GERI-RX Flashcards
(25 cards)
How was AGS BEERs criteria found?
MD Beers, started research and found inappropriate med. More people in SNF than acute care. Ask the questions? is this the right drug?
Mrs. Jones 75 yo complains of n/v since starting fuoresmide and her BP is still 150/85? What are concerns regarding absorption?
Absorption- dfx will lower the drug levels.
reduced stomach acidity
reduced gastric motility
reduced first pass biotransformation
reduced dermal absorption
What question should you ask Mrs. Jones?
Due to impaired absorption.
Ask about:
altered nutritional habits-less meals
increased use of OTCs, antacids, laxatives etc (block drug absorption)
Ms. Jones has lowered body water and higher body fat? What does this affect?
Distributions altered:
Dec msk
lipophilic drugs remain in fat longer
altered albumin levels -increased free drug levels
What is most important aspect of drugs and elimination?
***PA good at this OUR DUTY FOCUS DONT MULTITASK START LOW GO SLOW ALLERGY CREATINE CLEARANCE PREV DRUG PMH
This phase is ideal for elderly due to unaffected biotransformation?
PHASE II reactions
what are factors that DEC metabolism in elderly and IMC?
DEC capacity of Phase I (MFO) enzymes
decreased blood flow to the liver
nutritional deficiency alters liver function
What do CYP inhibitor due to drugs?
INC toxicity
What do CYP induces due to drugs?
DEC serum level
Faster clearance
How does the t1/2 affect the elders if their CC is decreased overtime?
Risk of accumulation and toxic
GFR dec w/ age
CC dec- creatine almost 100% cleared. IF creatine is high, then renal failure
How do you adjust dose if CC 50%?
50% reduced renal fx. if drug is 200mg/day Give 100/day Find chart in drugs or CC and dose Creatine Clearance- Crockcroft Gault wt, age, creatine- <28 Marked poor CC CC RI- Ideal 100mL/min is
What changes in receptor affinity in elderly can lead
to adverse response to CNS drugs?
Receptor affinity and/or receptor numbers can change
What are the ADR of Geriatrics that is important for HCP?
Elderly death nearly 20K/yr
- more drugs, Avg. 6-8 compared to younger population.
- Prescription errors due to lack of consideration of pharmacokinetic changes in the elderly.
- Multiple physicians treat same patient unaware of all the drugs
- INC OTC use
- drug compliance poor, more drugs less compliance
- INC dosing req = inc errors
- SNF 50% have and ADR, not legal or OK
What are the ideal Benzodiazepines?
Lorazapam and oxazepam
Other biotransformed into active metabolites which adds to potential of toxicity
SE of toxic- ataxia, falls, fractures.
Check Benzo dose
Which drugs should be avoided?
OPIOIDs
Which drug reduces clearance of LI?
thiazides-clothalidone
Be careful
Lot of drugs
What are newer less toxic CNS AchE inhibitors for Alzheimer’s?
Donepezil, rivastigmine and galantamine
Avoid azole with d/t CYP
What are cleared through renal mechanisms and CC dose adjustment is required?
beta lactams aminoglycosides- ototoxcity
nephrotoxicity-rise in CC
Gram neg- Ecoli., sepsis
IV, QD
Which drug causes osteoporosis which results in fractures?
Corticosteroids
Which drug cause cell necrosis in renal tubules may result from dec. production of prostaglandins (PGs)
and thus impairs kidney fx?
NSAIDs- act cyclooxygenase 1 and 2 (COX 1 &2) to block synthesis of inflammatory prostaglandins.
PGs- are potent vasodilators, lack of results in vasoconstriction which results in ischemia and cell death
use Tylenol
75-year old female who winters in Arizona from the mid-west. Presented with forgetfulness, intermittent disorientation, depression. She was weak and suffered palpitations. What is considered
DDX- digoxin toxicity
hyponatremia
hypokalemia
renal failure d/t NSAID
TX:
withdraw digoxin and ibuprofen
reduce diuretic
switch from aspirin to acetaminophen
When writing RX for elderly what should be considered?
1- lower cost alternative drugs- but SAFE
2- Caution stopping an antibiotic early
3- AVOID ADR. Integrate prescription drug choices with other HCP
4-Ask about CAM, still a drug. 70% of patients will not disclose taking
5- “Child proof” containers are often “patient proof”
6- Patients with tremor, arthritis, visual problems can not self-administer correctly.
7- 1 pill/day 1x/day co-ordinate their dosing requirements to reduce number of different times required.
Describe step to write a RX for elderly?
Ultimate responsibility is with the PA or MD who wrote the prescription.
1-“Start low and go slow” 1/2 the usual adult dose and titrate to the desired effect.
2-fewest and simplest dosing regimen.
3) Patient education dose
(4) income and limited or no insurance.
(5) Review patient’s drug list periodically/yr
(6) Provide patient with a portable prescription record to take to other physicians.
(7) Make home health aides aware of ADRs observed
What has a long t1/2, used for irregular HR, takes months to resolve especially with Increased body fat in geriatric patient? Takes long to reach steady state.
Amiodarone
ADRs d/t CYP enzymes
MAJOR DI- Warfarin
