Beers Criteria- Geriatric Meds

Question 1

ACE-I and K

Answer 1

hyperkalemia

Question 2

BB and AChE-I

Answer 2

Bradycardia

Question 3

CCB/nitrate/alpha-blocker

Answer 3

hypotension

Question 4

Diuretic and Diuretic

Answer 4

e-ltyle disturbance, dehydration, hypotenision

Question 5

Benzo, sedative hypnotic, GI antispasmodics, muscle relaxants, 1st generation antihistamines

Answer 5

sedation, confusion, falls, cognitive impairment

Question 6

Pharmacodynamics

Answer 6

“what drug does to the body”

Question 7

benzo, opioids, warfarin, dig ,anticholinergic’s

Answer 7

• increases SENSITIVITY in changes in receptor/affinity- pharmacodynamic

Question 8

BB and B- agonists

Answer 8

DECREASE sensitivity in changes in receptor/affinity- pharmacodynamic

Question 9

Change in homeostatic Response

Answer 9

orthostatic BP- decreases barorectpor response
NA and water conserve
mobility and balance issues

Question 10

Pharmacokinetics -Lipid Soluble drugs i.e. Diazepam

highly bound drugs i.e. phenytoin

Answer 10

stay in the body longer because there is increased body fat and decreased serum albumin

Question 11

pharmacokinetics-

Answer 11

what body does to the drug

ADME

Question 12

creatine clearance

Answer 12

volume of the body fluid from which the drug is removed per unit time
- lower muscle mass- low serum crt - Scr level round to 1.0 (not overestimatE)

Question 13

GI

Answer 13

increase stomach pH, decrease GI blood flow, slowed gastric emptying, GI tranist
decrease drug absorption, decrease first pass metabolism, rate of absorption prolonged
i.e. ulceration with ASA, NSAIDS, iron/b12/ca with achlorhydria

Question 14

Body Composition

Answer 14

decreased TBW, lean body mass, serum albumin, increase body fat
increases lipid soluble drugs and decrease water soluble
i.e. benzo like diazepam (lipid soluble high half life)
i.e. phenytoin (highly aluminum bound)

Question 15

Liver

Answer 15

decreased liver mass, liver flow, CYP enzymes
first pass effect increase high t1/2
i.e. morhpine, propranolol- first pass

Question 16

Renal

Answer 16

decreased GRF, tubular secretion, renal blood flow, renal mass

• renal emlimination of meds decreases, t 1/2 increases
  i. e. numerous drugs

Question 17

Strategies to increase adherence to meds

Answer 17

simplify dosing regimens
use pill box
have family/friends help
explain benefits to adherence
discuss SE in context of med benefits
use monitoring to motivate and educate
write clear written instructions
have pt carry list of medications
put indication on RX and label

Question 18

Types of Non-adherence to meds

Answer 18

intentional (se, lack of benefit)

unintentions (forgot, financial issues)

Question 19

bio-availability

Answer 19

fx of drug dose reaching systemic circulation

Question 20

metabolism

Answer 20

conversion of drug to pharmacological active or inactive compound.

Question 21

body compositiion in agigin

Answer 21

lean body mass, decrease serum albumin, increase body fat leads to
lipid soluble meds- long t1/2-benozo
or highly albumin bound drugs i.e. phenytoin (increase free fx)

Question 22

highly albumin bound drugs

Answer 22

phenytoin- increase free fx

Question 23

cr CL in elderly

Answer 23

lower muscle mass, lower serum level = Scr 1.0

Question 24

polypharmacy

Answer 24

> 6 meds- more medications than clinically necessary- increase risk of cognitive impairment, falls, functional status, costs

Question 25

non-adherence

Answer 25

half pts d/c tx after 6 months with statins | 50% of pts d/c anti-htn after 1 year

Question 26

sertraline, venlafaxine, paroxetine -non-adh

Answer 26

withdrawal syndromes with non-adherence

Question 27

atenolol- non-adh

Answer 27

1 missed dose - rebound HTN

Question 28

interventions to help with NON-adh

Answer 28

``` simply doses pill box for reminders enlist family, friends, community service benefits of adherence of regimen SE of medication education use of monitoring to motivate/edu clear written instruction carry list of meds indication of medication on RX and label ```

Question 29

PIM- NSAID, non-DHP CCB(verapamil, diltiazem), rosiglitazone

Answer 29

heart failure exacerbated AVOID

Question 30

PIM- AChE-I (donepezil), alpha blockers (doxazosin, terazosin, prazosin),TCA

Answer 30

ortho hypotension - AVOID

Question 31

PIM- anticholinergics, H2B, Benzo, Zolpidem

Answer 31

increase CNS AE- i.e. dementia nad cognitive impairment AVOID

Question 32

PIM- anti-psychotics, benzo, non-benzo, TCA, SSRI

Answer 32

ataxia, falls, syncope- AVOID if multiple falls and depression

Question 33

PIM- antimuscarinics for UI (oxybutynin, tolterodine), non-dhp CCB (verapamil, dilitazem), Anticholinergics, 1st gen antihistamines

Answer 33

add to chronic constipation | AVOID

Question 34

PIM- NSAIDS, triamterene

Answer 34

increase risk of kidney injury AVOID if CKD 4 or 5

Question 35

>80 YO avoid primary prevention

Answer 35

ASA

Question 36

PIM- antipsychotics, SNRI, SSRI< TCA, vasodilators

Answer 36

hyponatremia- monitor- see how quickly it drops if acute or chronic drop *can be used to their benefit if hypernatremia)

Question 37

start slow go slow

Answer 37

celexa 10mg Daily (with normal QT only) then increase if tolerated - no more FDA alert mirtazaine 7.5mg qhs increase to 15mg