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Pharm for Geri Flashcards

(47 cards)

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1
Q

Pharmacokinetics vs dynamics

A

Pharmacokinetics
What the body does to the drug

Pharmacodynamics
What the drug does to the body

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2
Q

What disorders can change GI?

A

Disorders that change GI motility: DM, IBS, GERD, dumping syndrome

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3
Q

Where do you see dumping syndrome after what surgery?

A

Cholecystectomy
All of the bile is no longer stored and it is released

this leads to problems with reabsorbtion

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4
Q

What is alchalsia?

A

Narrowing of esophagus

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5
Q

What is biliary dyskeniesia?

A

Gallbladder is not working

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6
Q

What is pseudoobstruction aka

A

ileus?

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7
Q

What are some drugs that delay gastric emptying?

A

Alcohol (vomiting lunch at two in the morning)
Aluminum hydroxide antacids Mylanta
Anticholinergics Atropine, oxybutynin (bladder)
Beta Blockers metoprolol, propranolol
Calcium channel blockers Nifedipine, amlodipine
Cyclosporin(transplants Prografttacrolimus
Diphenydramine Benadryl
GLP1 Byetta,
GLP2 Tirzeptaide, semaglutide
H2 receptor antagonists Famotidine, ranitidine,
Levadopa Sinemet ( Parkinson’s )
Lithium Bi polar disorder
Ondansetron Zofran
Opioids
Phenothiazines Antipsychotics, Compazine
Proton pumpinhibitors omeprazole
Tricyclic antidepressants Elavil amitriptyline(can

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8
Q

What is zofran for, what is something to know about what will happen a couple days later?

A

Will have constipation

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9
Q

What can tricyclics be used for as well?

A

Migraines and sleep

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10
Q

How is distribution altered by aging?

A

Impacted by lean muscle replaced with adipose tissue, reduction in total-body water content (less fluids), decreased serum albumin

Inc adipose tissue: lipophilic drugs (BZD) = dec serum level, inc vol of distribution, inc metabolism, inc elimination _-life

Low total-body water content = dec vol of distribution for Hydrophilic meds (e.g., digoxin, lithium) = higher serum levels

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11
Q

How is metabolism affected in older?

A

Impacted by Reduction in cytochrome P450 metabolism due to age-related reduced hepatic blood flow and liver size

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12
Q

How is excretion affected in older?

A

Due to by decrease in Renal tubular function and GFR

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13
Q

What is important to know about the levels of creatinine in older patients?

A

loss of muscle mass means that it might be normal

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14
Q

Why should you not give an NSAID to geriatric on anticoagulation

A

GI bleed
Inability to break it down
Hard to control BP, so they are on HTN therapy

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15
Q

What is polypharmacy?

A

The simultaneous use of multiple drugs by a single patient, for one or more conditions; > 5 drugs

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16
Q

Approx. ___ of patients 57 years and older take ≥ 5 meds/day
Approx. ____ of patients 65 years and older take ≥ 10 meds/day

A

50%
20%

important stat (probably on test)

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17
Q

What typically leads to adverse drug reactions in elderly?

A

Due to polypharmacy
Most often related to the use of multiple medications and the number of chronic illnesses present

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18
Q

What is the MC reason why elderly patients are hospitalized for drug use?

A

Anticoagulants and hyperglycemics (insulin) are responsible for 2/3 of all medication related hospitalizations

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19
Q

What are some narrow therapeutic index drugs?

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A

digoxin
warfarin
lithium
theophylline
clyclosporine
tacrolimus
gentamicin

20
Q

How many ED visits each year for adverse drug reactions?

21
Q

What are some adverse drug reactions?

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A

Bradycardia leading to syncope with B-blocker use
Diarrhea related to abx use
Bleeding associated with anticoagulants

22
Q

What are some adverse drug events?

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A

An injury/harm resulting from the use of a pharmacologic agent
Adverse drug reaction
Unintentional overdose
Withdrawal reaction after abrupt discontinuation (benzos, seizure from withdrawls)

23
Q

What is the MC drug-drug interaction in elderly?

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A

Inhibition of P450 system

24
Q

What is an important inhibition of 450 that will likely be on the exam?

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A

Inhibition of P450 slows metabolism of atorvastatin leading to toxic levels of statin resulting in liver dysfunction, myalgias, and rhabdomyolysis

25
What are some common P450 inhibitors?
rifampin, barbiturates, carbamazepine, phenytoin
26
What is an example of an underlying disease increases susceptibility to unwanted physiologic effects of a drug
Example: Patient with severe COPD or asthma is prescribed a Beta-Blocker for hypertension because an ACE-inhibitor alone is not controlling BP May result in worse pulmonary symptoms
27
What is poly-provider syndrome?
Multiple providers
28
How much does each provider increase the odds of a DDI?
29%
29
How do you prevent poly-providers?
Limit the number of pharmacy (should go to 1 if possible) Electronic prescribing (drug/drug already included)
30
When you have a geriatric patient, what are some additional questions you should ask before prescribing?
1. Is there an indication for the drug? 2. Is the medication effective for the condition? 3. Is the dosage correct? 4. Are the directions correct? 5. Are the directions practical? (is it 4 times a day?) 6. Are there clinically significant drug–drug interactions? 7. Are there clinically significant drug–disease/condition interactions? 8. Is there unnecessary duplication with other drugs? 9. Is the duration of therapy acceptable? 10. Is this drug the least-expensive alternative compared with others of equal utility (IMPORTANT TO KNOW)
31
What is important to adjust for elderly patients? Based on what?
Dosages - adjusted based on creatinine clearance
32
What is the serum creatinine for elderly patients?
Serum creatinine levels often remain within normal limits despite a decrease in GFR – older people typically have less muscle mass and are physically less active than younger adults and thus produce less creatinine Don’t be misled by following serum creatine levels
33
What percentage of of geriatric patients use at least 1 drug that consensus criteria recommends avoiding in older patients?
20-30%
34
What is the BEERS criteria cover?
Drugs to avoid in most older patients Drugs to avoid in patients with specific health conditions Drugs to avoid in combination with other treatments due to concern for drug-drug interactions Drugs to use with caution because of risk of harmful side effects Drugs to dose differently or avoid in patients with renal insufficiency
35
What is the MC medication implicated for ER visits d/t adverse drug reactions? 2nd?
Warfarin Insulin is 2nd
36
What are long-acting sulfonureas worry of?
All have potential to cause hypoglycemia Risk is greater in older adults due to decreased drug clearance Glipizide should be avoided
37
Why is digoxin avoided in elderly?
Very narrow therapeutic window - toxicity common Impaired renal function and drug-drug interactions lead to elevated serum digoxin levels
38
What are NSAIDs CI in?
Heart failure Renal dysfunction High risk of peptic ulcer induced GI bleeding
39
What are some alternatives to NSAIDs?
acetaminophen (Tylenol) diclofenac gel (Voltaren) Topical NSAID with relatively minimal systemic absorption Use at the lowest dose, for the shortest duration possible Co-administer PPI Take with food
40
What are some high risk medications that begin with anti-?
Antihistamines Antidepressants Antipsychotics (clozapine) Antiemetics (promethazine)
41
What are other classes of medications that you should be caution of?
Bladder and GI antispasmodics Muscle relaxants
42
Anticholinergics can lead to an increase in these three problems in elderly
Falls Functional decline Impaired cognition
43
What is worrisome about opioids in elderly?
Safety concerns Psychomotor impairment Increased risk of delirium impaired gait/falls sedation N/V/C Respiratory depression Central sleep apnea
44
When do you use antispychotics?
Dementia, sometimes post-op
45
What do antipsychotics increase the risk of in the elderly?
MI, stroke, VTE Falls, fractures Mortality
46
Nonadherence Affects approx. ___ older adults. Contributes to ____ of outpatient adverse drug reactions
50% 20%
47
What are some things that may make someone not adhere in elderly?
Asymptomatic disease Medication side effects Inadequate follow-up Lack of patient understanding of the value of treatment poor patient education poor provider–patient relationship low literacy poor hearing, cognitive impairments Missed appointments and transportation difficulties Complicated dosing regimens Polypharmacy Financial hardships

Geriatrics (5 decks)

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