Geriatric Pharmacology

Question 1

Polypharmacy

Answer 1

Use of 5+ medications concurrently

Question 2

Risks of polypharmacy

Answer 2

Can lead to increased risk for falls, depression, and hospitalization

Question 3

Causes of polypharmacy

Answer 3

Can be caused by prescriptions from multiple doctors, inappropriate prescribing, self-medicating, and a prescribing cascade (treating only side effects)

Question 4

How does body composition changes in older adults impact medication effects?

Answer 4

Decreased total body water, lean mass, and bone density and increased body fat leads to medications distributing differently

Question 5

How does cardiac changes in older adults impact medication use?

Answer 5

Decreased cardiac output and increased total peripheral resistance leads to an increased risk for heart failure and hypertension
Increases the need to monitor blood pressure and heart rate

Question 6

How does respiratory changes in older adults impact medication use?

Answer 6

Decreased strength of muscles for respiration, decreased maximal breathing capacity, and decreased gas exchange increases the likelihood of respiratory complications
Need to monitor respiration rate and shortness of breath

Question 7

How do digestive changes impact medication effects?

Answer 7

Increase in gastric pH due to decreased acid production and decrease in rate of gastric emptying leads to medications being absorbed differently
Need to monitor for constipation and heartburn

Question 8

How do urinary changes in older adults impact medication effects/use?

Answer 8

Decreased renal blood flow and glomerular filtration rate leads to medications being eliminated slower
Need to monitor for urine output and color

Question 9

How do liver changes in older adults impact medication effects/use?

Answer 9

Decreased size of liver and hepatic blood flow leads to medications being metabolized differently
Need to monitor for jaundice

Question 10

Changes in absorption of medication in older adults

Answer 10

Increased permeability at blood-brain barrier leads to medications entering the CNS more easily
Need to monitor for excessive sedation, confusion, changes in sleep habits, and changes in mood

Question 11

How do changes in vision affect medication use?

Answer 11

Cataracts, macular degeneration, glaucoma, and diabetic retinopathy lead to visual deficits which increase likelihood of taking medications incorrectly.

Question 12

Pharmokinetics

Answer 12

How the body affects medication

Question 13

Pharmokinetic changes of oral medications

Answer 13

Slower rate of absorption and delayed peak effect of medication
Medications may stay in body due to poor kidney function which increases duration of medication action, and increase toxicity

Question 14

Pharmokinetic changes of transdermal medication

Answer 14

Less medication is absorbed due to decreased blood flow to skin

Question 15

Pharmodynamic changes

Answer 15

How medication affects the body

Question 16

Anticholinergic effects

Answer 16

Dry eyes
Dry mouth
Blurred vision
Fatigue
Disorientation
Constipation
Urinary retention

Question 17

CNS side effects

Answer 17

Confusion
Sedation
Dizziness
Agitation
Irritability
Hallucination

Question 18

Gastrointestinal side effects

Answer 18

Constipation
Diarrhea
Mucosal damage such as ulcerations and GI bleeding

Question 19

Effect of NSAIDs in older adults

Answer 19

May irritate mucosal lining of stomach and may lead to GI bleed

Question 20

Medication for mild to moderate pain relief

Answer 20

Tylenol/acetaminophen is good for elderly patients at lower doses (max 2 grams/day)
Good for mild-moderate pain releif

Question 21

Medication for severe pain relief

Answer 21

Narcotics
May cause sedation, dizziness, confusion, hallucination, and fall risk
Respiratory depression is possible in high doses

Question 22

Side effects of calcium-channel blockers

Answer 22

Increases risk of orthostatic hypotension

Question 23

Side effects of anti-arrhythmia medication

Answer 23

Increased risk of toxicity in older adults

Question 24

Side effects of anticoagulant/antiplatlet medications

Answer 24

Increased risk of bleeding and brusing

Question 25

Hypertension

Answer 25

Persistently elevated arterial blood pressure

Question 26

Essential or primary hypertension

Answer 26

Unknown or idiopathic cause (90% of cases)

Question 27

Secondary hypertension

Answer 27

Results from another condition (10% of cases)

Question 28

Antihypertensives

Answer 28

Any medication that lowers blood pressure
May cause orthostatic hypotension
May precipitate a gout attack due to hyperuricemia

Question 29

Side effects of sleep medications

Answer 29

Benzodiazapines and non-benzodiazepines may cause daytime sedation and confusion
Very habit forming
Antihistamines may cause daytime sedation, confusion, and constipation

Question 30

Side effects of skeletal muscle relaxants

Answer 30

May cause sedation, dizziness, and fall risk

Question 31

Side effects of anti-spasmodics

Answer 31

May cause sedation and dizziness

Question 32

Alzheimer’s Disease

Answer 32

Most common cause of dementia

Question 33

Effect of Alzheimer’s Medications

Answer 33

Cholinesterase inhibitors may cause sedation, nausea, vomiting, diarrhea, anorexia, and weight loss
NMDA-receptor antagonists are generally well tolerated

Question 34

Side effects of urinary incontinence drugs

Answer 34

May cause dry mouth, dry eyes, blurred vision, constipation, fatigue, dizziness, confusion, and hallucination

Question 35

Are colace and miralax safe?

Answer 35

Yes

Question 36

Antihistamines to avoid

Answer 36

Avoid use of Benadryl, Unisom, Tylenol PM, Advil PM due to containing diphenhydramine

Question 37

Use of Asprin

Answer 37

Low does may help thin blood to decrease risk of stroke or heart attack
Side effects may include increased risk of bleeding and ulcers
Call physician if you notice unprovoked bruises, unnatural bleeding, or black tarry stools

Question 38

Medications that create a minor fall risk

Answer 38

Antidepressants
Anticonvulsants
Antihypertensives
Antihistamines
Antipsychotics
Anti-alzheimer’s agents
Anti-Parkinson’s agents
Narcotic analgesics

Question 39

Medications that create a major fall risk

Answer 39

Hypnotics
Anxiolytics
Narcotic analgesics
Muscle relaxants

Question 40

Medication management for OT

Answer 40

Create a pill schedule card that is in large, plain font
- Lamination and bright white paper may make it more difficult to read

Arrange medication by TV schedule