Geriatrics

Question 1

what is the prescribing cascade

Answer 1

prescribe a drug that cuases a side effect and then prescribe more drugs for the side effects of that drug

Question 2

what is desprescribing

Answer 2

dose decrease or stopping meds

Question 3

risks of depresccribing

Answer 3

withdrawal

Question 4

benefit of deprescribing

Answer 4

decreased med burden, side effects, drug interactions

Question 5

which meds should you stop first

Answer 5

no indication and causing harm
no indication and limited benefit
benefit but unfavourable risk profile

Question 6

testing for orthostatic hypotension

Answer 6

drop in systolic 20mmhg or diastolic 10mmhg diastolic within 3 min of standing

Question 7

non pharms for low BP

Answer 7

avoid standing stilll for long period of time
stand up slowly with support
use a walker
replace fluids
raise head of bed while sleeping

Question 8

elderly bp target

Answer 8

150/90

Question 9

drugs that require tapering

Answer 9

opioids
benzos
antipsychotics
antidepressants
beta blocker

Question 10

harder to deprescribe whne

Answer 10

lack of patient buy in
short half life
longer duration
high dose

Question 11

criteria for deprescribing

Answer 11

> 65 T2DM

at risk of hypoglycemia, uncertain clinical benefit, or experiencing adverse effects

Question 12

who is at increased risk of hypoglycemia

Answer 12

had an event
frail
on sulfonylurea or insulin 
decreased renal function
drug interaction 
multiple comorbidities

Question 13

patients where clinical benefit lacking

Answer 13

frail elderly

dementia

Question 14

drug that increases sulfonylurea

Answer 14

TMPSMX

Question 15

elderly targets

Answer 15

<8.5%
<12mmol/L
end of life just avoid symptomatic hypo/hyperglyvemia

Question 16

switch glyburide to

Answer 16

gliclazide

Question 17

switch NPH insulin to

Answer 17

glargine

Question 18

drugs requiring dose decrease in impaired renal function

Answer 18

metformin

sitagliptan

Question 19

monitoring after deprescribing

Answer 19

BG levels more frequently 
if hypo deprescribe more (dizzy, weak)
if hyper go back up (increased thirst, headache)
resolution of AE
A1C every 3 months

Question 20

drugs causing hyperglycemia

Answer 20

thiazides
corticosteroids
tacrolimus, cyclosporine
atypical antipsychotics 
**when these meds stopped increased risk of hypo

Question 21

drugs causing hypoglycemia

Answer 21

alcohol
beta blocker - decreases ability to sense hypo
ACEi?
salicyalate?

Question 22

harms of hypo

Answer 22

seizure
falls
impaired physical and cognitive function
hospitalizaion

Question 23

how long to treat to prevent CV complications

Answer 23

5-10years

Question 24

symptoms of hypoglycemia

Answer 24

dizzy, weak
sweating
increased heart rate 
hunger
anxiety
confusion

Question 25

problem with dementia in diabetes

Answer 25

difficulty sensing hypoglycemia

Question 26

items of the edmonton frail scale

Answer 26

``` physically health functional independence medicaiton use cognition nutrition ```