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Intro to D&D Midterm > Geriatrics Part 2 > Flashcards

Geriatrics Part 2 Flashcards

1
Q

when pharmacokinetic changes do not explain alterations to a drug response in a geriatric patient, what changes are assumed?

A

pharmacodynamic changes

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2
Q

which changes with aging are better understood – pharmacokinetics or dynamics?

A

pharmacokinetic changes are better understood

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3
Q

which are more VARIABLE -pharmacokinetic or dynamic changes with age?
explain

A

pharmacodynamic changes are more variable

changes in the:
-number of receptors
-sensitivity of receptors
-counter regulatory mechanisms

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4
Q

give an example of drug receptors that INCREASE sensitivity with age

A

benzodiazepines and CNS depressants

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5
Q

give an example of drug receptors that DECREASE sensitivity with age

A

beta-adrenergic receptors

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6
Q

geriatrics have _____ baroreceptor sensitivity

explain

A

decreased

leads to orthostatic hypotension - low Bp when standing and baroreceptors are not as sensitive - increases fall risk

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7
Q

name 3 drugs that can enhance the issue of orthostatic hypotension in elderly patients

A

tricyclic antidepressants
vasodilators
antihypertensives

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8
Q

antipsychotics in elderly patients increases the risk of what?
is this a pharmacokinetic or dynamic effect?

A

increased risk of tardive dyskinesia and parkinsonism (rapid sudden movements)

pharmacodynamic

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9
Q

true or false

elderly patients have a decreased sensitivity to anticholinergic effects

A

FALSE - increased sensitivity

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10
Q

elderly patients have ____ sensitivity to warfarin

A

increased (bc less albumin - more free drug)

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11
Q

true or false

geriatrics have increased sensitivity of Na+, K+, ATPase

A

true

leads to increased toxicity to digoxin especially with low potassium

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12
Q

explain the elderly response to ACE inhibitors and ARBS (angiotensin receptor blockers)

A

decreased response to them bc of decreased renin and aldosterone levels

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13
Q

geriatrics have an increased risk of hyperkalemia with what drugs?

A

NSAIDS
ACE inhibitors and ARBS (bc decreased response to them)
potassium sparing diuretics (spiranolactone)

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14
Q

explain how evidence-based prescribing is an important consideration in the older population

A

need to see what research has been done on the very old

not a lot of clinical trials on very old people

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15
Q

what is the saying for dosing an elderly patient on medication

A

start low, go slow, but don’t stop too soon

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16
Q

a specific issue in older adults is whether or not we should bother treating a certain condition

give an example of this

A

treating dyslipedemia (high cholesterol) for primary prevention

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17
Q

name 2 diseases that we treat less intensively in older adults

A

diabetes - don’t NEED below 7 A1C
hypertension - don’t treat too much - risk of orthostatic hypotension and falls

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18
Q

as time goes on, care changes from ____ to ____

A

curative to palliative

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19
Q

as care changes from curative to palliative, what happens to the amount of appropriate medications?

A

decreases

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20
Q

_______ side effects are of particular concern in the elderly

A

anticholinergic

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21
Q

what is the AGS Beers Criteria?

A

a list of potentially inappropriate medications for use in older adults

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22
Q

how many tables are in the 2023 updated Beers Criteria?

A

7

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23
Q

what medications are on table 2 in the Beers criteria

A

medications/classes that should be AVOIDED in persons 65 or older

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24
Q

what medications are on table 3 of the beers criteria

A

meds that should be avoided in older person with specific disease/syndrome

drug-disease interactions

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25
what meds are on table 4 of beers criteria
meds that should be used with CAUTION in older adults not enough info to be put on 2 or 3, but on radar
26
what meds are on table 5 of beers criteria
potential important drug-drug interactions to avoid in geriatrics
27
what meds are on table 6 of beers criteria
meds that should be avoided/lower dose in older people with decreased renal function
28
what is on table 7 of beers criteria
meds with strong anticholinergic properties
29
what is the fall risk factor that is most preventable and reversible?
medication use
30
why are alpha blockers avoided in elderly? name 2
increases fall risk terazosin and doxasozin
31
true or false diuretics can increase fall risk
true - have to pee more, have to stand up fast, run to bathroom and fall
32
____ or more CNS depressants can increase fall risk
3
33
can antidepressants increase fall risk
yes
34
say the pneumonic to remember anticholinergic side effects
dry as a bone dry eyes, mouth full as a flask constipation, urinary retention blind as a bat mad as a hatter delirium tachycardia
35
what can drugs with anticholinergic side effects do to heart rate
increase
36
name 3 classes of drugs with strong anticholinergic properties what Beers table are they on?
table 7 1st generation antihistamines (anything "pm" in OTC aisle) phenothiazines tricyclic antidepressants
37
name 3 skin and connective tissue diseases commonly seen in geriatrics
arthritis gout glaucoma
38
which type of arthritis is most common in older adults?
osteoarthritis rheumatoid starts younger and is more systemic
39
how are medications related to arthritis?
NSAIDS and opioids can cause/worsen arthritis in elderly patients that's why diclofenac is preferred as an NSAID bc it has no systemic side effects when applied topically
40
when an elderly patient has gout, what is an important consideration?
possible renal issues
41
name an issue with antibiotics in older adults
renal function is a big consideration in antibiotics renally excreted
42
name the 3 most common infections in geriatrics
UTI pneumonia skin infections
43
what symptoms may a geriatric patient experience when they have a UTI?
atypical symptoms like confusion and falls their sensation for burning is not as strong
44
what symptoms may a geriatric patient experience when they have pneumonia?
not typical symptoms like cough may have similar to UTI like confusion and falls
45
why are skin infections 1 of the 3 most common infections in geriatrics
elderly have thin skin
46
what is the GOAL blood pressure for geriatric patients why?
130/80 or less than 130, but not too low - concern with orthostatic hypotension
47
what blood pressure medications should be avoided in geriatrics and why
alpha blockers - fall risk (terazosin/doxasozin) beta blockers (for LONE htn) can be used if for afib
48
name 4 favored agents for HTN for older adults
low dose diuretics ACE inhibitors ARBS ca channel blockers (amlodipine)
49
what is a side effect of calcium channel blockers that is a concern with the elderly
ankle swelling
50
what is the most costly medicare diagnosis in the US
heart failure
51
explain the treatment guidelines for heart failure for elderly patients vs younger patients
essentially the same - want to balance fluid overload vs dehydration
52
in treating a heart failure patient, what are important things to monitor?
renal function and potassium levels
53
what is a drug that is not 1st line for HTN
digoxin have to monitor for toxicity - especially if low potassium - binds to same receptors visual changes, nausea, anorexia, confusion
54
true or false digoxin is renally eliminated
true
55
true or false anticoagulants are contraindicated in the elderly
FALSE - age is not a contraindication
56
in afib, an important consideration is controlling ____ vs controlling ____
rate vs rhythm
57
in AFIB patients, anticoagulants are used to prevent stroke which drugs are preferred
DOACS (direct oral anticoagulants) over warfarin
58
why is treating dyslipidemia not really done in the elderly
few studies risk-benefit for primary prevention: side effect of statins is muscle pain and this increases fall risk
59
true or false aspirin should be avoided for primary prevention in people over 60
TRUE - not secondary prevention tho (already had heart attack/stroke) risk for bleeding
60

Intro to D&D Midterm (29 decks)

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