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CDM 1 Exam 1 > Geriatrics Info > Flashcards

Geriatrics Info Flashcards

1
Q

4 areas of Cardiovascular Aging

A

Electrical Conduction
Hypertrophy
Ischemic Area
Fibrosis

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2
Q

Cardiovascular Aging: Vasculature

A

Blunted Baroreceptor Reflex

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3
Q

Cardiovascular Aging: Heart Rate

A

Decreased maximum HR, resting HR stays the same

Decreased sensitivity to Beta Stimulation (ie Beta blockers)

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4
Q

Cardiovascular Aging: Orthostatic Hypotension

A

More susceptible to it occurring

Diuretics and Alpha Blockers can increase chances

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5
Q

Cardiovascular Aging: HFpEF

A

Want to be careful treating, don’t want to drop blood pressure too much

Systolic hypertension

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6
Q

Cardiovascular Aging: Bradycardia

A

Exercise Intolerance

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7
Q

Respiratory Aging: Increased….

A

Energy of breathing
Airway Resistance
Dead Space

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8
Q

Respiratory Aging: Decreased….

A

Respiratory muscle strength
Total alveolar surface
Vital capacity

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9
Q

Gastrointestinal Aging: Esophagus & Stomach

A

Decreased Taste sensation
Dysphagia (discomfort swallowing)/Aspiration
GERD
Decreased gastric acid secretion

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10
Q

Gastrointestinal Aging: Small intestine & Colon

A

Decreased absorption of calcium, folic acid, vitamin B12

Nutrient depletion
diverticulosis
Constipation
Incontinence

Slow transit time & increased water reabsorption

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11
Q

Renal Aging: Functional Changes

A

Decreased Glomerular filtration rate

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12
Q

Renal Aging: Hormone Effects

A

Decreased response to Aldosterone and ADH

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13
Q

Genitourinary Aging: Bladder/Urethra Increased….

A

Residual urine volume

Activity of detrusor muscle

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14
Q

Genitourinary Aging: Bladder/Urethra Pathophysiology…

A 
Urinary frequency (overactive bladder)
Urinary retention/obstruction
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15
Q

Genitourinary Aging: Women

A

Menopause:
Decreased estrogen
Ovaries, uterus, vagina atrphy

Vaginal Changes:
Decreased Lubrication

Pathophysiology:
UTI & Dsypareunia (pain during sexy time)

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16
Q

Genitourinary Aging: Men

A

Pathophysiology:

BPH and ED

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17
Q

Genitourinary Aging: Sex

A

Old people be fuckin

Risk for STDs and HIV/AIDS

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18
Q

Cause of aging of skin?

A

Loss of interdigitations between epidermis and dermis leading to ease of tearing or breakdown

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19
Q

Sensory Aging: Vision (Lens)

A

Increased Opacity, Sensitivity to glare

Decrease Elasticity

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20
Q

Sensory Aging: Vision (Pathophysiology)

A

Light/Dark adaptation
Accommodation/presbyopia
Contrast sensitivity
Depth perception

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21
Q

Sensory Aging: Hearing (Pathophysiology)

A

Hearing loss (high pitch and background noise)
Vertigo
Cerumen (earwax) impaction

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22
Q

Ototoxic drugs….

A

Amino-glycosides
High dose salicylates (Super high aspirin dose)
Diuretics (Furosemide)

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23
Q

Skeletal Aging: Changes

A

Decreased bone mass and density

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24
Q

Skeletal Aging: Pathophysiology

A 
Osteoporosis
Arthritis
Gait Changes
Loss of Balance
Falls
Fractures
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25
Q

Pharmacokinetics: Absorption info

A

Potential for DELAY in absorption, but no significant change in EXTENT of absorption for most drugs

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26
Q

Pharmacokinetics: Absorption Exceptions

A

Increased Gastric pH:
decreased absorption of acid-dependent drugs (calcium carbonate)

Drug-Induced changes:
pH (PPI, Antacids)
Gastric motility/emptying (opioids/anticholinergics)

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27
Q

Aging effect on body composition

A

decrease total body water and lean body mass

increase body fat

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28
Q

(Geriatrics) Pharmacokinetics: Distribution of Hydrophilic drugs

A

Decreased Vd
Increase plasma conc
greater swing within the dosing interval

examples: ethanol, lithium, aminoglycosides

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29
Q

Pharmacokinetics: Distribution of Lipophilic drugs

A

Increased Vd
Half-life increase
Duration of therapeutic and toxic effects increase

Examples: diazepam, phenothiazine, phenytoin, benzos

30
Q

Decreased Vd can be further impacted by drugs that…..

A

affect extracellular water

31
Q

Pharmacokinetics: Distribution (protein-binding)

A

decrease albumin
increase % of unbound or free drug

Age-related decrease is modest but important in chronically ill or malnurished

32
Q

Pharmacokinetics: Distribution (protein-binding) Clinically significant interactions

A

Highly protein bound drugs

Example: Warfarin, phenytoin, benzos

33
Q

Which CYP inducers/inhibitors do you have to be careful with?

A

CYP450

34
Q

(Geriatrics) Pharmacokinetics: Metabolism

A

1st pass metabolism decreased due to decreased hepatic blood flow and mass

decrease dose of drugs with high hepatic extraction and consider efficacy of prodrugs

35
Q

Pharmacokinetics: Metabolism (Phase I metabolism)

A

decrease clearance and increase half life

should decrease dose and adjust based on patient

Drugs metabolized by Phase II preferred

36
Q

Drugs undergoing first pass have….

A

higher bioavailability

37
Q

(Geriatrics) Prodrugs will have…..

A

lower bioavailability

38
Q

Pharmacokinetics: Excretion (reduction in GFR)

A

CrCL may not be accurate

Check product labeling to determine use of CrCL or eGFR

39
Q

(Geriatrics) Pharmacokinetics: Excretion (Drugs & Excretion)

A

decreased clearance and increased 1/2 life for drugs with renal elimination and active metabolites

40
Q

Most significant age-related change in Pharmacokinetics?

A

Decreased renal clearance, accounts for majority of necessary dose adjustments

41
Q

Renal Aging: CrCL

A

Estimated using Cockroft-Gault
Used for Drug dosing most drugs
Overestimate due to frail, reduced muscle mass patients

42
Q

Renal Aging: GFR

A

estimated using MDRD
Stages CKD
Drug dosing of new drugs
Underestimates heathy patients

43
Q

Which drugs show increased sensitivity and side effects?

A

Centrally-acting drugs

Benzo
Opioids
Alcohol
Neuroleptics
Anticholinergics
H1-antihistamine 1st gen
44
Q

Pharmacologic effects: Beta Blocker

A

Decreased response

45
Q

Pharmacologic effects: Warfarin

A

Increased risk of bleeding

46
Q

Pharmacologic effects: Cardiac Drugs

A

increased risk of orthostatic hypertension

47
Q

Pharmacologic effects: Diuretics

A

Decreased effectiveness

48
Q

ADLs

A

Activities of Daily Living

Bathing
Transfers
Eating
Dressing
Toileting
Ambulation
49
Q

IADLs

A

Instrumental ADLs

Shopping
Cooking/Cleaning
Using phone or transportation
Managing money and medications

50
Q

Prescribing Cascade

A

Treating side effects of the previously prescribed drug

“Research shows that any symptoms in an elderly person should be considered an adverse effect until proven otherwise”

51
Q

STOPP vs START

A

STOPP: Potentially inappropriate/duplication of therapy
Drugs you want to stop due to poly pharmacy

START: Omission of therapy
Drugs that you want to consider to start prescribing/using

52
Q

AGS Beers Criteria: Sedating Antihistamines

A

1st Gen antihistamines

Potential harm (highly anticholingeric and reduced clearance in older patients)

Exceptions: Benadryl used for allergic reactions

Extra: Tolerance develops when used as a hypnotic

53
Q

AGS Beers Criteria: PPIs

A

Conditions: Avoid use > 8 weeks
Potential Harm: C.Dif infection, bone loss/fractures

Exceptions:
Chronic NSAID or corticosteroid use
Erosive esophagitis
Failure of drug discontinuation or H2 blocker trial

54
Q

AGS Beers Criteria: Cardiovascular Drug (Digoxin)

A

conditions:
used 1st line for HF or rate control fib
want doses <125mcg/day

Potential Harm:
higher doses have no added benefit, just toxicity
other agents have evidence of mortality and hospitalization benefits in HFrEF

55
Q

AGS Beers Criteria: Cardiovascular Drug (Alpha blockers)

A

Conditions: when used for treatment of hypertension

Potential Harm: Orthostatic hypotension = high risk

56
Q

AGS Beers Criteria: Benzos

A

Rationale:
Increased sensitivity and decreased metabolism

Potential Harm:
Cognitive impairment, delirium, falls/fractures

Exceptions:
Seizes disorders, REM sleep behavior disorder, ethanol withdrawal and severe anxiety

57
Q

AGS Beers Criteria: Tricyclic Antidepressants

A

Potential Harm:
Highly Anticholinergic
Sedating
Orthostatic Hypertension

58
Q

AGS Beers Criteria: HF

A

Med: All NSAIDs
Harm: Fluid retention may exacerbate HF

59
Q

AGS Beers Criteria: Chronic Kidney Disease

A

Med: All NSAIDs
Harm: May cause acute kidney injury or worsen renal function

Med: H2 Blockers
Harm: May need to reduce dose if CrCl < 50ml/min

60
Q

AGS Beers Criteria: Delirium

A

Med: H2 Blockers
Harm: May cause or increase confusion

61
Q

AGS Beers Criteria: Dementia

A

Med: Anticholinergics
Harm: Adverse CNS effects

62
Q

Medication Appropriateness Index

A

Bunch of questions about the medication

Ranging from safety, to correct dosage/instructions/to cost compared to other options

63
Q

Medication Review

A

Dosing: Start Slow, Go Slow, But go

Monitoring: Meds that are no longer needed

Consider medications individually and within the big picture

64
Q

Elder Abuse Characteristics

A

more common females
often family member
not just physical

65
Q

Physical Elder abuse

A

Intentional use of physical force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, distress, or death

66
Q

Sexual Elder abuse

A

Forced and/or unwanted sexual interaction (touching and non-touching acts) of any kind with an older adult

67
Q

Psychological or Emotional Elder Abuse

A

Verbal or nonverbal behavior that results in the infliction of anguish, mental pain, fear, or distress

68
Q

Financial or Exploitation Elder Abuse

A

Illegal, unauthorized, or improper use of an older individual’s resources, for the benefit of someone other than the older individual

69
Q

Intentional Elder Neglect

A

Failure to protect an elder from harm or to meet needs for essential necessities of life which results in a serious risk to health and/or safety

70
Q

Unintentional Elder Neglect

A

Failure to meet needs due to ignorance or infirmity

71
Q

Self Elder Neglect

A

Older adult fails or refuses to address their own basic physical, emotional, or social needs in a way that threatens his/her own health and safety

CDM 1 Exam 1 (14 decks)

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