 years.
22%
20%
Older adults with seizure / epilepsy have lower seizure threshold when taking:
antipsychotics (-ines), bupropion, tramadol
Older adults should minimize total number of ________ class drugs to minimize cognitive impairment
anticholinergics
Older adults have increased fall risk when combining _____ with >2 other ________
opioids
CNS active medications
Older adults taking warfarin and ______ have increased bleed risk
NSAIDs
Aspirin for primary prevention in patients >80 should be _______ due to ________ changes
used with caution
renal function
Hyponatremia in older adults can be caused by medications due to __________ and _____ changes should be considered
renal function changes
dosing
STOPP/START tool shown to _____ in hospital in RCT
decrease ADR
This afib med should not be used first line among older adults
Amiodarone
