ADEs of old ppl drugs

Question 1

constipation = new symtom

what is the drug responsible?

Answer 1

narcotics

Question 2

renal failure, hearing loss =new symtom

what is the drug responsible?

Answer 2

aminoglycosides

Question 3

new symptom = dry mouth, constipatio, urinary retention, and deliriumtom

what is the drug responsible?

Answer 3

anticholinergic

Question 4

diarrhea(quinidine); urinary retetion(disopyramide) = new symtom

what is the drug responsible?

Answer 4

antiarrhythmics

Question 5

dehydration, hyponatremia, hypokalemia, incontience = new symtom

what is the drug responsible?

Answer 5

diuretics

Question 6

delirium, sedation, hypotension, extrapyramidal disorders=new symtom

what is the drug responsible?

Answer 6

antipsychotics

Question 7

excessivve sedation, delirium, gait disturbance=new symtom

what is the drug responsible?

Answer 7

sedative-hypnotic

Question 8

interference w/drug absorption

Answer 8

antacid

Question 9

polypharmacy: drug-drug interaction
consequence: protein binding displacemen
ex: oral hypoglycemics, aspirin, chloral hydrate

Answer 9

warfarin

Question 10

consequence: altered metabolism
affects: propanoll

theophylline

phenytoin

Answer 10

cimetidine

Question 11

altered extrection

drug inovlved: lithium

Answer 11

diuretics

Question 12

consdquence = increased bioavilability;

drugs: dextromethorpham, midazolam, imatinb

culprit?

Answer 12

grape fruit juice = CYP inducer

Question 13

disease: dementia

**drug: **

**ADE: 2 **

Answer 13

drug: psychotropics

ADE: confusion and delirium

Question 14

disease: glaucoma

drug:

ADE:

Answer 14

drug: antimuscarinic

ADE: acute glaucoma

Question 15

disease: CHF
drug: 2

ADE:

Answer 15

beta blockers, and verapamil = drugs

ADE: acute decompression

Question 16

disease: conduction disordrs
drug:

ADE:

Answer 16

DRug: TCAs

ADE: heart block

Question 17

disease: HTN
drug:

ADE:

Answer 17

drug: NSAIDs
effect: increase BP

Question 18

disease: peripheral vascular disease
drug:

ADE:

Answer 18

drug: beta blockers
effect: intermittend claudication

Question 19

disease: COPD
drug:

ADE:

Answer 19

drug: beta blockers

ADE: brochoconstriction

Question 20

disease: chronic renal impairment
drug: 3

ADE:

Answer 20

disease:
drug: NSAIDs, contrast, aminoglycosides

ADE: acute renal failure

Question 21

disease: DM
drug: 2

ADE:

Answer 21

disease:
drug: diuretics, prednisone(cortisol enchanes gluconeogenesis)

ADE: hyperglycemia

Question 22

disease: BPH
drug:

ADE:

Answer 22

disease:
drug: antimuscarinic agents

ADE: urinary retention

Question 23

disease: depression
drug: 5

ADE:

Answer 23

drugs: beta blcokers, central antihypertensives, alochol, benzos, steroids
effect: precipitation or exacerbation of depression

Question 24

disease: hypokalemia
drug:

ADE:

Answer 24

disease:
drug: digoxin

ADE: cardiac arrhythmias

Question 25

PUD ## Footnote disease: Peptic ulcer disease drug: 2 ADE:

Answer 25

disease: drug: NSAIDs, anticoagulant ADE: GI hemorrhage

Question 26

what are the 7 classes of drugs with strong anti-cholinergic activity

Answer 26

Anti-histamine Anti-parkisnonia skeletal muscle relexants, antimuscarinics - urinary incontinence anti-depresants anti-psychotics

Question 27

condition: dysrhtymia high risk med(s): effect:

Answer 27

condition: high risk med(s): TCAs effect: prolonged QT

Question 28

condition: COPD high risk med(s): 2 effect:

Answer 28

condition: high risk med(s): beta blockers, long acting benzodiazepines effect: respiratory depression

Question 29

condition: heart failure high risk med(s): 2 effect:

Answer 29

condition meds: **inotrope effect**s(disopyramide), drugs with **high Na+ content**(bisphosphanate, citrate, salicylate) effect: fluid retention, increase heart failure

Question 30

condition: chronic constipation high risk meds: 2 effect:

Answer 30

high risk meds: CCBs, anticholinergics effect: increase constpation, impaction, obstruction

Question 31

condition: hyponatremia high risk med: effect:

Answer 31

condition: high risk med: SSRI effect: hyponatremia

Question 32

condition: orthostatic hypotension high risk med: 3 effect:

Answer 32

condition: high risk med: diuretics, alpha blockers, vasodilators effect: near syncope, syncope falling--\>potential for injury

Question 33

3 drug classes with high Beers criteria

Answer 33

anxiolytics anti-depressants sedative-hypnotics also at risk for: addition, abuse, oversedation, respiratory depressin, confusion

Question 34

many old ppl on benzos will become dependent and sudden termination --\>emergence of withdrawal symptoms. which two short acting benzos should be used?

Answer 34

alprazolam temazepam lorazepam

Question 35

which anti-depressant with strong anti-cholinergic and sedative properties should be avoided in old ppl?

Answer 35

amitriptyline

Question 36

which depression drugs are safer for older ppl with a decreased riks for cardiotox, orthostatic hypotension, and anticholinergic effects?

Answer 36

SSRIs (citalopram, escitalopram)

Question 37

which anti-arrhythmic drug in C/I in older patients by BEERS criteria b/c of significant anticholinergic properties? IT can induce heart block especially in patients with congestive heart failure.

Answer 37

DISOPYRAMIDE

Question 38

according to BEERS criteria, 33% of ED visits in geriatric pts were due to an ADE of: (3 drugs here IDW)

Answer 38

Insulin warfarin digoxin

Question 39

comment: although appropriate, aggresssive glycemic control may be harmful potential harm: drug:

Answer 39

potential harm: hypoglycemia drug: insulin and sulfonylureas (CYP and plasma protein binding)

Question 40

potential harm: GI and intracranial bleeding comment: altough a risk drug, careful control of INR in therapeutic range tightly linked to risk/benefit ratio

Answer 40

drug: WARFARIN!! (S-warfarin & CYP2C9) note: S-warfarin = 2-5x more potent

Question 41

drug: potential harm: impaired cognition and heart block comment; may have 3rd line role in systolic heart failure, suboptimal choice for rate control in atrial fibrillation

Answer 41

drug: digoxin potential harm: i

Question 42

what does the mnemonic MASTER stand for? start low, go slow add one, take one away

Answer 42

M- minimize the number of drugs used A- alternatives should always be considered, especially non-drug therapies S-start low, go slow T- titrate therapy; adjust dose on an individual basis E- educate the pt and family; provide clear writen instructions R- review regularyy - remember that the older paiten will need closer monitoring

Question 43

which 3 drug classes will caused SIADH in old ppl? VPS

Answer 43

vinka alkaloids sulfonylureas psychotropics (SSRIs, TCA, haloperidol)

Question 44

what disease would most likely give rise to orthostatic hypotension in an elderly patient?

Answer 44

diabetes. why? think: peripheral neuropathy --\> alpha receptors on vasculature unable to respond to decrease in BP