Intro to Geriatrics - Block 4

Question 1

How do you assess geriatric status?

Answer 1

Question 2

Describe the absorption of geriatric?

Answer 2

1. Decreased gastric acid
2. SLower GI motility
3. Delayed gastric emptying

Medications:
* Passive diffusion -> less likely to be affected
* Active transport -> more likely to be affect
* Drugs affected by gastric pH are affected in a small proportion of adults

Question 3

Describe distribution in geriatrics?

Answer 3

1. Augmented blood flor
2. Plasma protein binding
3. Body composition
4. CNS permeability

Question 4

Describe the metabolism in geriatric?

Answer 4

1. FLow limited
2. Capacity limited

Question 5

How does flow-limited metabolism affect drugs?

Answer 5

1. Affects drugs dependent on high intrinsic clearance
2. High intrinsic clearance is due to grug’s structure mimicking endogenous agents
3. Poor metabolism of these drugs is due to decreased hepatic perfusion

Examples: metoprolol, propranolol, lignocaine, nifedipine, fentanyl and verapamil

Question 6

How does capacity limited metabolism affect drugs?

Answer 6

1. Affects drugs that are dependent on low intrinsic clearance
2. Enzymatically driven and largely affected by protein binding

Examples: reduced (lorazepam, piroxicam, warfarin), increased (ibuprofen, naproxen, phenytoin) or unchanged (diazepam, temazepam and valproic acid)

Question 7

Describe phase metabolism in geriatrics?

Answer 7

Phase 1 metabolism is usually more affected by hepatic dysfunction as compared to phase 2
* Reduced phase II dues to inflammation

Question 8

How is elimination affected by age?

Answer 8

Age related deterioration must be evaluated but decrease in renal function doesnt directionally correspond to age

Decreased muscle mass can affect CrCl calculations; GFR can be skewed by high protein intake

Question 9

Describe the PK parameters in geriatrics?

Answer 9

Question 10

Describe the PD changes in elders?

Answer 10

1. Changes in concentrations of the drug at the receptor
2. Changes in receptor numbers
3. Changes in receptor affinity
4. Post receptor alterations
5. Age-related impairment of homeostatic mechanisms

Question 11

How might cause CNS changes in elders?

Answer 11

1. Changes in brain size and weight
2. Increased BBB penetration
3. Dopaminergic alterations

Question 12

What are drugs that are affected by CV changes?

Answer 12

Calcium channel blockers: increased hypotensive and bradycardic effects
β-blockers: reduced blood pressure response
Diuretics: reduced effectiveness
Warfarin: increased risk of bleeding

Question 13

What is goal of pharmacotherapy in elders?

Answer 13

Cure or palliate disease and enhance HRQOL

Question 14

What are HRQOL considerations in elders?

Answer 14

1. Improvements in physical functioning
2. Psychological functioning
3. SOcial functioning
4. Overall health

Question 15

What is the definition of polypharm?

Answer 15

1. ≥5 or more meds
2. Multiple medications that are used for the same indication
3. Unnecessary drug use or use without indications

Contributing factors: comorbidities

Question 16

What is the difference between medication related problem and ADR?

Answer 16

MRP: therapy that interferes with desired outcomes for a patient
ADR: response to a drug that is noxious and unintended and occurs at doses normally for prophylaxis, therapy, or modification of physiological function

Question 17

Describe the severity of ADRs in elders?

Answer 17

1. More sever
2. confusion, depression, falls, loss of independence and physical disability
3. Higher hospitalization rate
4. Atypical prescription

Question 18

What are the RF associated with Polypharm?

Answer 18

1. Using ≥5 medications
2. Taking ≥12 doses/day
3. Dementia
4. Depression
5. Female sex
6. Low body weight or body mass index <22
7. Multiple chronic conditions
8. Age ≥85 years
9. CrCl <50 mL/min
10. Recent hospitalization
11. Multiple prescribers
12. Multiple pharmacies
13. Prior adverse drug event
14. Regular use of alcohol

Question 19

What are the causes of ADRs?

Answer 19

1. Improper drug or dosage selection
2. Nonadherence to the drug regimen
3. ALtered PK
4. ALtered PD
5. Multiple meds
6. Multiple providers

Question 20

WHat are common sx of ADRs?

Answer 20

1. Fatigue
2. ALtered mental status
3. FAllung
4. Constipation
5. Blurred vision
6. Depression
7. DZ

Question 21

What are the mechanism to combat poly pharm?

Answer 21

1. Comprehensive geriatirc assessment
2. Pharm-physician relationships
3. Frewuent med recs

Question 22

What are some resources used for geriatric med reviews?

Answer 22

1. Beers
2. Screening Tool of Older Persons’ Prescriptions (STOPP)
3. Screening Tool to Alert doctors to Right Treatment (START)

Question 23

What is MAI?

Answer 23

Medication Appropriateness Index: measure of potential improvement in prescribing quality due to a clinical pharmacist intervention

Max score: 18 -> indicating inappropriateness

Question 24

What is the beers list used?

Answer 24

1. Improve medication selection
2. Educate clinicians and patients
3. Reduce ADRs
4. Serve as a tool for QoC, cost, paterns of drug use in elders

Question 25

What are the limitations of using Beers?

Answer 25

1. Unable to address the full spectrum of drug-related problems
2. Captures only a small fraction of meds
3. Very few drugs that cause difficulty for older adults are inherently bad

Question 26

What are the considerationg for geriatric med safety?

Answer 26

1. Prescribe cautiously
2. Prescribe appropriately
3. Start low, go slow
4. Review regularly
5. Reduce polypharm
6. Remeber the risky medicinces (i.e. Beer’s list)