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Pharm II Exam 4 > Geriatrics > Flashcards

Flashcards in Geriatrics Deck (29):
1

What conditions can present atypically w/ confusion in older adults?

Acute MI
CHF
URI
UTI

2

Older adults w/ a GI bleed can present atypically w/ ___

AMS

3

Describe medication use among older adults

OTC med use = 46%

Herbal & dietary = 38-49%

Sharing meds = 13-20%

4

Define polypharmacy

Either the concomitant use of multiple drugs OR the administration of more meds than are indicated

5

What % of prescription drugs is consumed today vs in the future?

Today = 33%

By 2040, will be 50%

6

Which population is at greatest risk for taking multiple meds?

Nursing home living elders

(7-9 different meds/day)

7

In nursing homes, how much is spent on ADEs for every $1.00 spent on med?

$1.33

8

What are predictors of ADEs?

≥ 6 concurrent chronic conditions

≥ 9 meds

≥ 12 doses of drugs/day

Prior ADE

Low body weight / BMI

≥ 85 yo

CrCl < 50

9

What are the most common meds involved in ADEs?

CV

Diuretics

NSAIDs

Hypoglycemics

Anticoagulants

Meds w/ narrow margin of safety

10

What % of all prescribed meds are estimated to be inappropriately selected or dosed?

25%

11

What % of all meds for older people is considered unnecessary?

30%

12

What criteria is used for potentially inappropriate medication in older adults?

Beers

13

According to the beers criteria, what drugs are commonly used inappropriately?

Antihistamines
Anticholinergics
GI/antispasmotics
Antipsychotics
Benzos
TCAs
Sedatives/hypnotics
Anticoagulants/antiplatelets

14

What does the beers criteria say about first-gen antihistamines?

clearance reduced w/ advance age

risk of tolerance, confusion, dry mouth, & constipation

Therefore they should be avoided in older adults

15

How does body composition change in older adults?

↓ Total body water
↓ Lean body mass
↑ Body fat
↔ or ↓ Serum albumin
↑ α1-Acid glycoprotein

16

What changes in the CV system are seen in older adults?

↓ CO

↑ SVR w/ loss of arterial elasticity & dysfunction of systems maintaining vascular tone

17

What change in the endocrine system is seen in older adults?

Altered insulin signaling

18

What changes in the GI system are seen in older adults?

↓ Motility of the large intestine

↓ Vitamin absorption by active transport

↓ Splanchnic blood flow

↓ Bowel surface area

19

What changes in hepatic system are seen in older adults?

↓ Hepatic size

↓ Hepatic blood flow

↓ Phase I (oxidation, reduction, hydrolysis) metabolism

20

What change in the pulmonary system is seen in older adults?

↓ Respiratory muscle strength

21

What oral change is seen in older adults?

Altered dentition

22

What renal changes are seen in older adults?

↓ GFR
↓ Renal blood flow
↓ Filtration fraction
↓ Tubular secretory function
↓ Renal mass

23

What skin change is seen in older adults?

Thinning of stratum corneum

24

What is the action of phase I pathways?

Convert drugs to metabolites w/ pharmacologic effects than parent compound

*CYP3A4 is involved in 50% of drugs on the market

25

What is the action of phase II pathways

Conjugate drugs to inactive metabolites that do not accumulate

*Less affected w/ age

26

Does SCr reflect CrCl in older adults?

HELL NAH

27

What is the "screening tool to alert doctors to the right treatment criteria" focused on?

identifying undertreatment of prescribing omissions in elderly

28

Describe the prescribing cascade

Drug 1 (metoclopramide) --> ADE (parkinsonism) --> misinterpretation as a new condition --> Drug 2 (CCB & antiparkinsonism) --> ADE (peripheral edema) --> misinterpretation as a new condition --> Drug 3 (diuretics)

29

What are common food interactions?

Dairy
Coffee/tea
Grapefruit
Alcohol
Charcoal-broiled
Green leafy veggies
Licorice
Ginseng