Flashcards in Geriatric Polypharmacy Deck (19):
1. What is the definition of polypharmacy?
2. The ore medications the patient takes the more what?
1. Polypharmacy = 4 or more medications
2. The more medications the patient takes, the greater the chance of having an adverse drug event
Examples of adverse drug events (most common)? 4
Most common causes of death from adverse drug reactions? 3
2. Orthostatic hypotension
3. Heart failure
Most common causes of death from adverse drug reactions
1. GI bleeding,
2. intracranial bleeding and
3. renal failure
Most common drugs associated with adverse events
How drug metabolism differs in the older adults
1. Liver changes? 2
2. Which drugs require smaller doses? 3
3. How do the kidneys change?
-Hepatic blood flow decreases by 40%
-Decreased first pass metabolism
-opiates require smaller doses
-Renal blood flow can decrease by about half at 80 years of age
How drug metabolism differs in older adults. How do the following affect metabolism:
1. Decreased lean body weight to body fat ratio?
2. Decreased serum protein?
3. Substance abuse?
1. Alters the distribution of drugs in body compartments
2. Drugs that are protein bound are now free to act resulting in a small dose needed for the desired effect
3. 10% are problem drinkers
-Can cause a change in drug metabolism
Some examples of drugs that are protein bound?
Medication review and reconciliation at each visit
Include drug reaction in your DDx for new complaints
Be familiar with what tools for this? 3
1. Be familiar with the Beers criteria
Screening tool of older persons’ potentially inappropriate prescriptions
Screening tool to alert prescribers to right treatment
Beers criteria for potentially inappropriate medication use examples
1. Nitrofurantoin (Macrobid)
2. Digoxin in doses > 125 mcg
3. Sliding scale insulin
5. Non-Cox-selective NSAIDs
Why are these potentially dangerous for the elderly:
1. Nitrofurantoin (Macrobid)? 2
2. Digoxin in doses > 125 mcg? 1
3. Sliding scale insulin? 1
4. Sulfonylureas? 1
5. Non-Cox-selective NSAIDs?
2 (what can you use to decrease these risks? 2)
-Potential for pulmonary toxicity
-Lack of efficacy with CrCl less than 60 ml/min due to inadequate drug concentration in the urine
2. Increased risk of toxicity, due to decreased renal clearance and decreased protein binding
3. Higher risk of hypoglycemia without improvement of hyperglycemia management
4. Glyburide – prolonged hypoglycemia
-Increased risk of GI bleeding,
-PUD. (Use of PPI or misoprostol decreases risk)
Drugs that may worsen constipation
1. Antimuscarinics for urinary incontinence (Oxybutynin, tolterodine and 4 others…)
2. Nondihydropyridine calcium channel blockers (Verapamil, Diltiazem)
3. First generation antihistamines
Use cautiously in older adults
1. May cause SIADH or
2. exacerbate underlying syndrome
Inappropriate Drugs in the Elderly
1. Diphenhydramine (Benadryl)
2. Amitriptyline (Elavil)
3. Alprazolam (Xanax)
4. Diazepam (Valium)
5. Chlorpropamide and Glyburide (1st gen. sulf)
6. Digoxin in doses > 0.125
7. GI antispasmodics
(Belladonna, dicyclomine, hyoscyamine)
8. Meperidine (Demerol)
9. Methyldopa (Aldomet)
Why should this definitely be avoided in older adults?
1. Dry mouth, confusion, urinary retention, constipation
2. Source of in-hospital morbidity/delirium
3. Is in many OTC products for sleep/URI/allergy
Why should Digoxin be avoided in the elderly? 2
What dosing is adequate for older adults?
1. can cause anorexia, confusion even at therapeutic drug levels
2. Renal excretion can change over time as age-related renal function declines.
0.125mg/day most often adequate
START: Most common omissions? 4
1. statins in atherosclerotic disease (26%)
2. warfarin in chronic atrial fibrillation (9.5%)
3. anti-platelet therapy in arterial disease (7.3%)
4. calcium/vitamin D supplementation in symptomatic osteoporosis (6%)
1. Don’t use __________ as first choice to treat behavioral and psychological symptoms of dementia
2. Avoid using medications to achieve A1C less than ____% in most adults ≥ 65
3. Don’t use _____________ or other sedative hypnotics in older adults as first choice for insomnia, agitation or delirium
Don’t prescribe what for dementia without periodic assessment for perceived cognitive benefits and adverse GI effects?
Avoid using prescription what for treatment of anorexia or cachexia in older adults? 2
Don’t prescribe a medication without conducting a medication review
1. appetite stimulants or
2. high-calorie supplements