Geriatrics

Question 1

Unique population

Answer 1

different physiology - aging, disease, medications
chronic conditions - 76% of seniors (high multimorbidity)

Question 2

Frailty

Answer 2

increased vulnerability from age-associated decline
acceleration of gradual decrease in physiological reserve

Question 3

Geriatric Syndrome

Answer 3

a multi-factorial condition with interaction between stressors and age-related risk factors leading to organ system damage
comorbidities

Question 4

Potentially Inappropriate Medication

Answer 4

harm outweighs benefit
safer alternatives are available
ex. Proton pump inhibitor - long term use leads to decreased Ca2+ and B12 absorption

Question 5

Polypharmacy

Answer 5

use of 2+ drugs for same purpose

Question 6

Polypharmacy prescribing cascade

Answer 6

use of a drug to treat the adverse reactions of another drug

Question 7

Aging

Answer 7

organ system changes beginning in the 5th decade of life

Question 8

physiological changes

Answer 8

decreased tissue/organ functioning leads to changes in pharmacodynamics and pharmacokinetics

Question 9

body composition

Answer 9

decreased muscle mass, increased fat mass

Question 10

cardiovascular

Answer 10

decreased cardiac output, decreased beta sensitivity

Question 11

renal

Answer 11

decreased GFR, decreased nephrons
changes lead to the majority of drug dosage adjustments

Question 12

GI

Answer 12

decreased H+, increased gastric emptying time

Question 13

hepatic

Answer 13

decreased size, decreased blood flow

Question 14

nervous

Answer 14

decreased blood flow to CNS

Question 15

endocrine

Answer 15

decreased hormonal secretions

Question 16

absorption

Answer 16

GI - delay in absorption and active transport
intramuscular, topical - concern in sedentary patients
absorption rate usually stays the same, affected only by medications

Question 17

distribution

Answer 17

decreased body water = decreased VOD for hydrophilic drugs
increased fat mass = increased VOD for lipophilic drugs

Question 18

metabolism

Answer 18

decreased first pass metabolism (phase I)
drugs metabolized by phase II are preferred
phase I metabolized drugs = decrease dose

Question 19

elimination

Answer 19

delayed elimination of renally eliminated drugs

Question 20

pharmacodynamics

Answer 20

change in receptor responsiveness = increased sensitivity to drugs

Question 21

CNS effects

Answer 21

neuronal loss, receptor down regulation
central anticholinergics, stimulants

Question 22

postural control effects

Answer 22

decreased dopamine receptors on striatum
antipsychotics

Question 23

movement effects

Answer 23

tardive dyskinesia, decreased dopamine neurons
antipsychotics

Question 24

blood pressure effects

Answer 24

orthostasis: hypotension from standing
blunting of beta response
antipsychotics, diuretics

Question 25

cardiovascular effects

Answer 25

arrhythmias from cardiac hypersensitivity

Question 26

coagulation effects

Answer 26

anticoagulation from poor hepatic production anticoagulants, thromolytics

Question 27

visceral muscle effects

Answer 27

visual disturbances, bladder instability anticholinergics

Question 28

temperature effects

Answer 28

poor thermoregulation CNS meds