Geriatrics

Question 1

What socioeconomic and physiologic factors make geriatric patients epsecially susceptible to adverse drug events?

Answer 1

frailty more common.
multiple diseases, nutritional problems, reduced financial resources, decreased dosing compliance, polypharmacy.
Average TN geriatric takes 43+ meds

Question 2

What is the purpose of the Beers criteria?

Answer 2

panel to determine suitability of drugs for use in elderly

Question 3

What qualifies as geriatric?

Answer 3

society says >65years

authority says > 75years

Question 4

What is used to measure frailty?

Answer 4

weight loss
exhaustion
weak grip
slow walk
low physical activity

Question 5

What are common causes of ADEs in old people?

Answer 5

unnecessary drug use, inappropriate drug choice, long term use W/O review, inappropriate dosing regimen, inappropriate dosing regiments, therapeutic duplication

Question 6

When should you suspect ADE drug effect in older patients?

Answer 6

if they become cognitively impaired, fall, or have N/V with weight loss

Question 7

What is Cockcroft-Gault equation?

Answer 7

form estimating GFR based on age and serum creatinine.
GFR = (114-.8xage)/serum creatinine
x0.85 for women

Question 8

Why doesn’t serum creatinine relfect decline in renal function in elderly?

Answer 8

because they also lose muscle mass and dont produce as much so levels stay same with loss of clearance and loss of production

Question 9

Which drugs have highest CNS access?

Answer 9

diazepam, nicotine, ethanol, phenytoin, heroin, phenobarbital

Question 10

What happens to gastric acidity with age? Gastric emptying and splanchnic blood flow?

Answer 10

all decrease. Low acidity changes absorption.

Slow emptying and low splanchnic blood flow affect 1st pass metabolism

Question 11

What happens to body fat levels and lean body mass in elderly?

Answer 11

fat increases, lean mass decreases changing the distribution pattern of drugs

Question 12

What happens to serum albumin in elderly?

Answer 12

decreases so less protein binding

Question 13

What happens to monoamine oxidase in elderly?

Answer 13

it increases

Question 14

What happens to acethylcoholine, dopamine and serotonin in elderly?

Answer 14

they all decrease

Question 15

What is a common new symptom when starting narcotics in elderly?

Answer 15

constipation

Question 16

What is a common new symptom when starting aminoglycosides in elderly?

Answer 16

renal failure, hearing loss

Question 17

What is a common new symptom when starting anticholinergics in elderly?

Answer 17

dry mouth, constipation, urine retention, delirium

Question 18

What is a common new symptom when starting antiarrhytmics in elderly?

Answer 18

diarrhea (quinidine); urine retention (disopyramide)

Question 19

What is a common new symptom when starting diuretics in elderly?

Answer 19

dehydration, hyponatremia, hypokalemia, incontinence

Question 20

What is a common new symptom when starting antipsychotics in elderly?

Answer 20

delirium, sedation, hypotension, extrapyramidal disorders

Question 21

What is a common new symptom when starting sedatives/hypnotics in elderly?

Answer 21

excessive sedation, delirium, gait trouble

Question 22

What drug will interfere with oral hypoglycemics, aspirins, and chloral hydrates?

Answer 22

warfarin. Will cause protein binding displacement

Question 23

What OTC used by elderly commonly will interfere with absorption of digoxin, isoniazid, and antipsychotics?

Answer 23

antacids

Question 24

What OTC used by elderly can alter the metabolism of propranolol or phenytoin?

Answer 24

cimetidine

Question 25

What common product causes increased bioavailabiliyt of DM, midazolam or imatinib?

Answer 25

grapefruit juice

Question 26

What must be avoided in elderly with glaucoma?

Answer 26

antimuscarinics

Question 27

What can cause acute decompensation if given to elderly with CHF?

Answer 27

BBs or verapamil

Question 28

What drug can cause heart block if given to elderly with conduction disorders?

Answer 28

TCAs

Question 29

What OTC can cause increased BP in elderly with HTN?

Answer 29

NSAIDs

Question 30

What drug can cause intermittent claudication in elderly with peripheral vascular disease?

Answer 30

BBs

Question 31

What drug can cause bronchoconstriction in elderly with COPD?

Answer 31

BBs

Question 32

What drugs can trigger acute renal failure in elderly with chronic renal impairment?

Answer 32

NSAIDs, contrast, aminoglycosides

Question 33

What drugs can worsen hyperglycemia in diabetics?

Answer 33

diuretics and prednisone

Question 34

What drug class will cause urinary retention in BPH patients?

Answer 34

antimuscarinics

Question 35

Can BBs sorsen depression?

Answer 35

yes. so can antiHTN, alcohol, BNZ, and steroids

Question 36

When is digoxin contraindicated?

Answer 36

hypokalemia. it will cause cardiac arrhtym

Question 37

In addition to antihistamines, what drug classes can also have anticholinergic activity?

Answer 37

antiparkinson agents - benzotropine, trihexyphenidyl skeletal relaxants - carisoprodol, cyclobenzaprine urinary incontinence agents - darifenacin, trospium Antidepressants - amitriptyline, doxepin antipsychotics - chlorpromazine, clozapine,

Question 38

What medication has high risk of prolong QT in elderly with dysrhythmias?

Answer 38

TCAs

Question 39

What drug has high risk of worsening hyponatremia?

Answer 39

SSRIs

Question 40

What drugs have high risk of syncope and falling in patients who already have orthostatic hypotension?

Answer 40

diuretics, a-blockers, vasodilators

Question 41

What drugs have high risk for worsening heart failure?

Answer 41

drugs with inotropic effects (disopyramide drugs with high Na content like bisphosphate, citrate or salicylate

Question 42

What are the preferred BNZs for elderly because they are less likely to cause falls?

Answer 42

alprazolam, temazepam and lorazepam because they are short acting

Question 43

What antidepressant should be avoided in elderly bcuase of its strong anticholinergic and sedative properties? What should be given instead?

Answer 43

amitriptyline makes you trip. | Give SSRI like citalopram or escitalopram instead

Question 44

What is disopyramide?

Answer 44

antiarrhythmic used to control v-fib. Works by inhibitng influx of Na through fast channels of mycaridal cells. significant anticholinergic properties that severely depress SA node so no net change in HR.

Question 45

ADE of disopyramide

Answer 45

strong anticholinergic effects so galucoma, excacerbation of BPH. Should be avoided in elderly. May induce heart failure becuase potent inotropic effects.

Question 46

What three drugs have been deemed too risky by the Beers criteria for elderly?

Answer 46

warfarin, digoxin and insulin