Geriatrics Flashcards Preview

Pharmacology > Geriatrics > Flashcards

Flashcards in Geriatrics Deck (46):
1

Main challenges in elderly

multiple co-morbidities, polypharmacy, compliance, cost, new drugs

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Leading causes of mortality

CVD, CA, respiratory

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Leading causes of morbidity

arthritis, HTN, hearing loss, heart disease

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Gastrointestinal changes w/ elderly

inc stomach pH, dec blood flow, slowed gastric emptying

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Skin changes w/ aging

thinning of dermis, loss of SQ fat

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Body composition changes w/ againg

decreased total body water, decreased lean body mass, body fat percentage changes

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Liver changes w/ aging

dec liver mass, dec blood flow, dec or no change to CYP 450

8

Renal changes w/ aging

dec glomerular filtration rate, dec blood flow, dec tubular secretion, dec mass, dec functional nephrons

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Absorption problems

rate of absorption decreased, little change in extent of absorption

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Decreased body water causes

higher drug concentrations and affects hydrophilic drugs

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Decreased lean body mass effects

lipid soluble drugs increased half-life

12

Decreased plasma protein effects

highly protein bound drugs increased free fractions

13

Effects of metabolism changes

reduction in first-pass metabolism, phase II metabolism is less affected by age

14

limitations in measuring CrCl

not everyone has decline in renal function, muscle mass reductions

15

Pharmacodynamic changes

reduced sensitivity to B-adrenergic stimulation, impaired baroreceptor reflex, more sensitive to antagonism of cholinergic receptors, CNS disorders, increased effects on some meds

16

CNS changes w/ aging

volume loss, slower processing, more activation required more simple tasks, dopaminergic decrease, serotonergic changes with depression, memory and cognition changes, sympathetic outflow increased

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Drugs that affect bone and muscle integrity

glucocorticosteroids, PPIs, phenytoin

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Drugs that affect balance

sedative hypnotics, antiHTN, long T1/2 or large dose benzos, TCAs, antipsychotics, anticonvulsants

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Drugs that affect mental state

anticholinergics, benzos, pentazocine, muscle relaxants, TCAs, amitryptyline, antispasmodics, diphenhydramine, antihistamines

20

Drugs that affect emotional state

methyldopa, reserpine, anastrozole, interferon a-2b, tamoxifen

21

Drugs that affect continence

anticholinergics, a-blockers, a-agonists, alcohol, acetylcholinesterase inhibitors, diuretics

22

Prescribing in the elderly

start w/ low dose, avoid starting multiple agents at same time, reach therapeutic dose before switching agents, consider non-pharm approaches

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Enhancing medication adherence

limit prescribing newer, expensive drugs, simplify regimen, pill organizers, educate pt on benefits, assess appropriateness of meds

24

Causes of constipation

dietary, failure to heed reflex, impaired physical mobility, disease, age, drugs

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Drugs that cause constipation

analgesics, antacids, anticholinergics, antidepressants, verapamil, clonidine, iron

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Non-pharm treatment

fluid, fiber, fitness

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Bulk laxatives

psyllium (Metamucil), Methylcellulose (Citrucel), Polycarbophil (Fibercon) -1250 mg PO 1-4/day

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MOA of bulk laxatives

increase bulk volume and water content of stool, stimulating peristalsis and decrease colonic transit time; 12-72 hr onset

29

Pearls of bulk laxatives

must have adequate fluid intake, not good for bed ridden pts or opioid induced, great for chronic management, as good as stool softener

30

Surfactant/emollient

Docusate (Colace)- 100 mg PO BID

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MOA of surfacant/emollient

decrease fecal surface tension, stool softener

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Pearl of surfacant/emollient

onset- 24-72 hr, mostly PO, sometimes enema, combo (senna- Peri- colace), very safe, OTC

33

Saline laxatives (Cathartics)

magnesium citrate (300 ml), Magnesium hydroxide (MOM, 30 ml), sodium bi/phosphate (Fleets phospho-soda), fleets enema

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MOA of saline laxatives

draws fluid into colon and stimulates activity

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pearls of saline laxatives

onset- 30min-3 hr, great for acute, avoid in pt w/renal disease, citrate and fleets used for prep (green bullet)

36

Hyperosmotics

glycerin- infants, lactulose (Chronulac)- chronic, liver failure, polyethylene glycol (Miralax), polyethylene glycol-electrolyte solution (GoLytely)

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Stimulants

bisacodyl (Ducolax)- 5-15 mg po, Senna (senokot), castor oil

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MOA of stimulants

irritates nerves in colon, stimulates motility

39

Bisacodyl mostly used

for short term, once daily if chronic, OTC, also prep

40

Senna used for

opioid induced constipation, OTC

41

Lubricants

mineral oil, lubricates intenstine, decreases water absorption, onset 6-8 hrs, not used often

42

Laxative ADRs

abd cramping, bloating, flatulence, distension, diarrhea, saline lxatives can cause diuresis, dehydration, electrolyte imbalances, bulk lax can cause GI obstruction

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General treatment guideline for constipation

first bulk-forming, surfactant/emollient or lubricant, saline cathartic, hyperosmotic agent, then stimulant

44

Special populations

elderly-docusate, lactulose, fiber, pregnancy-fiber, children- glycerin suppositories, polyethylene glycol, diabetics- metoclopramide, stimulant, post op- MOM, maybe stimulant

45

Restless leg syndrome non-pharm

avoid EtOH, tobacco, Fe, avoid drugs that alter serotonin, follow regular sleep patterns, exercise, avoid prolonged sedentary activities, stretch, massage leg

46

RLS pharm approach

dopaminergic agents, give before bed, levodopa/carbidopa- may be best option, dopamine agonists (Pramipexole (Mirapex), Ropinirole (requip)), sedatives, hypnotics, anticonvulsants, opioids