Intro to Geriatrics & Polypharmacy

Question 1

Define “health span”.

Answer 1

Number of years spent free from pain, morbidity, functional limitations

Question 2

Examples of ADLs?

Answer 2

Dressing, Bathing, Toileting, Eating, Walking

Question 3

Examples of IADLs?

Answer 3

Shopping, Housekeeping, Food Prep, Med / Financial Management

Question 4

T or F: Age dictates one’s rate of functional decline.

Answer 4

False… Is one of the factors, but not the only one!

Question 5

How does gastrointestinal function change as we age?

Answer 5

-Reduced acid secretion
-Reduced GI blood flow
-Slowed gastric emptying
-Delayed transit

Question 6

T or F: Rate & extent of absorption change as we age.

Answer 6

False… Only rate (extent does not change).

Question 7

What unique drugs see a reduced EXTENT of absorption with increasing patient age (due to decreased gastric acid secretion)?

Answer 7

-Fe2+ Supplements
-Ketoconazole
-Ca2+ Carbonate

Question 8

What medications see reduced rates of percutaneous absorption as we age & our skin dries out?

Answer 8

-Fentanyl
-Testosterone
-Estradiol

Question 9

What tends to happen to body composition as we age?

Answer 9

-Increased BF (25-30%)
-Reduced TBW (25-30%)

Question 10

Lipophilic drugs such as Diazepam & Amiodarone will see what happen to their half-lives (as we age)?

Answer 10

Much longer (& larger Vd with increasing fat percentages).

Question 11

Hydrophilic drugs such as Lithium & AG Antibiotics (e.g. Gentamicin, Tobramycin) will see what happen with respect to their peak effects (as we age)?

Answer 11

Increased peak effects (less lean body tissue to distribute into, more free drug in bloodstream).

Question 12

What two drugs show pronounced increases to their fu(b) with increasing age?

Answer 12

Phenytoin & Warfarin

Question 13

T or F: Persistently low albumin production with old age means that Warfarin & Phenytoin will continue exhibiting large unbound fractions.

Answer 13

False… More of a 1st Pass effect. With time, metabolism & elimination compensate.

Question 14

What sorts of drugs show increased bioavailability in older adults (due to reductions in hepatic blood flow & size)?

Answer 14

-Morphine
-Verapamil
-Amitriptyline
-Levodopa
-Beta Blockers (MPL)

Question 15

Provide examples of drugs that undergo Phase II metabolism (& thus show no changes with increased age).

Answer 15

-LOT Benzos
-Acetaminophen
-Valproic Acid
-Zaleplon

Question 16

After the age of 30, GFR decreases at a rate of approximately ___% per decade.

Answer 16

10%

Question 17

T or F: MDRD is used more frequently to stage kidney disease rather than for dosage adjusting.

Answer 17

True!

Question 18

With respect to kidney function, how might the Cockcroft-Gault equation estimate for somebody who weighs less than their IBW? More than IBW?

Answer 18

Underweight: Underestimates kidney function.

Overweight: Overestimates kidney function.

Question 19

At what CrCl value should Gabapentinoids be dose adjusted?

Answer 19

< 60mL / min

Question 20

At what CrCl value should H2RA drugs such as Ranitidine be dose adjusted?

Answer 20

< 50mL / min

Question 21

At what CrCl value should Digoxin be dose adjusted?

Answer 21

< 50mL / min

Question 22

At what CrCl value should Lithium be outright avoided?

Answer 22

< 30mL / min

Question 23

Literature supports the definition of polypharmacy as being >/= ___ medications.

Answer 23

5

Question 24

What is the number one risk factor for adverse drug reactions?

Answer 24

Number of medications being taken!!!

Question 25

What percentage of hospitalizations in older adults are preventable?

Answer 25

65%

Question 26

Pertaining to evidence-based interventions, what issues do we run into with older age & increasing numbers of comorbid conditions?

Answer 26

Lack of studies (often extremes of age, dementia, LTC patients are excluded from trials).

Question 27

Increasing cumulative exposure to 1st Generation Antihistamines in those with old age leads to increased risk of what?

Answer 27

1) Falls 2) Delirium 3) Dementia

Question 28

In what preventative situation should Aspirin be avoided in older adults? Primary Secondary

Answer 28

Primary... IS generally indicated for secondary prevention & established CVD.

Question 29

Why is Warfarin on the Beers List?

Answer 29

Higher risk of major bleeds than DOACs.

Question 30

Which DOAC is on the Beers List? Apixaban Rivaroxaban Edoxaban Dabigatran

Answer 30

Rivaroxaban (higher risk for major bleed when used long-term for treatment of VTE or Nonvalvular Atrial Fibrillation).

Question 31

According to the Beers criteria, when is Amiodarone favorable to use?

Answer 31

Concomitant HF / Substantial LV Hypertrophy + Atrial Fibrillation

Question 32

What antidepressants should be avoided in older adults?

Answer 32

Paroxetine & TCAs

Question 33

Why is long-term usage of Antipsychotics in older adults not advisable (unless indicated)?

Answer 33

Increased risk stroke, greater rates of cognitive decline & mortality.

Question 34

Gertrude is an elderly woman whom you've recently discontinued Prednisone for. What might be some withdrawal side effects she could experience?

Answer 34

Nausea Weakness Decreased BP

Question 35

What are some drugs with no adverse withdrawal effects?

Answer 35

Bisphosphonates Denosumab Aspirin Statins Anticoagulants Vitamins & Minerals